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Jin MC, Jensen M, Barros Guinle MI, Ren A, Zhou Z, Zygourakis CC, Desai AM, Veeravagu A, Ratliff JK. Getting what you pay for: impact of copayments on physical therapy and opioid initiation, timing, and continuation for newly diagnosed low back pain. Spine J 2024; 24:923-932. [PMID: 38262499 DOI: 10.1016/j.spinee.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND CONTEXT Physical therapy (PT) is an important component of low back pain (LBP) management. Despite established guidelines, heterogeneity in medical management remains common. PURPOSE We sought to understand how copayments impact timing and utilization of PT in newly diagnosed LBP. STUDY DESIGN/SETTING The IBM Watson Health MarketScan claims database was used in a longitudinal setting. PATIENT SAMPLE Adult patients with LBP. OUTCOME MEASURES The primary outcomes-of-interest were timing and overall utilization of PT services. Additional outcomes-of-interest included timing of opioid prescribing. METHODS Actual and inferred copayments based on nonnonprimary care provider visit claims were used to evaluate the relationship between PT copayment and incidence of PT initiation. Multivariable regression models were used to evaluate factors influencing PT usage. RESULTS Overall, 2,467,389 patients were included. PT initiation, among those with at ≥1 PT service during the year after LBP diagnosis (30.6%), occurred at a median of 8 days postdiagnosis (IQR 1-55). Among those with at least one PT encounter, incidence of subsequent PT visits was significantly lower for those with high initial PT copayments. High initial PT copayments, while inversely correlated with PT utilization, were directly correlated with subsequent opioid use (0.77 prescriptions/patient [$0 PT copayment] versus 1.07 prescriptions/patient [$50-74 PT copayment]; 1.15 prescriptions/patient [$75+ PT copayment]). Among patients with known opioid and PT copayments, higher PT copayments were correlated with faster opioid use while higher opioid copayments were correlated with faster PT use (Spearman p<.05). For multivariable whole-cohort analyses, incidence of PT initiation among patients with inferred copayments in the 50-75th and 75-100th percentiles was significantly lower than those below the 50th percentile (HR=0.893 [95%CI 0.887-0.899] and HR=0.905 [95%CI 0.899-0.912], respectively). CONCLUSIONS Higher PT copayments correlated with reduced PT utilization; higher PT copayments and lower opioid copayments were independent contributors to delayed PT initiation and higher opioid use. In patients covered by plans charging high PT copayments, opioid use was significantly higher. Copays may impact long-term adherence to PT.
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Affiliation(s)
- Michael C Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Jensen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Alexander Ren
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Zeyi Zhou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Atman M Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
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McGrath RL, Shephard S, Hemmings L, Verdon S, Parnell T. Preventing Suicide: Time to Mobilize the Physical Therapist Workforce. Phys Ther 2023; 103:pzad116. [PMID: 37622921 DOI: 10.1093/ptj/pzad116] [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: 01/11/2023] [Revised: 04/16/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023]
Abstract
Each year, approximately 700,000 people, including 46,000 Americans, die by suicide; however, many more people experience suicidal thoughts and behaviors. Historically, the prevention of suicide has largely been the domain of mental health professionals working within specialist mental health care settings. An issue with this approach is that many individuals who experience suicidal ideation never disclose these thoughts to a mental health professional. The nonprofessional and paraprofessional mental health movement aims to bring suicide prevention to the people who need it, rather than wait for them to seek help. The nonprofessional and paraprofessional mental health movement does so by upskilling people who are not recognized as mental health professionals but may have contact with people experiencing suicidal thoughts and behaviors. In this Perspective, we argue that physical therapists are well-positioned to engage in suicide prevention. For example, physical therapists working in pain management are likely to frequently encounter clients experiencing suicidal thoughts and behaviors. Physical therapy is also viewed as a physical health profession, meaning that they may have contact with a broad range of populations at high risk of suicide who may be difficult to reach through traditional channels (eg, men from rural communities). Physical therapists will require training on how to provide crisis support, including how to link clients with appropriate mental health services. However, given the size of the physical therapist workforce globally, the impact of mobilizing the physical therapist workforce could be significant.
