Wednesday, September 30, 2009

Quick Survey: Clinical Decision Rules

Presenting an article at work tomorrow, wanted to run a quick survey of who has heard of and who actually uses any/all of the following:

Ottawa Ankle/Foot Rules
Ottawa Knee Rules
Canadian C-Spine Rules
Canadian CT head Rule
Wells Clinical Prediction Rule

Can Exercise Make You Smarter

One way I stay on top of current literature is through my phone and subscribing to numerous blogs and news sites. I usually share the most interesting articles I find over on the right hand side of my blog (over there >>>>>> [in the navy blue box]). If you look through that list you will often see a new study supporting some benefit of exercise. Ben Braxley, one of the elite New Professionals in the field, was kind enough to forward me this NY Times article along the same lines:

Phys Ed: What Sort of Exercise Can Make You Smarter?

It is a quick read summarizing one main study and a few others that support exercise as a brain booster.
“It would be fair to say that any form of regular exercise,” he says, if it is aerobic, “should be able to maintain or even increase our brain functions.”

Why should exercise need to be aerobic to affect the brain? “It appears that various growth factors must be carried from the periphery of the body into the brain to start a molecular cascade there,” creating new neurons and brain connections, says Henriette van Praag, an investigator in the Laboratory of Neurosciences at the National Institute on Aging. For that to happen, “you need a fairly dramatic change in blood flow,” like the one that occurs when you run or cycle or swim. Weight lifting, on the other hand, stimulates the production of “growth factors in the muscles that stay in the muscles and aren’t transported to the brain,” van Praag says.

Ortho Supersite

I likely mentioned this site at some point of my blogging life, but the recent "issue" I received via e-mail had a few great snippets worth sharing and inspired me to recommend their newsletter.

Some of the articles that piques my interest:
-The increasing number of THA revisions in the United States: Why is it happening?

-Investigators find way to halt excessive bone growth following trauma or surgery

-Pigmented Villonodular Synovitis of the Knee: Diagnosis and Treatment

They constantly have a bunch of interesting ortho related articles including some of the most recent advances in the field which is vital to stay on top of. Subscribing is free... Enjoy!

Saturday, September 12, 2009

Weight Lifting in Women w/Breast-Cancer-Related Lymphedema

I recently read a very interesting article that challenged previously held beliefs in the health care industry. I like challenging the norms, especially when it can get the patient better outcomes. The study pubished in the Aug 13 issue of the New England Journal of Medicine found that
In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength.

The study was made more significant by being longer (1 year follow-up) and being the largest randomized controlled trial to date (sample of 141 patients). Furthermore it was made more generalizable by including nonwhite women and women with a broad range of occupational and educational levels.

An argument is made in the editorial regarding this article that there are potential cost savings, not only by reducing direct health care costs but also by potentially reducing the risk of disability and allowing women to return to work at full capacity.

Exacerbations of the lymphedema was one of the main outcomes and they found that of the 70 patients in the control group there were 195 visits secondary to a flare-up while the weight lifting group that had 71 patients only had 77 visits.

While recently this population had been cautioned against making repetitive arm movements and lifting more than 10-15 poinds, in this study the weight lifting exercises included seated row, chest press, lateral or front raises, bicep curls, and tricep pushdowns as well as a number of lower-body exercises. To bust through the 10-15 pound limit there was no upper limit placed on the weight to which women could progress in any exercise (although they do not specify in the study how high they actually went).

Another element of the study I enjoyed is that the women were not just told to go exercise but given clear instructions with proper biomechanical focus from professionals trained in Lymphedema management at a local YMCA which is very accessible to most individuals in most cities, so this could be a program that would be much more realistic to implement. They also were nice enough to offer a free year of this program to the control group after the study was over.

Monday, September 7, 2009

Continuing Education

New York State (where I live and work) as of September 1, 2009, requires 36 hours of continuing education every 3 years in order to maintain your license. Here is the news from NYPTA:

Mandatory Continuing Education Update
Physical Therapy Continuing Education Regulations Part 77 of the Commissioners Regulations have been amended to implement Chapter 207 of the Laws of 2008, which requires physical therapists and physical therapist assistants to complete thirty-six hours of continuing education during each three-year re-registration period. The law takes effect September 1, 2009.

