scholarly journals PROLOTHERAPY COMBINED WITH PHYSICAL THERAPY IN A RECREATIONALLY ACTIVE MIDDLE-AGED MAN WITH CHONDROMALACIA PATELLA

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Kristin Bowne ◽  
Joshua Prall ◽  
Michael Ross
Keyword(s):  
Physical Therapy ◽  
Knee Pain ◽  
Physical Therapist ◽  
Weight Bearing ◽  
Left Knee ◽  
Middle Aged ◽  
Hamstring Muscles ◽  
Patient Reported ◽  
Chondromalacia Patella ◽  
Training Activities

The purpose of this case report is to describe the use of physical therapy combined with prolotherapy in a recreationally active, middle-aged man with knee pain and chondromalacia patella. The patient was a 50 year-old male triathlete presenting with a chief complaint of persistent left knee stiffness and anterolateral knee pain. The patient’s symptoms began insidiously 9 months prior after an increase in his triathlon training activities. His knee pain progressed to the point that he could not perform any weight bearing exercise without significant discomfort. Previous treatments included management by a physical therapist, as well as corticosteroid and hyaluronic acid injections. Although these previous treatments provided minimal benefit, the patient sought further management by another physical therapist. Magnetic resonance imaging findings revealed moderate to severe chondromalacia at the lateral patellar facet. In addition to management by a physical therapist, the patient received a series of three prolotherapy injections to the knee. Physical therapy management consisted of manual therapy for the lower quarter, targeted therapeutic exercise to address strength deficits of the quadriceps and hamstring muscles, and a gradual return to weight bearing exercise and functional activity. At 4 months following the physical therapy and prolotherapy injections, the patient reported no pain during daily activities. Additionally, he had returned to swimming, cycling, unlimited walking and hiking on various surfaces, and agility drills. In patients with knee pain and chondromalacia patella, especially those who have not responded to prior interventions, physical therapy combined with prolotherapy may serve as a treatment option. <p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0887/a.php" alt="Hit counter" /></p>

scholarly journals Managing a Patient's Constipation With Physical Therapy

2006 ◽  
Vol 86 (11) ◽  
pp. 1511-1519 ◽  
Author(s):  
Kendra L Harrington ◽  
Esther M Haskvitz
Keyword(s):  
Physical Therapy ◽  
Physical Therapist ◽  
The United States ◽  
Program Outcomes ◽  
Diet Modification ◽  
Unsuccessful Treatment ◽  
Patient Reported ◽  
Abdominal Massage ◽  
Typical Treatment ◽  
And Function

Abstract Background and Purpose. Constipation is a prevalent condition in the United States, with typical treatment consisting of diet modification, stool softeners, and laxatives. These interventions, however, are not always effective. The purpose of this case report is to describe the use of abdominal massage in physical therapist management for a patient with constipation. Case Description. An 85-year-old woman with constipation was referred for physical therapy following unsuccessful treatment with stool softeners. The patient was instructed in bowel management as well as a daily, 10-minute home abdominal massage program. Outcomes. Upon re-examination, the patient reported a return of normal bowel frequency and function without the need to strain or use digital evacuation. Discussion. Physical therapy incorporating abdominal massage appeared to be helpful in resolving this patient's constipation. Unlike medical management of constipation, no known side effects have been identified with abdominal massage. [Harrington KL, Haskvitz EM. Managing a patient's constipation with physical therapy. Phys Ther. 2006;86:1511–1519.]

scholarly journals Patient-Reported Outcomes Associated With Use of Physical Therapist Services by Older Adults With a New Visit for Back Pain

2015 ◽  
Vol 95 (2) ◽  
pp. 190-201 ◽  
Author(s):  
Sean D. Rundell ◽  
Karen J. Sherman ◽  
Patrick J. Heagerty ◽  
Charles Mock ◽  
Jeffrey G. Jarvik
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Back Pain ◽  
Physical Therapy ◽  
Pain Intensity ◽  
Patient Reported Outcomes ◽  
Physical Therapist ◽  
Leg Pain ◽  
Primary Care Visit ◽  
Patient Reported