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Affiliation(s)
- Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Laura Hemmings
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
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Hughey L, Flynn TW, Dunaway J, Moore J, Sabbahi A, Fritsch A, Koszalinski A, Reynolds B. Mindfulness, exercise, diet, and sleep - A necessary and urgently needed skill set of the musculoskeletal practitioner. Musculoskeletal Care 2023; 21:198-201. [PMID: 35989616 DOI: 10.1002/msc.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Jeff Moore
- South College, Knoxville, Tennessee, USA
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Magel J, Bishop MD, Lonnemann E, Cochran G, Fritz JM, West N, Gordon AJ. The association between advanced orthopedic certification and confidence and engagement in prescription opioid medication misuse management practices: a cross-sectional study. J Man Manip Ther 2022; 30:228-238. [PMID: 34784850 PMCID: PMC9344956 DOI: 10.1080/10669817.2021.2000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In the United States, attaining the orthopedic certified specialist (OCS) credential or the orthopedic subspecialty credential of Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT), may lead to a higher level of orthopedic practice. It is unknown whether attaining these credentials influences physical therapist confidence in and frequency of engagement in prescription opioid medication misuse (POMM) management practices. A national cross-sectional web-based survey of PTs identified whether respondents had an OCS or FAAOMPT credential. Self-report confidence in POMM-related management practices and the frequency of engaging in these practices were assessed. Logistic regression evaluated association between credential status and confidence in, and frequency of, engagement in POMM-related management practices. The analysis included 402 respondents with a mean age of 41.0 (SD = 11.2) and 203 (50.4%) females. There were 91 (22.6%) PTs with a FAAOMPT credential, 143 (35.6%) with an OCS but with no FAAOMPT credential and 168 (41.8%) had neither credential. Compared to those with an OCS credential, FAAOMPTs reported greater confidence in, and greater frequency of engagement in, POMM-related management practices (p< .05). Compared to those without an OCS or FAAOMPT credential and compared to those with an FAAOMPT credential, those with an OCS did not report greater confidence or greater engagement in any POMM-related management practice (p≥ .05). Obtain the FAAOMPT credential may increase PTs' confidence in some POMM-related management practices. Research is needed to determine why FAAOMPTs report greater confidence and engagement in POMM-related management practices.
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Affiliation(s)
- John Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Mark D. Bishop
- Department of Physical Therapy Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, United States
| | - Elaine Lonnemann
- Transitional Doctor of Physical Therapy Program, College of Health Sciences, University of St. Augustine for Health Sciences, St. Augustine, Fl, United States
| | - Gerald Cochran
- Program for Addiction, Research, Clinical Care, Knowledge, and Advocacy (PARCKA) and Greater intermountain Node (GIN) of the NIDA clinical Trials Network, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine and Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Nancy West
- Division of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - Adam J. Gordon
- Program for Addiction, Research, Clinical Care, Knowledge, and Advocacy (PARCKA) and Greater intermountain Node (GIN) of the NIDA clinical Trials Network, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine and Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
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Essman M, Lin CY. The Role of Exercise in Treating Low Back Pain. Curr Sports Med Rep 2022; 21:267-271. [PMID: 35946845 DOI: 10.1249/jsr.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The purpose of this review is to highlight the role of exercise in preventing and managing acute and chronic axial low back pain (LBP). LBP is one of the leading contributors to years lived with disability as well as health care expenditures in the United States. With an expected increase in prevalence due to an aging population, sports medicine providers have a unique opportunity to provide effective treatment strategies incorporating exercise advice and prescription. Although the majority of individuals with acute LBP will have their symptoms resolve spontaneously, almost 40% will have recurrence or develop chronic LBP within 1 year. No single exercise method has been shown to be more effective than another. The evidence for walking programs, aerobic exercise, yoga, Pilates, and tai chi for LBP is discussed. Our review summarizes the beneficial role of a personalized exercise program and related counseling strategies in the prevention and management of LBP.