The Office of the Professions Link is:

The NYPTA is deemed as an approved provider; and as soon as the proper paperwork is filed and procedures defined, we’ll be forwarding that information to our members.

Journal of Physical Therapy

One of the benefits of being a member of the APTA ( is receiving the Journal of Physical Therapy. The importance of Evidence-Based Practice cannot be overlooked, and this Journal does a great job addressing so many areas of our widespread field. You can utilize the website for supplemental videos, podcasts, and the clinical bottom line which is an excellent way of summarizing the research that was performed.

Take for instance the Table of Contents of the most recent issue:

(They also have very snazy art on the cover of each issue)


PRISMA: Helping to Deliver Information That Physical Therapists Need
Christopher Maher
PHYS THER 2009;89 870-872


Reprint—Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
David Moher, Alessandro Liberati, Jennifer Tetzlaff, Douglas G. Altman and the PRISMA Group
PHYS THER 2009;89 873-880

Research Reports

Impact of Physical Therapist–Directed Exercise Counseling Combined With Fitness Center–Based Exercise Training on Muscular Strength and Exercise Capacity in People With Type 2 Diabetes: A Randomized Clinical Trial
J. David Taylor, James P. Fletcher, and Jakesa Tiarks
PHYS THER 2009;89 884-892

Factors Associated With Surgeon Referral for Physical Therapy in Patients With Traumatic Lower-Extremity Injury: Results of a National Survey of Orthopedic Trauma Surgeons
Kristin R. Archer, Ellen J. MacKenzie, Michael J. Bosse, Andrew N. Pollak, and Lee H. Riley, III
PHYS THER 2009;89 893-905

Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique
Sarah Walmsley, Darren A. Rivett, and Peter G. Osmotherly
PHYS THER 2009;89 906-917

Strategies to Promote Evidence-Based Practice in Pediatric Physical Therapy: A Formative Evaluation Pilot Project
Joe Schreiber, Perri Stern, Gregory Marchetti, and Ingrid Provident
PHYS THER 2009;89 918-933

Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase
Reinhard Schuh, Stefan G. Hofstaetter, Samuel B. Adams, Jr, Florian Pichler, Karl-Heinz Kristen, and Hans-Joerg Trnka
PHYS THER 2009;89 934-945

Job Strain in Physical Therapists
Marc A. Campo, Sherri Weiser, and Karen L. Koenig
PHYS THER 2009;89 946-956

Clinical Interpretation of a Lower-Extremity Functional Scale–Derived Computerized Adaptive Test
Ying-Chih Wang, Dennis L. Hart, Paul W. Stratford, and Jerome E. Mioduski
PHYS THER 2009;89 957-968

Development of a Self-Report Measure of Fearful Activities for Patients With Low Back Pain: The Fear of Daily Activities Questionnaire
Steven Z. George, Carolina Valencia, Giorgio Zeppieri, Jr, and Michael E. Robinson
PHYS THER 2009;89 969-979


Traumatic Brain Injury and Vestibular Pathology as a Comorbidity After Blast Exposure
Matthew R. Scherer and Michael C. Schubert
PHYS THER 2009;89 980-992

Letters and Responses

On "Effects of forced use on arm function in the subacute phase..." Hammer AM, Lindmark B. Phys Ther. 2009;89:526–539.
Steven L. Wolf
PHYS THER 2009;89 993-995

Author Response
Ann M. Hammer and Birgitta Lindmark
PHYS THER 2009;89 995-997


Santamato A, Solfrizzi V, Panza F, et al. "Short-term effects of high-intensity laser therapy versus ultrasound therapy..." Phys Ther. 2009;89:643–652.
PHYS THER 2009;89 999

Scholarships, Fellowships, and Grants

News from the Foundation for Physical Therapy
PHYS THER 2009;89 1001-1002

Interested in Travel PT?

I am in a great situation right now but travel PT seems like such a great way to experience the sights and sounds of the country as well as provide numerous challenges and learning experiences otherwise not seen. You can share and learn from so many different settings. The prospects are quite exciting.

If you are interested please check out the following community of online travel rehab professionals, it looks to be a very useful resource: