Lumbar Spinal Stenosis: Non-Surgical Options Compared

MedicalResearch.com Interview with:

Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences  University of Pittsburgh

Dr. Schneider

Dr. Michael Schneider DC, PhD
Associate Professor
School of Health and Rehabilitation Sciences
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: Lumbar spinal stenosis (LSS) is one of the fastest growing problems in the country due to its aging population. One third of Medicare users have the condition, and it is the number one reason for spine surgery in this population. Existing research evaluates the benefits of nonsurgical treatment options compared to surgery, but there was no existing research that compared the available nonsurgical options to each other to determine the best course of treatment for each patient.

We studied three nonsurgical treatments for LSS: medical management with medications and/or epidural injections, individualized care with a physical therapist or chiropractor, and group exercise. We assessed each of these treatment methods with a questionnaire, a walking distance test, and a physical activity monitor. 

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In Non-Locking Meniscal Knee Tears, Physical Therapy May Be As Good As Surgery

MedicalResearch.com Interview with:
"Meniscus adalah tisu/rawan berbentuk huruf C yang berfungsi mencegah dua tulang bergesel di antara satu sama lain di bahagian lutut. Tisu meniscus yang koyak berpunca kebiasaannya daripada bersukan yang melibatkan pergerakan lutut yang banyak. Warga emas" by Rawatan Alternatif Shah Alam is licensed under CC BY 2.0
Victor A. van de Graaf, MD
OLVG Ziekenhuis
Amsterdam

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although meniscal surgeries are among the most frequently performed surgical procedures in orthopedic surgery, until just recently there were hardly any randomized trials proving its superiority over conservative treatment.

In this randomized clinical trial, including 321 patients with non-obstructive (e.g. no locking of the knee joint) meniscal tears, we found physical therapy non-inferior to arthroscopic partial meniscectomy. 

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Leg cycling and electrical muscle stimulation for the critically ill? Still many peaks to climb up

MedicalResearch.com Interview with:
“cycling” by Urs Steiner is licensed under CC BY 2.0Guillaume Fossat, Physiotherapist and
Thierry Boulain, M.D.
Médecine Intensive Réanimation
Centre Hospitalier Régional
Orléans, France

MedicalResearch.com: What is the background for this study?

Response: Critically ill patients may suffer terrific muscle wasting during their intensive care unit stay. In most patients, particularly those with sepsis or other high inflammatory states, this is due to proteolytic pathways runaway that may persist as long as the cause of inflammation has not been eliminated. What is more, forced rest, as the one imposed to severely ill patients who need sedation to tolerate artificial respiratory support also induces muscle deconditioning and mass loss. In short, the more you are severely and acutely ill, the more you breakdown your muscle proteins and use the catabolic byproducts to fuel the rest of your organism. As a result of this sort of autophagy, intensive care unit survivors may have lost tens of muscle mass kilograms at discharge, to the point that they have lost all or parts of their functional autonomy. The personal and social burden is considerable as muscle weakness may persist several years after hospital discharge.

In the 2000’s, physiotherapy and early rehabilitation during intensive care have emerged as a way to counteract the autophagic muscle wasting and help patients to speed up their return to functional autonomy. Therefore, a standardized early rehabilitation that consists in early muscle exercises, systematic lowering or interruption of sedative drugs dosages to allow prompt patient’s awaking, early transfer to chair and early first walk try, has become the standard of care. However, to what extent, when and how muscles should be exercised during the intensive care unit stay in order to optimize the positive effects of rehabilitation remains a nearly blank clinical research area.

In-bed leg cycling and electrical muscle stimulation, each for their part, have shown encouraging results. In our study, we sought to know if the very early combination of both could improve global muscle strength in survivors at intensive care unit discharge.

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Arm Cycling Can Improve Walking After Stroke

MedicalResearch.com Interview with

Paul Zehr PhD Professor & Director Centre for Biomedical Research, Rehabilitation Neuroscience Laboratory, McKinnon Division of Medical Sciences Exercise Science, Physical & Health Education International Collaboration on Repair Discoveries (ICORD)| Affiliate, Division of Neurology, Department of Medicine, UBC

Dr. Zehr

E. Paul Zehr PhD
Professor & Director
Centre for Biomedical Research,
Rehabilitation Neuroscience Laboratory, McKinnon
Division of Medical Sciences
Exercise Science, Physical & Health Education
International Collaboration on Repair Discoveries (ICORD)|
Affiliate, Division of Neurology, Department of Medicine, UBC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For many years we explored the role of the spinal cord in regulating rhythmic arm and leg movements like we do during walking, running and swimming.  Although we humans tend to move and locomote around on our two legs as bipeds, we are basically quadrupeds in terms of how our nervous system controls our limbs during walking. We have an extensive network of brain and spinal cord connections that help coordinate our limbs while we move. A lot of our work showed that using the arms rhythmically, like during arm cycling, strongly affected the activity of the spinal cord controlling leg muscles. Getting the spinal cord for leg muscles more coordinated and activated is a major goal of rehabilitation  of walking after neurotrauma so we wanted to see if training the arms could help with this. This is particularly important because a lot of the time, the arms are not engaged at all in rehabilitation training for the legs.