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Affiliation(s)
- Matthew Essman
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA
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Varela AJ, Melvin A. The theatre of depression: a role for physical therapy. Physiother Theory Pract 2022:1-17. [DOI: 10.1080/09593985.2022.2041136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonio J Varela
- School of Physical Therapy, Arkansas College of Health Education, Fort Smith, AR, USA
| | - Ann Melvin
- School of Social and Behavioral Sciences, Capella University, Minneapolis, MN, USA
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Magel J(J, Cochran G, West N, Fritz JM, Bishop MD, Gordon AJ. Physical therapists' attitudes are associated with their confidence in and the frequency with which they engage in prescription opioid medication misuse management practices with their patients. A cross-sectional study. Subst Abus 2022; 43:433-441. [PMID: 34283690 PMCID: PMC8770682 DOI: 10.1080/08897077.2021.1944959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: In the US, prescription opioid medication misuse (POMM) necessitates engagement of physical therapists (PTs). We (1) evaluated the attitudes of (PT) related to their management of patients with POMM and (2) examined the association between these attitudes and PTs confidence in POMM-related management abilities and the frequency with which they engaged in POMM-related management practices. Methods: We conducted a national survey of PTs that included a modified Drug and Drug Problems Perception Questionnaire (DDPPQ). Confidence in POMM-related abilities and the frequency of engaging in POMM-related management practices were measured. Logistic regression evaluated the association between the DDPPQ subscales (role adequacy, role legitimacy, role self-esteem, role support, job satisfaction) and confidence and frequency outcomes. Results: The analysis included 402 respondents. Role adequacy and legitimacy subscales were associated with confidence and frequency outcomes (p<.05), indicating that more favorable role adequacy and legitimacy attitudes are associated with greater odds of having more confidence in POMM-related management abilities and of engaging in more frequent POMM-related management practices. Conclusions: PTs with a greater sense of preparedness to engage in POMM-related management were more likely to report greater confidence in POMM-related management abilities and engage in POMM-related management practices with greater frequency.
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Affiliation(s)
- John (Jake) Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Gerald Cochran
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA,Informatics, Decision–Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Nancy West
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Mark D. Bishop
- Department of Physical Therapy, Center for Pain Research, Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA,Informatics, Decision–Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Magel J, Kietrys D, Kruger ES, Fritz JM, Gordon AJ. Physical therapists should play a greater role in managing patients with opioid use and opioid misuse. Subst Abus 2021; 42:255-260. [PMID: 34524070 DOI: 10.1080/08897077.2021.1971818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists' knowledge and skills related to managing patients taking prescription opioid medications for pain.
