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Ferguson J, Fritsch A, Rhon DI, Young JL. Adverse Events Reported in Trials Assessing Manual Therapy to the Extremities: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:507-517. [PMID: 38452161 DOI: 10.1089/jicm.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Objective: This review aimed to describe the quality and comprehensiveness of adverse event (AE) reporting in clinical trials incorporating manual therapy (MT) as an intervention for extremity conditions using the Consolidated Standards of Reporting Trials (CONSORT)-Harms extension as the benchmark. The secondary aim was to determine whether the quality of AE reporting improved after the availability of the CONSORT reporting checklist. Design: Systematic review. Methods: A literature search was conducted using multiple databases to identify trials where MT was used to treat extremity conditions. Studies that reported AEs were identified and evaluated using the CONSORT-Harms extension. The frequency of trials reporting study AEs before and after the publication of the updated 2010 CONSORT statement was calculated, along with the categorization of how study AEs were reported. Results: Of the 55,539 studies initially identified, 220 trials met all inclusion criteria. Eighty trials (36.4%) reported AE occurrence. None of the studies that reported AEs adhered to all 10 criteria proposed by the 2010 CONSORT-Harms extension. The most commonly reported criterion was number four, which clarified how AE-related information was collected (30% of trials). The least reported criterion was number six, which describes the participant withdrawals for each arm due to AEs and the experience with the allocated treatment (1.3% of trials). The nomenclature used to describe AEs varied substantially. Fifty-nine of 76 trials (33.3%) were published after the updated CONSORT Harms-checklist was available, compared to 21 of 44 trials (46.7%) published before it was available. Conclusion: Reporting of AEs in trials investigating MT for extremity conditions is poor. Every included trial lacked adherence to all 10 criteria proposed by the CONSORT-Harms Extension. The quality and comprehensiveness of AE reporting did not improve after the most recent CONSORT update recommending AE reporting. Clinicians must obtain informed consent before performing any intervention, including MT, which requires disclosing potential risks, which could be better known with improved tracking, analyzing, and reporting of AEs. The authors recommend improved adherence to best practices for adequately tracking and reporting AEs in future MT trials.
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Affiliation(s)
- Jeffrey Ferguson
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Adam Fritsch
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Daniel I Rhon
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
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Aherrao S, Phansopkar P, Tikhile P. The Integral Role of Physiotherapy in Optimizing Movement and Function in a Case of Polytrauma: A Case Report. Cureus 2024; 16:e61427. [PMID: 38947633 PMCID: PMC11214730 DOI: 10.7759/cureus.61427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
Multiple fractures are frequently encountered in adults following road traffic accidents. A 32-year-old male presented with multiple fractures in his right lower extremity, including a femoral shaft fracture, distal third fractures of the tibia and fibula, as well as a calcaneal fracture. The patient provided a history indicative of a road traffic accident. X-rays were performed on both hip joints, both knee joints, and the ankle joints. Treatment involved open reduction and internal fixation (ORIF) with interlocking nailing for the femur, tibia, and fibula, alongside ORIF with plating using a screw-out set (SOS) and cannulated cancellous (CC) screw fixation for the calcaneal fracture. Additionally, the Ilizarov procedure was conducted following debridement over the right foot. Post-surgery, the patient experienced primary symptoms of hip joint pain and restricted hip joint movement. Physiotherapy was initiated to address these issues. Evaluation of outcome measures indicated a reduction in joint pain, significant enhancement in joint mobility, and an increase in muscle strength.
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Affiliation(s)
- Samruddhi Aherrao
- Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Priya Tikhile
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Gottlieb REW, Panzer KV, Wang M, Leis AM, Whitney DG. Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy. Phys Ther 2023; 103:pzad090. [PMID: 37440438 PMCID: PMC10471154 DOI: 10.1093/ptj/pzad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. METHODS This retrospective cohort study included adults who were ≥18 years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6 months to 3 years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. RESULTS Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55-1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57-1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. CONCLUSION Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6 months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. IMPACT Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6 months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3 years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.
