The Role of US Military Physical Therapists During Recent Combat Campaigns.
The Role of US Military Physical Therapists During Recent Combat Campaigns.
Phys Ther. 2013 May 2;
Moore JH, Goffar SL, Teyhen DS, Pendergrass TL, Childs JD, Ficke JR
U.S. military physical therapists have a proud history of providing medical care during operational deployments ranging from war to complex humanitarian emergencies. Regardless of environment austerity or intensity of hostility, U.S. military physical therapists serve as autonomous providers, evaluating and treating service members with and without physician referral. Our perspective is that the versatility of U.S. military physical therapist practice enables them to not only diagnose musculoskeletal injuries, but equally important to provide a wide range of definitive care and rehabilitation, reducing the need for costly evacuation. While war is not sport, the delivery of skilled musculoskeletal physical therapy services as close to the point of injury parallels the sports medicine model for on or near field practice. This model that mixes direct access with near immediate access enhances outcomes, reduces costs, and allows other healthcare team members to work at the highest levels of their licensure. HubMed – rehab
Factors Associated With Utilization of Preoperative and Postoperative Rehabilitation Services by Patients With Amputation in the VA System: An Observational Study.
Phys Ther. 2013 May 2;
Resnik LJ, Borgia ML
BACKGROUND: The Department of Veterans Affairs (VA) and the Department of Defense (DoD) published evidence-based Guidelines (Guidelines) to standardize and improve rehabilitation of lower limb amputees, however no studies have examined the guideline impact. OBJECTIVES: To 1) describe the utilization of rehabilitative services in the acute care setting by persons who underwent major lower limb in the VA from 2005 to 2010; and 2) identify factors associated with receipt of rehabilitation services; and 3) examine impact of the Guidelines on service receipt. DESIGN: Cross-sectional study of 12,599 patients, who underwent major surgical amputation of the lower limb at a VA medical center from January 1, 2005 to December 31, 2010. Data were obtained from main and surgical inpatient datasets and the inpatient encounters files of the Veterans Health Administration databases. METHODS: Rehabilitation services were categorized as physical therapy (PT), occupational therapy (OT), and either (any therapy), before or after amputation. Separate multivariate logistic regressions examined impact of Guideline implementation, and identified factors associated with service receipt. RESULTS: Patients were 1.45 and 1.73 times as likely to receive pre-operative PT and OT, and 1.68 and 1.79 times as likely to receive post-operative PT and OT (p<0.0001) after Guideline implementation. Patients in the Northeast had the lowest likelihood of receiving pre-operative and post-operative rehabilitation services, while patients in the West had the highest likelihood. Other patient characteristics associated with service receipt were identified. LIMITATIONS: The sample included only Veterans who had surgeries at VA Medical Centers and cannot be generalized to Veterans with surgeries outside the VA or to non-Veteran patients and settings. CONCLUSIONS: Further quality improvement efforts are needed to standardize delivery of rehabilitation services for Veterans with amputations in the acute care setting. HubMed – rehab
Comparative Kinematic and Electromyographic Assessment of Clinician- and Device-Assisted Sit-to-Stand Transfers in Patients With Stroke.
Phys Ther. 2013 May 2;
Burnfield JM, McCrory BJ, Shu Y, Buster TW, Taylor AP, Goldman AJ
BACKGROUND: Workplace injuries from patient handling are prevalent. with the adoption of no-lift policies, sit-to-stand transfer devices have emerged as one tool to combat injuries. However, the therapeutic value associated with sit-to-stand transfers using an assistive apparatus cannot be determined due to a lack of evidence-based data. OBJECTIVE: The aim of this study was to compare clinician-assisted, device-assisted, and the combination of clinician- and device-assisted sit-to-stand transfers in individuals who recently experienced a stroke. DESIGN: Cross-sectional, controlled laboratory study that used a repeated measures design. METHODS: The duration, joint kinematics and muscle activity of four sit-to-stand transfer conditions were compared for 10 stroke patients. Each patient performed four randomized sit-to-stand transfer conditions: clinician-assisted (CA), device-assisted with no patient effort (D-NE), device-assisted with patient’s best effort (D-BE), and device- and clinician-assisted (D-CA). RESULTS: Device-assisted transfers took nearly twice as long as clinician-assisted transfers. Hip and knee joint movement patterns were similar across all conditions. Forward trunk flexion was lacking and ankle motion was restrained during device-assisted transfers. Encouragement and guidance from the clinician during device-assisted transfers led to increased lower extremity muscle activation levels. LIMITATIONS: One lifting device and one clinician were evaluated. Clinician effort could not be controlled. CONCLUSIONS: Lack of forward trunk flexion and restrained ankle movement during device-assisted transfers may dissuade clinicians from selecting this device for use as a dedicated rehabilitation tool. However, with clinician encouragement, muscle activation increased, suggesting that it is possible to safely practice transfers while challenging key leg muscles essential for standing. Future sit-to-stand devices should not only promote safety for the patient and clinician, but also encourage a movement pattern that more closely mimics normal sit-to-stand biomechanics. HubMed – rehab