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Affiliation(s)
- John Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - David Kietrys
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - Eric S Kruger
- School of Medicine, Department of Orthopaedics and Rehabiliation, Division of Physical Therapy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Brown-Taylor L, Beckner A, Scaff KE, Fritz JM, Buys MJ, Patel S, Bayless K, Brooke BS. Relationships between physical therapy intervention and opioid use: A scoping review. PM R 2021; 14:837-854. [PMID: 34153178 DOI: 10.1002/pmrj.12654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To synthesize available evidence that has examined the relationship between physical therapy (PT) and opioid use. TYPE: Scoping Review LITERATURE SURVEY: Data sources including Google Scholar, Embase, PubMed, Cochrane Library, and CINAHL were searched for English articles up to October 24, 2019 using terms ("physical therapy"[Title/Abstract] OR physiotherapy[Title/Abstract] OR rehabilitation[Title/Abstract]) AND (opiate*[Title/Abstract] OR opioid*[Title/Abstract]). METHODOLOGY Included studies evaluated a PT intervention and reported an opioid-use outcome. Data were extracted to describe the PT intervention, patient sample, opioid-use measurement, and results of any time or group comparisons. Study quality was evaluated with Joanna Briggs checklists based on study design. SYNTHESIS Thirty studies were included that evaluated PT in at least one of these seven categories: interdisciplinary program (n = 8), modalities (n = 3), treatment (n = 3), utilization (n = 2), content (n = 3), timing (n = 13), and location (n = 2). Mixed results were reported for reduced opioid-use after interdisciplinary care and after PT modalities. Utilizing PT was associated with lower odds (ranging from 0.2-0.8) of using opioid medication for persons with low back pain (LBP) and injured workers; however, guideline-adherent care did not further reduce opioid use for persons with LBP. Early PT utilization after index visit for spine or joint pain and after orthopedic surgery was also associated with lower odds of using opioid medications (ranging from 0.27-0.93). Emergency department PT care was not associated with fewer opioid prescriptions than standard emergency department care. PT in a rehabilitation center after total knee replacement was not associated with lower opioid use than inpatient PT. CONCLUSIONS The relationship between timing of PT and opioid use was evaluated in 13 of 30 studies for a variety of patient populations. Eight of these 13 studies reported a relationship between early PT and reduced subsequent opioid use, making the largest sample of studies in this scoping review with supporting evidence. There is limited and inconclusive evidence to establish whether the content and/or location of PT interventions improves outcomes because of heterogeneity between studies.
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Affiliation(s)
- Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Medpace Inc., Cincinnati, Ohio, USA
| | - Aaron Beckner
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Ochsner Health System, New Orleans, Louisiana, USA
| | - Katie E Scaff
- Jonathan M. Wainwright Memorial VA Medical Center, Walla Walla, Washington, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Michael J Buys
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Shardool Patel
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Kim Bayless
- Department of Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Benjamin S Brooke
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Davenport TE, DeVoght AC, Sisneros H, Bezruchka S. Navigating the Intersection Between Persistent Pain and the Opioid Crisis: Population Health Perspectives for Physical Therapy. Phys Ther 2020; 100:995-1007. [PMID: 32115638 DOI: 10.1093/ptj/pzaa031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/24/2019] [Indexed: 02/09/2023]
Abstract
The physical therapy profession has recently begun to address its role in preventing and managing opioid use disorder (OUD). This topic calls for discussion of the scope of physical therapist practice, and the profession's role, in the prevention and treatment of complex chronic illnesses, such as OUD. OUD is not just an individual-level problem. Abundant scientific literature indicates OUD is a problem that warrants interventions at the societal level. This upstream orientation is supported in the American Physical Therapy Association's vision statement compelling societal transformation and its mission of building communities. Applying a population health framework to these efforts could provide physical therapists with a useful viewpoint that can inform clinical practice and research, as well as develop new cross-disciplinary partnerships. This Perspective discusses the intersection of OUD and persistent pain using the disease prevention model. Primordial, primary, secondary, and tertiary preventive strategies are defined and discussed. This Perspective then explains the potential contributions of this model to current practices in physical therapy, as well as providing actionable suggestions for physical therapists to help develop and implement upstream interventions that could reduce the impact of OUD in their communities.