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Affiliation(s)
- Rachel E W Gottlieb
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Kate V Panzer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mia Wang
- School of Public Health, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleda M Leis
- Epidemiology Department, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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Whitney DG, Xu T, Whibley D, Ryan D, Caird MS, Hurvitz EA, Haapala H. Post-Fracture Inpatient and Outpatient Physical/Occupational Therapy and Its Association with Survival among Adults with Cerebral Palsy. J Clin Med 2022; 11:jcm11195561. [PMID: 36233436 PMCID: PMC9570908 DOI: 10.3390/jcm11195561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Physical and/or occupational therapy (PT/OT) may improve post-fracture health and survival among adults with cerebral palsy (CP), but this has not been studied in the inpatient setting. The objective was to quantify the association between acute inpatient and outpatient PT/OT use with 1-year mortality among adults with CP. This was a retrospective cohort study of adults with CP with an incident fragility fracture admitted to an acute care or rehabilitation facility using a random 20% Medicare fee-for-service dataset. Acute care/rehabilitation PT/OT was measured as the average PT/OT cost/day for the length of stay (LOS). Weekly exposure to outpatient PT/OT was examined up to 6 months post-fracture. Cox regression examined the adjusted association between the interaction of acute care/rehabilitation average PT/OT cost/day and LOS with 1-year mortality. A separate Cox model added time-varying outpatient PT/OT. Of 649 adults with CP, average PT/OT cost/day was associated with lower mortality rate for LOS < 17 days (HR range = 0.78−0.93), and increased mortality rate for LOS > 27 days (HR ≥ 1.08) (all, p < 0.05). After acute care/rehabilitation, 44.5% initiated outpatient PT/OT, which was associated with lower mortality rate (HR = 0.52; 95% CI = 0.27−1.01). Post-fracture inpatient and outpatient PT/OT were associated with improved 1-year survival among adults with CP admitted to acute care/rehabilitation facilities.
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Affiliation(s)
- Daniel G. Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence:
| | - Tao Xu
- Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Dayna Ryan
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michelle S. Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Edward A. Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Heidi Haapala
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
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Whitney DG, Xu T, Ryan D, Whibley D, Caird MS, Hurvitz EA, Haapala H. Post-fracture rehabilitation pathways and association with mortality among adults with cerebral palsy. Clin Rehabil 2022; 37:119-131. [PMID: 36039504 PMCID: PMC10150496 DOI: 10.1177/02692155221123544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Rehabilitation may mitigate the high mortality rates and health declines post-fracture for adults with cerebral palsy, but this is understudied. The objectives were to characterize the post-fracture rehabilitation pathways and identify their association with 1-year survival among adults with cerebral palsy. METHODS A retrospective cohort study of adults with cerebral palsy with a fragility fracture with continuous health plan enrollment ≥1-year prior to and ≥1 day after their fracture date was performed using a random 20% Medicare fee-for-service dataset. Participants were categorized as a home discharge or inpatient rehabilitation admission post-fracture. For the home discharge cohort, weekly exposure to outpatient physical/occupational therapy (PT/OT) was examined up to 6-month post-fracture. Cox regression examined the association between time-varying PT/OTuse within 6-month post-fracture and mortality from 30 days to 1-year post-fracture before and after adjusting for confounders (e.g. medical complexity). RESULTS Of 3598 adults with cerebral palsy with an incident fragility fracture, 74% were discharged home without inpatient rehabilitation; they were younger, but more medically complex compared to the 26% admitted to inpatient rehabilitation. Among the home discharge cohort (n = 2662), 43.1% initiated PT/OTwithin 6-month post-fracture, and cumulative PT/OTexposure post-fracture was associated with improved survival; for example, per 3 weeks of PT/OTexposure, the adjusted mortality rate was 40% lower (95% confidence interval (CI) = 0.41-0.89). CONCLUSIONS Most adults with cerebral palsy with a fragility fracture were discharged home rather than to inpatient rehabilitation, and only 43.1% of that group initiated outpatient PT/OTwithin 6 months post-fracture. Receiving outpatient PT/OTwas associated with improved 1-year survival.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, MI, USA
| | - Tao Xu
- Kidney Epidemiology and Cost Center, School of Public Health, 1259University of Michigan, Ann Arbor, MI, USA
| | - Dayna Ryan
- Department of Physical Medicine and Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, 1259University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, 1259University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA
| | - Heidi Haapala
- Department of Physical Medicine and Rehabilitation, 1259University of Michigan, Ann Arbor, MI, USA