Background Among older adults, it is not clear how different types or amounts of physical therapy may be associated with improvements in back pain and function. Objective The study objective was to investigate the association between types or amounts of physical therapist services and 1-year outcomes among older adults with back pain. Design This was a prospective cohort study. Methods A total of 3,771 older adults who were enrolled in a cohort study and who had a new primary care visit for back pain participated. Physical therapy use was ascertained from electronic health records. The following patient-reported outcomes were collected over 12 months: back-related disability (Roland-Morris Disability Questionnaire) and back and leg pain intensity (11-point numerical rating scale). Marginal structural models were used to estimate average effects of different amounts of physical therapy use on disability and pain for all types of physical therapy and for active, passive, and manual physical therapy. Results A total of 1,285 participants (34.1%) received some physical therapy. There was no statistically significant gradient in relationships between physical therapy use and back-related disability score. The use of passive or manual therapy was not consistently associated with pain outcomes. Higher amounts of active physical therapy were associated with decreased back and leg pain and increased odds of clinically meaningful improvements in back and leg pain relative to results obtained with no active physical therapy. Limitations The fact that few participants had high amounts of physical therapy use limited precision and the ability to test for nonlinear relationships for the amount of use. Conclusions Higher amounts of active physical therapy were most consistently related to the greatest improvements in pain intensity; however, as with all observational studies, the results must be interpreted with caution.

scholarly journals A CHALLENGING CASE OF HAEMOPHILIA

2021 ◽  
Vol 10 (4) ◽  
pp. 3196-3198
Author(s):  
Om C Wadhokar
Keyword(s):  
Physical Therapy ◽  
Genetic Disorder ◽  
Weight Bearing ◽  
Rare Condition ◽  
Left Knee ◽  
Clotting Factors ◽  
Excessive Bleeding ◽  
Type C ◽  
The Common

Haemophilia it “philia” means love and “haemo” means blood it is a genetic disorder in which blood doesn’t clot which leads to excessive bleeding occurring to any injury or damage the bleeding is internal or external. Haemophilia is an X linked disorder. Females are carriers while males are sufferers. there are three types of haemophilia, haemophilia A, B and C out of this three type C is an autosomal recessive. The common symptoms present in haemophilia are pain, swelling, unexplained bleeding and blood in urine and stool. It is a rare condition 1 in million cases per year. Earlier haemophilia is treated by using Haemate P and Beriate P which dramatically improved the quality of life and life expectancy of haemophilia patients. The currently present treatment can help but cure is not yet found. Although physical therapy plays an important role in preventing joint bleeding and splinting to avoid further injury and a promptly designed programme to start weight bearing helps patient to gain back functionality. While recent advances like gene therapy, engineered clotting factors and an extensive pipeline of new approaches and modality. A 9 year old boy suffered a direct hit on his left knee there was no external bleeding at that time due to swelling the patient was taken to hospital where he was diagnose with haemophilia and was started with factors for Haemophila and then referred to physical therapy for pain, swelling, and improving strength. The patient responded very well to the physical therapy with significant improvement in the condition.

scholarly journals Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis: A case report and literature review

2020 ◽  
Author(s):  
Weiming Yang ◽  
Caiqiong Zhao ◽  
Xuewei Cao
Keyword(s):  
Elderly Patients ◽  
Knee Pain ◽  
Subchondral Bone ◽  
Medial Meniscus ◽  
Early Stage ◽  
Weight Bearing ◽  
Left Knee ◽  
Meniscus Tear ◽  
Walking Ability ◽  
Meniscal Root Tear

