Insights News Pulse – August 5, 2016

Our featured article this week centers on “useless surgeries” and physical therapy’s role as an effective alternative for pain relief.

Other topics include a 3,000% increase in medical services due to the opioid epidemic, a new PT specialty created to treat cancer patients, and a physical therapist serving as an advisor to the Veteran Affairs’ Prosthetics and Special-Disabilities Program.

Healthcare costs skyrocket with opioid epidemic: A recent study from Fair Health illustrates a massive 3,000% increase in medical services due to opioid abuse from 2007 to 2014– statistics that cement the opioid issue as an “epidemic.” Specifically, these services included office visits, lab tests, and other related treatments. Kaiser Health News: “Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds” by Julie Appleby, August 1, 2016. therapist with patient

Injections helping patients manage pain: Becker’s Spine Review provides eight insights into a 24-month trial of MPC injections for chronic low back pain patients. In particular, the study showed that patients’ pain improved significantly when compared to control therapies, and the “six million MPC dose” was the most impactful for better outcomes. Becker’s Spine Review: “Mesoblast’s 24-month trial results for chronic low back pain released: 8 insights from the study on MPC injections” by Megan Wood, August 1, 2016.

Cancer PT is here: The APTA 2016 House of Delegates has passed a motion enabling PTs to become Certified Oncological Physical Therapists, with this specialty focused on treating patients who have experienced cancer, lymphedema, and HIV. Rehab Management: “Cancer PTs Go Big: Oncology Specialty Approved by APTA” by Staff, August 3, 2016.

Exercise and PT for fibromyalgia: A new clinical practice guideline for fibromyalgia found that a combination of physical therapy and graded exercise is the only intervention “highly recommended” for patients with the condition. APTA: “European Guidelines Strongly Recommend Physical Therapy With Exercise for Fibromyalgia” by Staff, August 3, walking up stairs

VA seeking PT insights for improved prosthetic rehab: Navy veteran and influential physical therapist William S. Quillen, PhD, director of the University of South Florida (USF) School of Physical Therapy and Rehabilitation Sciences, has been appointed to the Veteran Affairs’ Advisory Committee on Prosthetics and Special-Disabilities Program. In his new role, Quillen will provide advice to the VA prosthetics programs and oversee rehabilitation research, including the development and evaluation of prosthetics technology. PT in Motion News: “PT Will Join Influential VA Committee” by Staff, August 4, 2016.

Featured article on “useless surgeries” and the efficacy of physical therapy as an alternative method for pain relief: The New York Times: “Why ‘Useless’ Surgery Is Still Popular” by Gina Kolata, August 3, 2016.

The theme of this summer seems to be “the value of PT,” as all healthcare stakeholders look to ensure the correct patient treatment path in the midst of the opioid epidemic and other pressing issues.therapist with patient

The New York Times continued this trend this past week, writing a great piece on “useless” surgeries and how clinical trials on their effectiveness (or lack there-of) are often not considered by referring physicians and payers.

In particular, the author spotlights spinal fusion, vertebroplasty, and meniscus surgery as procedures that have been proven to have “no benefit” to their patients compared to nonsurgical methods. In each case, reduced pain levels were observed in clinical trials, but the improvements were negligible between surgical interventions and “alternative” methods such as physical therapy.

The meniscus procedure has been heavily spotlighted recently, with a study of 400,000 middle-aged and older Americans showing that it is “next to useless.” Despite these worrisome statistics, the surgery– and others like it– is still often seen as the quickest way to pain relief and return-to-work.

According to experts, physicians may continue prescribing these surgeries simply because they are paid for by the insurers, further suggesting that doctors may demonstrate bias from positive patient experiences in the past.

So, how can we ensure that these patients receive the correct treatment course for their pain? According to Dr. Gordon H. Guyatt, professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, it is up to the individual to decide– once they have the available facts.

Dr. Guyatt says: “I personally think the operation should not be mentioned. But if a doctor says anything, say this: ‘we have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense, and potential complications.’”

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