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Affiliation(s)
- Todd E Davenport
- Department of Physical Therapy, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, 3601 Pacific Avenue, Stockton, CA 95211 USA
| | | | | | - Stephen Bezruchka
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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Magnusson DM, Rethorn ZD, Bradford EH, Maxwell J, Ingman MS, Davenport TE, Bezner JR. Population Health, Prevention, Health Promotion, and Wellness Competencies in Physical Therapist Professional Education: Results of a Modified Delphi Study. Phys Ther 2020; 100:1645-1658. [PMID: 32280980 PMCID: PMC8344295 DOI: 10.1093/ptj/pzaa056] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Physical therapists are well positioned to meet societal needs and reduce the global burden of noncommunicable diseases through the integration of evidence-based population health, prevention, health promotion, and wellness (PHPW) activities into practice. Little guidance exists regarding the specific PHPW competencies that entry-level clinicians ought to possess. The objective of this study was to establish consensus-based entry-level PHPW competencies for graduates of US-based physical therapist education programs. METHODS In a 3-round modified Delphi study, a panel of experts (N = 37) informed the development of PHPW competencies for physical therapist professional education. The experts, including physical therapists representing diverse practice settings and geographical regions, assessed the relevance and clarity of 34 original competencies. Two criteria were used to establish consensus: a median score of 4 (very relevant) on a 5-point Likert scale, and 80% of participants perceiving the competency as very or extremely relevant. RESULTS Twenty-five competencies achieved final consensus in 3 broad domains: preventive services and health promotion (n = 18), foundations of population health (n = 4), and health systems and policy (n = 3). CONCLUSIONS Adoption of the 25 accepted competencies would promote consistency across physical therapist education programs and help guide physical therapist educators as they seek to integrate PHPW content into professional curricula. IMPACT This is the first study to establish consensus-based competencies in the areas of PHPW for physical therapist professional education in the United States. These competencies ought to guide educators who are considering including or expanding PHPW content in their curricula. Development of such competencies is critical as we seek to contribute to the amelioration of chronic disease and transform society to improve the human experience.
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Affiliation(s)
| | - Zachary D Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina
| | - Elissa H Bradford
- Physical Therapy Program, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri
| | - Jessica Maxwell
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts
| | - Mary Sue Ingman
- Physical Therapy Program, Henrietta Schmoll School of Health, St Catherine University, St Paul, Minnesota
| | - Todd E Davenport
- Physical Therapy Program, University of the Pacific, Stockton, California
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock, Texas
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Abstract
During the protective phase of treatment, therapy for hand and wrist injuries in athletes is similar to the plan of care provided to all patients. The nuances in the care provided to athletes become apparent during the transition to the postprotective phase of rehabilitation when the focus has shifted to return to play. Therapy following a sports injury should address the individual needs of the athletes in their everyday lives as well as the specificity of their training and sports-specific activities. The factors that influence return to play are discussed.
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Affiliation(s)
- Jane M Fedorczyk
- Center for Hand and Upper Limb Health and Performance, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 600, Philadelphia, PA 19107, USA.
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Neal Webb SJ, Bridges JP, Thiele E, Lambeth SP, Schapiro SJ. The implementation and initial evaluation of a physical therapy program for captive chimpanzees (Pan troglodytes). Am J Primatol 2020; 82:e23109. [PMID: 32077522 DOI: 10.1002/ajp.23109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/24/2022]
Abstract
Due to advances in captive nonhuman primate (NHP) medical care, the number of geriatric chimpanzees (≥35-years old) is growing. With old age comes a variety of physical conditions, including arthritis, stroke, and mobility impairments. Programs aimed at enhancing the welfare of geriatric chimpanzees are now quite common, but there are few published empirical evaluations of the efficacy of such programs. The current study aimed to create, implement, and evaluate the effects of participation in a physical therapy (PT) program on physical health, mobility, welfare, and behavior. Nine chimpanzees with mobility impairments participated in personalized PT routines (using positive reinforcement training) twice per week for 5 months. Additionally, nine control chimpanzees (non-mobility-impaired, matched with PT chimpanzees on age and gender) participated in body exam behavior sessions (also using positive reinforcement training) twice per week. All chimpanzees were rated on 14 health, well-being, and behavior items, as well as level of mobility throughout the PT program. Chimpanzees that participated in the PT program showed significant increases in ratings of physical health, well-being, and activity levels across phases of the program. Furthermore, compared to control chimpanzees, PT chimpanzees showed significant increases in ratings of ease of movement. Because raters were not blind to physical therapy treatment, our results represent an initial evaluation of the program that may suggest that participation in the PT program has physical, behavioral, and welfare benefits. Assessments of novel geriatric-focused care strategies and programs are essential to further enhance the welfare of the captive chimpanzee population, which is currently comprised of many geriatric animals, whose proportion of the captive population will only increase.
