/
Interventions in Treating Patients Interventions in Treating Patients

Interventions in Treating Patients - PowerPoint Presentation

pressio
pressio . @pressio
Follow
342 views
Uploaded On 2020-08-06

Interventions in Treating Patients - PPT Presentation

With Low Back Pain Sara Patterson SPT Clinical Instructor Kelly Fosberg PT DPT Objectives Learn about the effectiveness of two different interventions used for your patients with low back pain ID: 800085

patients pain therapy study pain patients study therapy physical quality care healthcare chronic traction manipulation active 2016 work lumbar

Share:

Link:

Embed:

Download Presentation from below link

Download The PPT/PDF document "Interventions in Treating Patients" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Interventions in Treating Patients With Low Back Pain

Sara Patterson, SPT

Clinical Instructor: Kelly

Fosberg

, PT, DPT

Slide2

Objectives

Learn about the effectiveness of two different interventions used for your patients with low back pain

Integrate these interventions into individualized care for your patients with low back pain

Learn about the value PTs can provide when treating patients with low back pain

Slide3

Meet S.E.

58 year old female

Work: Inspects products

Chief Complaint: L. LE Throbbing pain

June, 2016

July, 2016

March, 2016

Slide4

Meet S.E.

Tests and Measures:

P-A Spring Testing

:

Mild

Hypomobility

Pain L4-S1

Active Lumbar Ext.: Mild pain; 150

Active Lumbar Flex:

Sharp pain; 450SLR

:

0-35

0

caused pain (ipsilateral)

Standing Lumbar Quadrant Ext. with Overpressure

:

+

ive

Myotomes

:

L. Knee Extension, L. ankle plantarflexion - 4/5

Slump Test

:

+

ive

Slide5

S.E.’s SINSS StatementSeverity

Throbbing Pain

Irritability

– Lumbar Flex. Hurts! (only can sit for ~15 min

.)

Nature – Nerve/radiculopathyStage – Chronic with subacute symptomsStability – Improving; pt. states due to injections

Slide6

ICF Model

Health Condition

:

Radiculopathy

, lumbosacral region

Body Structure and Function:

Hypomobility

Pain w/ Flex.

Pain w/ Ext.

Strength

Participation

:

Abilities:

- Sleep

Restrictions:

- Work

- Family

- Driving

Activity

:Abilities: - StandingLimitations: - Sitting

Environmental Factors+: Insurance Family- : Stress of Work

Personal Factors+ : Motivated- : Stress

Slide7

Study Design:

Cross Sectional, Observational Study

Test, Retest

Objective:

To investigate prevalence and reliability of placement into a intervention from translating the use of subgroups to a classification algorithm

(Physical Therapy, 2011)

Slide8

(Physical Therapy, 2011)

Slide9

PICO Question

P: In a 58

y.o

. woman with chronic low back

pain and

L. posterolateral leg symptoms

I: would traction be more effectiveC: than manipulation

O: in reducing pain?

Slide10

(Cochrane Database of Systematic Reviews, 2013)

Selection Criteria:

RCT’s involving traction to treat acute, subacute, or chronic non-specific LBP w/ or w/0 sciatica (32 RCTs were included)

Outcome Measurements:

Pain Intensity

Functional Status

Global Improvement

Return to Work

Results:

Low to moderate quality evidence - no impact on pain intensity, functional status, or global improvement

Low to moderate

quality evidence

-

makes little or no difference when comparing sham, placebo, or no treatment

Very low to moderate

quality evidence - makes little or no difference when comparing physiotherapy and traction or other treatments

Limitations:

Amount of high quality studies

Studies distinguishing between people with different symptom patterns

*23/32 studies included mostly people with LBP and sciatica pain

8 studies were a mix of with and without sciatic1 study had no sciatica painQuality of Review: Good2

Slide11

(Annals of Internal Medicine, 2014)

Objective: To compare spinal manipulative therapy (SMT) plus home exercise and advice (HEA) vs. HEA alone while studying the reduction in pain, short term and long term

Limitations:

Patients and providers were not blinded

Study size

Back pain potentially gets better over time

Study Design:

192 patients (191 at 12

wks

, 179 at 52

wks

)

96 patients assigned to each group

Patients were 21

y.o

. or older and have had BRLP for at least 4

wks

Outcomes:

Leg Pain

Low Back Pain

Global ImprovementMedication UseSatisfaction

Slide12

(Annals of Internal Medicine, 2014)

Quality of Study: Fair

2

*Effect size for leg pain at 12

wks

was considered medium (0.6)

Slide13

Did I answer my PICO question . . . .

No . . .

Why?

The research I found does not compare traction and manipulation

Clinical prediction rule for utilization of manipulation as an intervention for patients with LBP suggests less likelihood of success for patients with symptoms distal to the knee

Slide14

Costs to the Healthcare System

61% of Americans experience back pain but 37% don’t seek professional help for pain

relief.

4

More than 1/3 of adults say that their low back pain has affected their ability to participate in daily living tasks, exercise, and

sleep.

4Overall U.S. healthcare expenditure for low back pain in 1998 was estimated at $90 billion dollars2Costs of low back pain have risen so high, total healthcare expenditure could not be observed

2Patients with chronic low back pain account for the bulk of these costs2

Slide15

PT’s Role

PT first vs. Imaging – Initial referral for PT costs on average $504 (3.8 visits) vs. an MRI which costs $1,306.

Avg. subsequent costs were 72% lower for patients who started with PT.

3

Effectiveness of PT – 471 patients

5Active PT (n=132) – high percentage of active exerciseNon-adherent care (n=339) – Involving greater than 25% passive treatments like hot/cold, ultrasound, E-stimRate of additional healthcare utilization was 65.8% compared with 55.3% for active care

Slide16

Remember the 3 legged stool

There is not one intervention for each diagnosis

If something is not working, try something different

Listen to your patients and figure out their goals to ultimately give them the best treatment

Practicing at the top of Your License!

Slide17

References

Bronfort

,

Gert

, Maria A.

Hondras

, Craig A. Schulz, Roni L. Evans, Cynthia R. Long, and Richard Grimm. "Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation." Annals of internal medicine 161, no. 6 (2014): 381-391.Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt E. Noninvasive Treatments for Low Back Pain. Comparative Effectiveness Review No. 169. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 16-EHC004EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2016. www.

effectivehealthcare.ahrq.gov/reports/final.cfmFritz, Julie M., Gerard P. Brennan, and Stephen J. Hunter. "Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: associations with future health care utilization and charges."

Health services research 50, no. 6 (2015): 1927-1940.Most

americans live with low back pain – and don’t seek treatment. American Physical Therapy Association. April 4th, 2012. http://www.apta.org/Media/Releases/Consumer/2012/4/4/

“PTs offer low-cost solutions to acute low back pain.” American Physical Therapy Association.

August 12, 2008. http://www.apta.org/Media/Releases/Consumer/2008/8/12/

Stanton

, Tasha R., Julie M. Fritz, Mark J. Hancock, Jane Latimer, Christopher G. Maher, Benedict M. Wand, and Eric C. Parent. "Evaluation of a treatment-based classification algorithm for low back pain: a cross-sectional study."

Physical therapy

91, no. 4 (2011): 496-509.

Wegner

, Inge, Indah S.

Widyahening

, Maurits W. van Tulder, Stefan EI Blomberg, Henrica CW de Vet, Gert Brønfort, Lex M.

Bouter, and Geert J. van der Heijden. "Traction for low‐back pain with or without sciatica." The Cochrane Library (2013).

Slide18

Any Questions?

Slide19