Cognitive-Behavioral–Based Physical Therapy to Improve Surgical Spine Outcomes: A Case Series.
Cognitive-Behavioral–Based Physical Therapy to Improve Surgical Spine Outcomes: A Case Series.
Phys Ther. 2013 Apr 18;
Archer KR, Motzny N, Abraham CM, Yaffe D, Seebach CL, Devin CJ, Spengler DM, McGirt MJ, Aaronson OS, Cheng JS, Wegener ST
BACKGROUND AND PURPOSE: Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purpose of this study was to describe the effects of a cognitive-behavioral based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the phone. CASE DESCRIPTION: Eight patients who underwent surgery for a lumbar degenerative condition completed the 6 session CBPT intervention. The intervention included empirically-supported behavioral self-management, problem-solving, cognitive restructuring and relaxation strategies, and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), post-intervention (3 months after surgery), and 6 months after surgery. Performance-based outcomes were tested at baseline and post-intervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, and 5 Chair Stand and 10-meter Walk tests. OUTCOMES: Seven of the patients demonstrated a clinically significant reduction in pain and all 8 of the patients had a clinically significant reduction in disability at 6 month follow-up. Improvement on the performance-based tests was also noted post-intervention, with 5 patients demonstrating clinically meaningful change on the 10-meter Walk test. DISCUSSION: Findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the phone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model. HubMed – rehab
Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial.
BMJ. 2013; 346: f2310
Bell KJ, Fulcher ML, Rowlands DS, Kerse N
OBJECTIVE: To assess the effectiveness of two peritendinous autologous blood injections in addition to a standardised eccentric calf strengthening programme in improving pain and function in patients with mid-portion Achilles tendinopathy. DESIGN: Single centre, participant and single assessor blinded, parallel group, randomised, controlled trial. SETTING: Single sports medicine clinic in New Zealand. PARTICIPANTS: 53 adults (mean age 49, 53% men) with symptoms of unilateral mid-portion Achilles tendinopathy for at least three months. Participants were excluded if they had a history of previous Achilles tendon rupture or surgery or had undergone previous adjuvant treatments such as injectable therapies, glyceryl trinitrate patches, or extracorporeal shockwave therapy. INTERVENTIONS: All participants underwent two unguided peritendinous injections one month apart with a standardised protocol. The treatment group had 3 mL of their own whole blood injected while the control group had no substance injected (needling only). Participants in both groups carried out a standardised and monitored 12 week eccentric calf training programme. Follow-up was at one, two, three and six months. MAIN OUTCOME MEASURES: The primary outcome measure was the change in symptoms and function from baseline to six months with the Victorian Institute of Sport Assessment-Achilles (VISA-A) score. Secondary outcomes were the participant’s perceived rehabilitation and their ability to return to sport. RESULTS: 26 participants were randomly assigned to the treatment group and 27 to the control group. In total, 50 (94%) completed the six month study, with 25 in each group. Clear and clinically worthwhile improvements in the VISA-A score were evident at six months in both the treatment (change in score 18.7, 95% confidence interval 12.3 to 25.1) and control (19.9, 13.6 to 26.2) groups. The overall effect of treatment was not significant (P=0.689) and the 95% confidence intervals at all points precluded clinically meaningful benefit or harm. There was no significant difference between groups in secondary outcomes or in the levels of compliance with the eccentric calf strengthening programme. No adverse events were reported. CONCLUSION: The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000824066, WHO U1111-1117-2641. HubMed – rehab
MOON-test – Determination of Motor Performance in the Pediatric Oncology.
Klin Padiatr. 2013 Apr 18;
Götte M, Kesting S, Albrecht C, Worth A, Bös K, Boos J
Pediatric cancer patients suffer from various negative consequences due to the disease, the medical therapy and the inactivity during the intensive treatment. Only few studies have systematically identified the adverse effects of cancer on motor performance in childhood.To determine the motor performance of pediatric cancer patients, a motor performance test was developed which is applicable for this specific patient group. Eight test items with reference values for healthy children were merged to the MOON-test (test for motor performance in the oncology).MOON was tested for feasibility and acceptance in 33 patients aged 4-18 years. Feasibility was confirmed for children with different types of cancer (hematological malignancies and solid tumors) and with amputation, endoprosthesis, during aplasia as well as reduced general condition. Furthermore the patients showed a broad acceptance.Based on the study findings, the use of MOON-test as a standardized motor performance diagnostic tool in clinical routine of oncological acute clinics as well as rehabilitation clinics can be recommended.· HubMed – rehab