We found that after only 5 weeks of arm cycling (3 x 30 minutes each week), neural excitability, strength, and leg function were increased along with enhanced clinical tests of balance and walking ability.

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Personalizing Human-Robot Interactions Can Facilitate Rehabilitation

MedicalResearch.com Interview with:

Ben-Gurion University of the Negev student researcher Shir Kashi interacts with robotic arm as part of her research in personalizing human-robot interactions to develop an interactive movement protocol for rehabilitation.

Ben-Gurion University of the Negev student researcher Shir Kashi interacts with robotic arm as part of her research in personalizing human-robot interactions to develop an interactive movement protocol for rehabilitation.

Shelly Levy-Tzedek, PhD
Head of the Cognition, Aging and Rehabilitation Lab
Faculty of Health Sciences, Dept. of Physical Therapy
& The Zlotowski Center for Neuroscience
The Ben Gurion University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Following brain injury, patients who need to practice their physical therapy exercises at home. Many don’t practice enough or at all at home, and so we are designing robot companions to encourage them to practice and to track their progress. This study is a first step towards this goal. Here, we studied how people played a leader-follower mirror game with a robotic arm, where a person and robot took turns following each other’s joint movements patterns. When the robotic arm was leading, it performed movements that were either sharp, like dribbling a ball, or smooth, like tracing a circle.

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Tele-Rehabilitation Can Improve Physical Function In Chronic Knee Pain Patients

MedicalResearch.com Interview with:
Rachel Nelligan, BPhysio
Physiotherapist & Research Physiotherapist
Department of Physiotherapy | Centre for Health, Exercise and Sports Medicine
The University of Melbourne
Victoria Australia

MedicalResearch.com: What is the background for this study?

Response: This novel study investigated the efficacy of an internet delivered model of service delivery that combined online education, Skype delivered exercise physiotherapy and an Internet-based interactive pain coping skills training program for people with persistent knee pain.

Osteoarthritis, the leading cause of chronic knee pain and disability globally, has a significant individual, societal and economic burden. On an individual level knee osteoarthritis causes loss of function, reduced quality of life, and psychological distress. Clinical guidelines recommend adoption of a biopsychosocial approach to management which should include nondrug, nonsurgical treatments. Specifically exercise, education and psychological interventions (including pain coping skills training (PCST)) that foster self-management are recommended. Evidence identifies that many knee OA sufferers are not receiving adequate management due in part to challenges of accessing these effective treatments. There is an urgent need for new models of health service delivery to rectify this.

Tele-rehabilitation is growing in acceptance as an effective, time efficient and convenient means for people to access effective health interventions. In knee OA internet delivered interventions specifically remotely delivered physiotherapy exercise using specialised tele-rehabilitation equipment and an Internet-based interactive PCST program (PainCOACH), designed to translate key therapeutic elements of clinician-delivered face-to-face PCST, have shown improved patient outcomes. Prior to this study the combination of these two internet-based treatments has not been investigated.

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Addition of Virtual Reality To Treadmill Training Reduced Falls in Older Adults

MedicalResearch.com Interview with:

Anat Mirelman, PhD Director- Laboratory of Early Markers of Neurodegeneration (LEMON) Center for the study of Movement , Cognition and Mobility (CMCM) Department of Neurology Tel Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv 64239, Israel

Dr. Anat Mirelman

Anat Mirelman, PhD
Director- Laboratory of Early Markers of Neurodegeneration (LEMON)
Center for the study of Movement , Cognition and Mobility (CMCM)
Department of Neurology
Tel Aviv Sourasky Medical Center
Sackler School of Medicine, Tel Aviv University
Tel Aviv 64239, Israel

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main aim of this research was to evaluate the efficacy of using a motor cognitive training using virtual reality in reducing fall frequency and fall risk in older adults.

Falls are a leading cause of morbidity and mortality in older adults. The prevalence of falls is huge, with one out of every 3 adults aged 65 years or older will fall at least once per year, with approximately half of these fallers suffering multiple falls in this period . These statistics are even higher in neurodegenerative conditions such as in Parkinson’s disease and in people with cognitive impairments. For example, studies have shown that as much as 80% of people with Parkinson’s disease fall each year. So many older adults are falling.
The consequences of falls are huge.

The most dramatic result is hip fracture. But this is relatively rare. However, even in the absence of a fracture or other injury, falls often lead to fear of falling, social isolation, and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls, more social isolation. In other words, falls often start a vicious cycle, which has many important negative health consequences. Falls are associated with morbidity and mortality and they also have a huge economic impact. In many western countries, 1-2% of healthcare dollars are spent on falls.