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Affiliation(s)
- Sarah J Neal Webb
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, National Center for Chimpanzee Care, Bastrop, Texas
| | - Jennifer P Bridges
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, National Center for Chimpanzee Care, Bastrop, Texas
| | - Erica Thiele
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, National Center for Chimpanzee Care, Bastrop, Texas
| | - Susan P Lambeth
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, National Center for Chimpanzee Care, Bastrop, Texas
| | - Steven J Schapiro
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, National Center for Chimpanzee Care, Bastrop, Texas.,Department of Experimental Medicine, The University of Copenhagen, Copenhagen, Denmark
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14
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Hussein AI, Bekampis CF, Jermyn RT. Review of Opioid Prescribing in the Osteopathic and Ambulatory Setting. J Osteopath Med 2019; 119:820-832. [PMID: 31790128 DOI: 10.7556/jaoa.2019.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The opioid epidemic in the United States is one of the largest modern health crises in the nation's history. The crisis has been cultivated in academic journals, driven by the medical-pharmaceutical complex, and fueled by campaigns representing the most prestigious health care organizations and advocacy groups. Comprehensive guidelines for proper prescribing have been released in addition to state-sponsored prescription drug-monitoring programs (PDMPs) in response to overprescribing habits. When considering opioid treatment for a patient, physicians should document a thorough history of pain, give an appropriate physical examination, and complete a risk assessment using the proper diagnostic tools. Considering the osteopathic philosophy and approach to chronic pain, physicians should account for an integrative treatment approach for improved patient outcomes when considering applying the osteopathic philosophy to chronic pain management. A successful treatment plan can integrate cognitive behavioral therapy and promote self-healing by treating somatic dysfunctions with osteopathic manipulative treatment. This literature review discusses how to treat patients with chronic pain and how to properly use and prescribe opioids. The researchers analyzed the history and current status of the opioid epidemic, examined opioid management in the outpatient setting, reviewed the current domestic and international opioid prescribing guidelines, and discussed the incorporation of the osteopathic philosophy to manage chronic pain.
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15
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Nikles J, Khan S, Leou J, Keijzers G, Ng J, Bond C, Nakamura G, Le R, Sterling M. Retrospective descriptive observational study of patients who presented to an Australian hospital emergency department with neck soft tissue injury. Emerg Med Australas 2019; 31:805-812. [PMID: 30895739 DOI: 10.1111/1742-6723.13253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe clinical presentation and management of neck soft tissue injury in an Australian ED. METHODS This is a retrospective cohort study conducted in a tertiary hospital ED in Queensland, Australia. This study included all patients aged 18-65 years presenting with neck sprain/strain in 2016. Main outcome measures are patient demographics, comorbidities, presentation, acute management and follow up. RESULTS Of 339 patients, 176 (52%) had cervical computed tomography (CT) scans and 3% plain radiographs. Two had fractures (CT yield of 2/176; 1.1%) and three were admitted with neurological symptoms, leaving 334 patients. Of 264 patients receiving medications in the ED, simple analgesia + oral opioid (146, 55.3%) was most frequently used, followed by simple analgesia (89, 33.7%) and opioid + benzodiazepine +/- simple analgesia (16, 6%). Opioids were prescribed for 169 (64%) (including i.v. opioids for 34 [12.9%] and for 85/97 (88%) with pain scores ≤4), and benzodiazepines for 22 (8.3%). Ten (3%) were referred for physiotherapy management in ED and eight (2.4%) for outpatient physiotherapy follow up. Of 113/334 (33.8%) receiving discharge prescription, 60 (53.1%) were prescribed oral opioid + simple analgesia, 37 (32.7%) oral opioids and seven (6.2%) opioids + benzodiazepines; 205 (61%) were discharged without a recorded follow-up plan. CONCLUSIONS There is large practice variation in management of neck soft tissue injury in ED. Over half of the patients received CT scans with modest yield. Opioids were commonly used both in ED and on discharge. There is need for a standard management plan to be developed for patients presenting with acute neck soft tissue injury.