Abstract Background: Spontaneous osteonecrosis of the knee (SONK) was defined as a distinct clinical entity with characteristical findings that subchondral lesions in the weight-bearing region of a single condyle. In the early stage of SONK, we usually think that injury of meniscus was to blame for the knee pain. Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis. Case presentation：A 67-year-old male complained of pain in the left knee for 3 months in 2013. Magnetic resonance imaging (MRI) revealed a medial meniscal root tear (level III), so that he patient underwent arthroscopic meniscectomy. However, no obvious pain relief achieved at the follow-up. The pain was associated with weight bearing, of which was initially intermittent, gradually progressed in intensity and became frequent even at rest. At 18 months after the first visit, we re-examined the knee MRI and results clearly revealed subchondral bone osteonecrosis of the condyle. Finally, we performed unicompartmental arthroplasty which significantly relieved the pain and restored the walking ability of the patient. Conclusions: Meniscus injury often coexist with SONK. In the early stages of SONK, the area of necrosis is small which is very easy to be ignored causing a misdiagnosis. The case reminds us should pay much attention to the possibility of subchondral bone necrosis in patients with knee pain and meniscal injury.

scholarly journals Orthopedic Surgeons and Physical Therapists Differ in Assessment of Need for Physical Therapy After Traumatic Lower-Extremity Injury

2009 ◽  
Vol 89 (12) ◽  
pp. 1337-1349 ◽  
Author(s):  
Kristin R. Archer ◽  
Ellen J. MacKenzie ◽  
Renan C. Castillo ◽  
Michael J. Bosse ◽  
Keyword(s):  
Physical Therapy ◽  
Lower Extremity ◽  
Self Efficacy ◽  
Knee Flexion ◽  
Physical Therapist ◽  
Weight Bearing ◽  
Lower Extremity Injury ◽  
Trauma Centers ◽  
Lower Extremity Injuries ◽  
Extremity Injuries

Background Lower-extremity injuries constitute the leading cause of trauma hospitalizations among people under the age of 65 years. Rehabilitation has the potential to favorably influence the outcomes associated with traumatic lower-extremity injuries. Objectives The objectives of this study were to explore variability in surgeon and physical therapist assessments of the need for physical therapy in patients with traumatic lower-extremity injuries and to determine the factors associated with assessments of need. Design This study was a retrospective cohort investigation. Methods Participants were 395 patients treated by reconstruction in the Lower-Extremity Assessment Project. They were evaluated at 8 level I trauma centers at 3, 6, and 12 months after hospitalization by an orthopedic surgeon and a physical therapist to determine the need for physical therapy. Analyses included multilevel logistic regression. Results Chi-square analyses showed that surgeon and therapist assessments of need differed statistically across trauma centers. Surgeons were more likely to assess a need for therapy at 3 months when participants had low work self-efficacy, impaired knee flexion range of motion (ROM), and weight-bearing limitations and at 6 and 12 months when participants had impaired knee flexion ROM and weight-bearing and balance limitations. Therapists were more likely to assess a need for therapy at 3 months when participants had moderate to severe pain and at 6 and 12 months when participants had low work self-efficacy, pain, impaired knee flexion ROM, and balance limitations. Conclusions The results revealed variability in assessments of the need for physical therapy at the provider and trauma center levels. Differences in provider assessments highlight the need for communication and further investigation into the outcomes and timing of physical therapy for the treatment of traumatic lower-extremity injuries.

The Relationship of Therapeutic Alliance to Patient Characteristics and Functional Outcome During an Episode of Physical Therapy Care for Patients With Low Back Pain: An Observational Study

2021 ◽  
Author(s):  
Faris Alodaibi ◽  
Jason Beneciuk ◽  
Rett Holmes ◽  
Stephen Karehla ◽  
Deanna Hayes ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Therapeutic Alliance ◽  
Functional Outcome ◽  
Physical Therapist ◽  
Patient Characteristics ◽  
Low Back ◽  
Patient Reported ◽  
Ceiling Effects ◽  
The Impact ◽  
The Relationship

