04
June 2015

Choose wisely!

in fact, these methods – including electrical stimulation and ultrasound – almost never help someone who requires physical therapy, and according to the APTA, can even cause harm. Schedule a consultation with a FIX physical therapist today and get back on the road to health.

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The American Physical Therapy Association (APTA), which has joined the Choosing Wisely Campaign, is supporting an initiative designed by the American Board of Internal Medicine Foundation to encourage conversations between patients and health care providers with the goal of providing better treatment. Instead of resorting to the heating pad or ice pack, APTA contends an active treatment plan, including exercise to restore strength, will have “a greater impact on pain, mobility, function and quality of life.”

 

“The evidence for any beneficial effect is almost nil,” Dr. Tony Delitto, University of Pittsburgh, told NPR. In addition to his responsibilities as chairman of the UPitt’s department of physical therapy, Delitto assumed the role of chairman of the group that wrote the “what not to do” list — five physical therapy recommendations for the Choosing Wisely Campaign.“When I graduated with my physical therapy degree in 1979, these physical agents were a large part of practice,” explained Delitto for the benefit of NPR. “We’ve had a hard time getting rid of them.”

 

Of course you have! Anyone who has ever been comforted by a snug heating pad is not about to take this news lying down (or, um, they might). Consider, for instance, one Linda Nichols, a former patient, who added these comments to NPR’s article discussing the topic: “You can have my heating pad when you pry it from my cold, dead fingers!! Or from my warm cozy fingers.”

 

However, science is science and science is now saying no more heating pads or the like. “There is emerging evidence that passive physical agents can harm patients,” wrote Delitto and his co-authors in their number one recommendation for therapists. In particular, the authors believe “communicating to patients that passive, instead of active, management strategies are advisable” amplifies a patient’s fears and anxiety about being physically active while in pain. And this can prolong recovery, add to costs, and may even increase the risk of needing injections or surgery.

 

Certainly, no one wants surgery, so perhaps it would be wise to take a look at the new rules addressed to physical therapists and which, in their entirety, read as follows:

 

  1. Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program.
  2. Don’t prescribe underdosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual’s abilities and goals.
  3. Don’t recommend bed rest following diagnosis of acute deep vein thrombosis after the initiation of anticoagulation therapy unless significant medical concerns are present.
  4. Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement.
  5. Don’t use whirlpool for wound management.

 

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