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Affiliation(s)
- Jane Nikles
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - Subaat Khan
- NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - John Leou
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Joanna Ng
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine Bond
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Gota Nakamura
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Rhonda Le
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
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16
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Lovecchio F, Premkumar A, Stepan JG, Albert TJ. Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review. HSS J 2019; 15:66-71. [PMID: 30863235 PMCID: PMC6384220 DOI: 10.1007/s11420-018-09662-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current research on opioid use within orthopedic surgery has focused on efforts to identify patients at risk for chronic opioid use. Studies addressing prevention of opioid misuse related to orthopedic care are lacking. Evidence-based interventions to reduce the reliance on opioids for post-operative pain relief will be a key component of any comprehensive institutional opioid policy. QUESTIONS/PURPOSES The purpose of this systematic review was to evaluate institutional strategies that reduce opioid administration or consumption after orthopedic surgery. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for English-language articles that analyzed interventions by physicians, nurses, pharmacists, physical therapists, or other hospital staff to reduce post-operative opioid use or narcotic prescription amounts after surgery. Studies that contained objective outcome measures (i.e., no expert opinion articles) were selected. Investigations on the effect of pharmacologic adjuvants, cryotherapy, or regional nerve blockades on opioid use were excluded. RESULTS The initial search yielded 6598 titles, of which 13 full-text articles were ultimately selected for inclusion in this systematic review. The review identified two major categories of interventions-patient-focused and provider-focused (e.g., physicians, nurses, physical therapists, pharmacists). Formal patient education programs were most effective in reducing opioid use. On the provider side, prescribing guidelines appear to decrease the overall number of pills prescribed, often without changes in patient satisfaction or requests for refills. CONCLUSIONS Researchers are just beginning to establish the most effective ways for institutions to reduce opioid use and promote responsible post-operative prescribing. Institutional prescribing guidelines, standardized bedside pain-management programs, and formal patient education curriculums are all evidence-based interventions that can achieve these goals. The available research also supports an interprofessional approach in any institutional opioid-reduction strategy.
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Affiliation(s)
- Francis Lovecchio
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ajay Premkumar
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jeffrey G. Stepan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Todd J. Albert
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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17
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Zadro JR, O'Keeffe M, Maher CG. Evidence-based physiotherapy needs evidence-based marketing. Br J Sports Med 2018; 53:528-529. [PMID: 30368444 DOI: 10.1136/bjsports-2018-099749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Joshua Robert Zadro
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Christopher G Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
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18
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Lopes-Martins RAB, Marcos RL, Leal-Junior ECP, Bjordal JM. Low-Level Laser Therapy and World Association for Laser Therapy Dosage Recommendations in Musculoskeletal Disorders and Injuries. Photomed Laser Surg 2018; 36:457-459. [DOI: 10.1089/pho.2018.4493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rodrigo Alvaro B. Lopes-Martins
- Laboratory of Biophotonics and Experimental Therapeutics, Institute of Research and Development, University of Vale do Paraíba—UNIVAP, São José dos Campos, Brazil
| | - Rodrigo Labat Marcos
- Post-Graduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho, São Paulo, Brazil
| | | | - Jan Magnus Bjordal
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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19
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August 2018 Letter to the Editor-in-Chief. J Orthop Sports Phys Ther 2018; 48:669-671. [PMID: 30064335 DOI: 10.2519/jospt.2018.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Letter to the Editor-in-Chief of JOSPT as follows: "Promoting Roles and Services Within Physical Therapy Not Supported by Evidence" with Authors' Response J Orthop Sports Phys Ther 2018;48(8):669-671. doi:10.2519/jospt.2018.0204.
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