Abstract Objective Research supports the relevance of the therapeutic alliance (TA) between patients and physical therapists on outcomes, but the impact of TA during routine physical therapist practice has not been quantified. The primary objective of this study was to examine the relationship between TA assessed during a physical therapy episode of care for patients with low back pain (LBP) and functional outcome at the conclusion of care. Secondary objective was to examine psychometric properties of the Working Alliance—Short Revised (WAI-SR) form, a patient-reported TA measure. Methods This study was a retrospective analysis of prospectively collected data from 676 patients (mean age = 55.6 y [SD = 16.1]; 55.9% female) receiving physical therapy for LBP in 45 outpatient clinics from one health system in the United States. Participating clinics routinely collect patient-reported data at initial, interim, and final visits. The Lumbar Computer-Adapted Test (LCAT) was used to evaluate functional outcome. The TA was assessed from the patient’s perspective at interim assessments using the WAI-SR, bivariate correlations were examined, and regression models were examined if interim WAI-SR scores explained outcome variance beyond a previously validated multivariate prediction model. Internal consistency and ceiling effects for the WAI-SR were examined. Results Interim WAI-SR scores were not correlated with patient characteristics or initial LCAT, but they were correlated with final LCAT and LCAT change from initial to final assessment. WAI-SR total score (adjusted R2 = 0.36, P &lt; .001), and task (adjusted R2 = 0.38, P &lt; .001) and goal subscales (adjusted R2 = 0.35, P &lt; .001) explained additional variance in outcome beyond the base model (adjusted R2 = 0.33, P &lt; .001). Internal consistency was higher for WAI-SR total score (α = 0.88) than for subscales (α = 0.76–0.82). Substantial ceiling effects were observed for all WAI-SR scores (27.2%—63.6%). Conclusion Findings support the importance of TA in physical therapist practice. Measurement challenges were identified, most notably ceiling effects. Impact This study supports the impact of the patient-physical therapist alliance on functional outcome. Results extend similar findings from controlled studies into a typical physical therapist practice setting. Better understanding of the role of contextual factors including the therapeutic alliance might be key to improving the magnitude of treatment effect for discrete physical therapist interventions and enhancing clinical outcomes of physical therapy episodes of care.

scholarly journals Structured physical therapy protocols following hip arthroscopy and their effect on patient-reported outcomes—a systematic review of the literature

2020 ◽  
Author(s):  
Hari K Ankem ◽  
Mitchell J Yelton ◽  
Ajay C Lall ◽  
Alex M Bendersky ◽  
Philip J Rosinsky ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Weight Bearing ◽  
Return To Sport ◽  
Rehabilitation Program ◽  
Patient Specific ◽  
Patient Reported ◽  
Rehabilitation Protocols

Abstract The purpose of this study was to analyze the effect of structured physical therapy protocols on patient-reported outcomes (PROs) following hip arthroscopy. A literature search was completed in October 2019 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify articles reporting specific rehabilitation protocols following hip arthroscopy that document PROs. Studies meeting all inclusion and exclusion were reviewed and data were extracted. Six studies were included in analysis. The mean age was 34.7% and 56.6% were males. Five studies described rehabilitation protocols in phases with specific goals and progression criteria. All studies included range of motion (ROM) and weight-bearing (WB) precautions. Return to sport (RTS)/activity varied between 7 and 32 weeks. The studies used variations of 21 different PROs. Significant improvements in baseline and post-operative PROs noted across studies. Rehabilitation protocols following hip arthroscopy typically consist of 4–5 phase programs with set goals and progression criteria. Several commonalities existed between studies on WB, ROM precautions and gait normalization. However, timing and recommendations for RTS/return to work varied between studies and were dependent on the concomitant procedures performed as well as type of patient population. Clinically significant improvement in PROs from baseline noted in majority of the studies reviewed that involved a structured rehabilitation program following arthroscopic management of femoroacetabular impingement. As there is heterogeneity in patient-specific characteristics across the included studies, no determination can be made as to which protocol is most effective and further high-quality comparative studies are needed. Clinical relevance: Adopting phase-based rehabilitation protocols following arthroscopic femoroacetabular impingement treatment help achieve improved outcomes that are predictable