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Young JL, Snodgrass SJ, Cleland JA, Rhon DI. The relationship between knee radiographs and the timing of physical therapy in individuals with patellofemoral pain. PM R 2021; 14:496-503. [PMID: 34288533 DOI: 10.1002/pmrj.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routine knee radiographs are discouraged for individuals with non-traumatic knee pain, but they are often still ordered despite limited evidence for their value in guiding treatment choices. Radiograph utilization may delay the use of physical therapy, which has been associated with improved outcomes and lower long-term costs. OBJECTIVE To examine the relationship between obtaining knee radiographs for patients with patellofemoral pain (PFP) and the timing of physical therapy, and the association between ordering radiographs for patients who use physical therapy and the likelihood of knee pain recurrence. STUDY DESIGN Retrospective cohort. SETTING United States Military Health System civilian and military clinics. PATIENTS 23,332 individuals aged 18 to 50 diagnosed with PFP between 2010 and 2011 in the United States Military Health System who received physical therapy. INTERVENTIONS Physical therapy provided to individuals who did or did not receive an initial radiograph. MAIN OUTCOME MEASURES Timing of physical therapy and recurrence of knee pain were compared between groups (with and without initial radiographs). RESULTS If radiographs were used, the odds of initiating physical therapy (aOR = 0.78; 95% CI 0.64 to 0.94) within 30 days of the initial diagnosis were significantly lower. The mean days from diagnosis to initiating physical therapy was 12.1 (95% CI 9.1 to 16.1) if patients had radiographs versus 6.9 (95% CI 5.2 to 9.1) without. The odds of knee pain recurrence were no greater if radiographs were used (aOR = 1.01; 95% CI 0.83 to 1.22). CONCLUSIONS Receiving knee radiographs as part of initial care for PFP was associated with delayed initiation of physical therapy, but there was no association between early knee radiographs and recurrence of knee pain. Routine use of radiographs for PFP is not warranted, and can potentially delay appropriate treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, 3201 Eaton Rd., Green Bay, WI, USA.,Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, University Dr., Callaghan, NSW, Australia
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, University Dr., Callaghan, NSW, Australia
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel I Rhon
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, University Dr., Callaghan, NSW, Australia.,TX, USA.,Physical Therapy Department, Baylor University, Stanley, TX, USA
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McLaughlin KH, Reider LM, Castillo RC, Ficke JR, Levy JF. Outpatient Physical Therapy Use Following Tibial Fractures: A Retrospective Commercial Claims Analysis. Phys Ther 2021; 101:6124110. [PMID: 33522593 PMCID: PMC8152919 DOI: 10.1093/ptj/pzab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/19/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibial fractures. METHODS This study used 2016 to 2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with International Classification of Diseases: Tenth Revision (ICD-10) diagnosis codes for tibial fractures. Use in the year following initial fracture management was determined using Current Procedural Terminology codes. Differences in use were examined using χ2 tests, t tests, and Kruskal-Wallace tests. RESULTS Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher in female patients, in patients with 1 or no major comorbidity, and in the western United States. Attendance was higher in patients with upper tibial fractures, moderate-severity injuries, and treatment with external fixation and in patients discharged to an inpatient rehabilitation facility. Patients started OPT on average [SD] 50 [52.6] days after fracture and attended 18 [16.1] visits over the course of 101 [86.4] days. The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors. CONCLUSIONS One-third of insured patients do not receive OPT following tibial fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibial fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibial fractures. IMPACT OPT use varies based on patient, injury, and treatment-level factors following tibial fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibial fractures.
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Affiliation(s)
- Kevin H McLaughlin
- Johns Hopkins University School of Medicine, Physical Medicine and Rehabilitation, Baltimore, Maryland, USA,Address all correspondence to Dr McLaughlin at:
| | - Lisa M Reider
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
| | - Renan C Castillo
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
| | - James R Ficke
- Johns Hopkins University School of Medicine, Orthopaedic Surgery, Baltimore, Maryland, USA
| | - Joseph F Levy
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
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Schepers T. Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:211-224. [PMID: 30784532 DOI: 10.1016/j.cpm.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of displaced intra-articular calcaneal fractures has changed numerous times in the last decades. Currently, less invasive surgery has reemerged and is increasingly used. The sinus tarsi approach is most commonly used. It combines the open approach to the subtalar joint with percutaneous reduction of the overall shape of the calcaneus. The results in the literature show overall similar functional outcome compared with the extended lateral approach, however with a significant reduction in wound complications. This article deals with the sinus tarsi approach in which the reduction is fixated using screws only. Indications, surgical technique, and possible pitfalls are discussed.
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Affiliation(s)
- Tim Schepers
- Trauma Unit, Amsterdam UMC, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
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