Clinic-Based Therapy Proves Highly Beneficial

A study published in the December issue of Physical Therapy (the journal of the American Physical Therapy Association) has found that although both clinic-based and home-based physical-therapy programs proved to be beneficial for osteoarthritis of the knee, clinic-based treatment programs, including manual therapy applied by physical therapists (PTs) combined with PT-supervised exercise, had better overall results.

The study, conducted by Gail D. Deyle, PT, DPT, at Brooke Army Medical Center in Fort Sam Houston, Tex, and colleagues, consisted of 134 patients with osteoarthritis of the knee. The patients were randomly assigned to either a clinic-based treatment group or a home-based exercise group. Patients in the clinic-based treatment group received supervised exercise, individualized manual therapy, and a home-exercise program over a 4-week period. Patients in the home-based exercise group received the same home-exercise program over the same period, reinforced at 2 weeks with a clinic visit.

Although both groups showed significant improvement, the clinic-based treatment group had a 52% improvement rate compared with 26% from the home-based exercise group. The average distance walked in 6 minutes improved about 10% in both groups. After 4 weeks, patients in both groups participated in identical home-exercise programs, with no clinical treatment intervention. At 1 year, both groups remained improved. However, the patients in the clinic-based treatment group were less likely to take medications for their arthritis.

The study investigators concluded that adding clinical physical therapy visits for manual therapy and supervised exercise provides greater symptom relief for patients with osteoarthritis of the knee.

Research Grant Awarded to Post-Stroke Trial

The National Institute of Neurological Disorders and Stroke (NINDS) and the National Center for Medical Rehabilitation Research (NCMRR) are providing $13.5 million over a 5-year period to support the “Locomotor Experience Applied Post-Stroke” (LEAPS) project. The clinical trial is designed to investigate the best timing and effectiveness of particular physical therapy interventions for reducing walking disabilities in patients following a stroke.

In the trial, researchers will study 400 stroke patients, ages 18 and older, to determine the best time to begin physical therapy and the effectiveness of particular interventions for reducing walking disabilities following a stroke. The multisite, randomized trial, in which patients practice walking on a treadmill, will assess whether there is a difference between patients who successfully recover their walking ability using a treadmill and those who are given a therapist-supervised, home-based exercise program.

The LEAPS trial is a collaborative effort between rehabilitation researchers at the University of Florida (Gainesville), the University of Southern California (Los Angeles), and clinicians in five community-based rehabilitation hospitals in Florida and Southern California.

PTs Can Expect Increased Salaries

According to a series of surveys conducted and released by the American Physical Therapy Association (APTA), physical therapists (PTs) are experiencing virtually no unemployment and are reporting overall increased salaries. The job market for PTs has continued to improve since the APTA conducted its last employment study in fall 2001.

APTA’s Physical Therapist Employment Survey was designed to assess trends in employment patterns. Based on the survey results, nonmembers of APTA were 21¼2 times more likely to experience employment turbulence (currently unemployed or currently employed but having lost a job within the past 6 months) than their PT counterparts who are members of the APTA.

A separate survey, APTA’s 2005 Median Income of Physical Therapists Summary Report, conducted among members, found that the median income of PTs has increased 23.6%, from $55,000 to $68,000 annually, between 1999 and 2004, while the adjusted income for inflation increased by 9%, from $33,013 to $35,998.

APTA also conducted a membership-based profile survey to examine the demographic description of its PT members. The survey found that 13.5% of the respondents have a doctorate of physical therapy degree or other doctorate degree.

FDA Approves Spinal Implant

The US Food and Drug Administration (FDA) has authorized the use of an implant, called X-stop, for patients suffering from a spinal condition that causes back and leg pain. The device is an alternative to difficult surgery and requires a much less invasive procedure.

X-stop, invented by James Zucherman, MD, medical director at the St Mary’s Spine Center in San Francisco, is a thumb of titanium on a mount that fits to a vertebra in the low back to reduce pain from lumbar spinal stenosis. The condition, the most common cause of back surgery in people over age 50, occurs when the tube for nerves in the spine becomes constricted as a person ages. Pain, numbness, and weakness are usually triggered by standing up, while symptoms are relieved when sitting down.

Previously, the condition could be treated with physical therapy, anti-inflammatory drugs, and injections, or by a laminectomy (a difficult surgery that involves full anesthesia and the removal of parts of bone and tissue to open up the canal of the spine). The X-stop achieves a similar effect by pressing against parts of either side of a vertebra, pushing open the tube without removing any of it. According to Zucherman, by wedging those bones apart, the tube is indirectly opened and the bones do not collapse on the nerves as they did before. Because the X-stop is implanted close to the skin, local anesthesia is required to insert it. Zucherman recommends the X-stop to patients with lumbar spinal stenosis who do not benefit from physical therapy and drug treatments.

The FDA had released documents last year stating that approximately 50% of people who received the implant experienced significant relief of symptoms, however, roughly 15% of patients reported a reoccurrence of symptoms. Zucherman has disputed claims that X-stop decreases in effectiveness to a greater degree than invasive surgical alternatives.