scholarly journals SAT0611-HPR LOW ADHERENCE TO RECOMMENDED PHYSICAL THERAPY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: A MIXED-METHOD CONTENT AND UTILIZATION ANALYSIS.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1266.2-1266
Author(s):  
E. Vanautgaerden ◽  
M. Kaerts ◽  
W. Dankaerts ◽  
K. De Vlam ◽  
T. Swinnen
Keyword(s):  
Physical Therapy ◽  
Disease Activity ◽  
Mixed Method ◽  
Axial Spondyloarthritis ◽  
Physical Therapists ◽  
Skills Training ◽  
Treatment Modalities ◽  
Patient Reported ◽  
Global Disease Activity ◽  
Therapy Sessions

Background:Patients with axial spondyloarthritis (axSpA) encounter limitations during daily activities and societal participation which seriously impart health-related quality of life. Optimal management of axSpA consists of combined pharmacological and non-pharmacological treatment modalities, including the encouragement of exercise and the consideration of physical therapy given the latter’s superior efficacy1. Few studies investigated the use of physical therapy and the alignment of treatment content with practice recommendations among patients with axSpA.Objectives:1) To estimate physical therapy use in patients with axSpA in a real life cohort; 2) to quantitatively and qualitatively describe the content of these physical therapy sessions; 3) explore possible determinants of physical therapy use and content.Methods:This cross-sectional study included 197 patients diagnosed with axSpA (Males/Females: 62.4/37.6%; mean±SD, age 42.6±12.0, BASDAI 3.7±2.1, BASFI 3.6±2.4, BASMI 3.1±1.8) and recruited during their routine consultation. The mixed-method approach included questionnaires (physical therapy use and content, medication, depression/anxiety (HADS), fear (TSK), physician global disease activity (PGDA)) and an in-depth qualitative interview (content of physical therapy). Interviews were analyzed using the Qualitative Analysis Guide of Leuven by two physical therapists. Spearman’s Rho correlations guided the exploration of determinants of physical therapy use and content.Results:Less than half (42.6%, n=84) of the axSpA of patients were in treatment with a physiotherapist. Most patients (40.0%) reported a physical therapy frequency of 1x/week. Session duration was typically 30 minutes (51.7% of the sample) and longer in fewer cases (30.0%). Exercise was in only 31.7% the cornerstone of their sessions. The majority of subjects (53.3%) were classified as receiving ‘passive therapy only’, with 10% of cases in the ‘exercise only’ and 36.7% in the ‘combination therapy’ groups. Interviews also revealed a lack of clear patient-centered treatment goals. We found moderate associations between physical therapy use/content parameters and medication, spinal mobility, fear, anxiety, depression, physician’s global disease activity versus (p<.05), but no relationship with patient-reported pain or disease activity.Conclusion:Despite the importance of exercise and the added value of physical therapy in axSpA, few patients engaged in physical therapy sessions that include exercise training of adequate dosage. Remarkably, physical therapy utilization seems to be predominantly guided by psychological factors. Professional education for physical therapists should therefore include skills training in the management of complex clinical presentations2. Last, future research should prepare the evidence-based implementation of state-of-the-art physical therapy guidelines in axSpA.References:[1]van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun;76(6):978-991.[2]Swinnen TW, et al. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther. 2018 Jul 27;20(1):156.Disclosure of Interests:Evelyne Vanautgaerden: None declared, Marlies Kaerts: None declared, Wim Dankaerts: None declared, Kurt de Vlam Grant/research support from: Celgene, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Eli Lilly, Galapagos, Johnson & Johnson, Novartis, Pfizer Inc, UCB, Thijs Swinnen: None declared

scholarly journals ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Adam Saloom ◽  
Nick Purcell ◽  
Matthew Ruhe ◽  
Jorge Gomez ◽  
Jonathan Santana ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Prospective Study ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Weight Bearing ◽  
Return To Sport ◽  
Time To Surgery ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

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