For many years, age-associated changes in muscle strength, balance and gait were viewed as the key factors that contribute to the risk of falls. However, more recently, we and others showed that certain aspects of cognition are also critical to safe ambulation. For example people with AD often fall, almost to the same amount as people with PD, highlighting the cognitive component of falls. This makes sense intuitively if we Imagine the cognitive skills we need just to cross a busy intersection. These tasks require executive function, specially, planning, the ability to avoid obstacles, and the ability to perform two or more tasks at the same time.

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Mobility Program During Hospitalization Improved Post-Discharge Ambulation

MedicalResearch.com Interview with:
Cynthia J. Brown, MD, MSPH, AGSF
Parrish Professor of Medicine and Director,
Division of Gerontology, Geriatrics, and Palliative Care
Comprehensive Center for Healthy Aging
University of Alabama at Birmingham
Birmingham, Alabama 35294

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Brown: Low mobility is common during hospitalization and associated with loss of activities of daily living ability and community mobility. The objective of this study was to examine the impact of an in-hospital mobility program on post-hospital function and community mobility. Brown and colleagues, using a single blind randomized trial design, found that a mobility program that included offering assistance with ambulation linked with a behavioral intervention that focused on goal setting and addressing mobility barriers prevented loss of community mobility one month after hospital discharge. Those who received usual care experienced a clinically significant decline in community mobility. Functional status as measured by activities of daily living was not significantly different between the usual care and mobility program groups either before or after the hospitalization. Because low mobility in the hospital is associated with adverse outcomes including functional decline and nursing home placement even after controlling for illness severity and comorbid illness, these findings have potentially significant clinical implications.

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Physical Therapy Has A Small Beneficial Effect In New Onset Back Pain

MedicalResearch.com Interview with:
Julie M. Fritz, PT, PhD, FAPTA

Professor, Department of Physical Therapy
Associate Dean for Research, College of Health
University of Utah
Salt Lake City, UT  84106

Medical Research: What is the background for this study? What are the main findings?

Dr. Fritz: Low back pain affects up to 80% of adults at some point in their lives and back pain is among the most common reasons why someone visits their primary care provider.  Despite how common back pain is, the health care system does a surprisingly poor job of managing patients with the condition. There are many things that can happen at the initial primary care visit for back pain that are unhelpful or may even delay recovery such as ordering an MRI or prescribing opioids. Most practice guidelines recommend that primary care providers avoid ordering an MRI or opioid pain medication, reassure the patient that they will begin to feel better quickly and then wait a few weeks before considering referral to physical therapy.  Others have suggested that earlier use of physical therapy may be more beneficial to patients.  We conducted this study to compare early physical therapy with a wait-and-see approach.

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Physical Therapy May Equal Surgery For Spinal Stenosis, But Many Patients Don’t Complete Treatments

Anthony Delitto, PT, Ph.D, FAPTA Professor and Chair Department of Physical Therapy Associate Dean for Research, SHRS School of Health and Rehabilitation Sciences Pittsburgh,MedicalResearch.com Interview with:
Anthony Delitto, PT, Ph.D, FAPTA

Professor and Chair
Department of Physical Therapy
Associate Dean for Research, SHRS
School of Health and Rehabilitation Sciences
University of Pittsburgh

Medical Research: What is the background for this study? What are the main findings?

Dr. Delitto: I work with a team, many of whom were authors on the paper, and we see a lot of patients with lumbar spinal stenosis. Some of them did very well with Physical Therapy and avoided surgery. Some people didn’t do well and we ended up having surgery. We really wanted to do a study that compared, in a randomized format, doing surgery vs. a non-surgical approach to lumbar spinal stenosis. The idea we had was to really put the two approaches head to head – a randomized trial of surgery vs. physical therapy for people with lumbar spinal stenosis. We decided only to recruit patients after they had consented to surgery in order to avoid the pitfalls of previous studies where people crossed over after being assigned to a group, for example, being assigned to surgery and then deciding against having surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. Delitto: Probably the biggest point to put across to physicians, patients and practitioners, one of the things we realized was: patients don’t exhaust all of their non-surgical options before they consent to surgery. And physical therapy is one of the non-surgical options. The obvious finding is, when you compare the two groups, they seem to do the same. The results were equivalent at two years. Now, embedded in that, there are patients who did well in surgery, and patients who failed in surgery. There are patients who did well in Physical Therapy, and there are patients who failed with PT. But when we looked across the board at all of those groups, their success and failure rates were about the same. So it tells us that for the most part there were equivalent outcomes at two years.

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Hip Osteoarthritis: How Beneficial is Physical Therapy?

Professor Kim Bennell ARC Future Fellow Department of Physiotherapy University of Melbourne Parkville, Vic 3010 AustraliaMedicalResearch.com Interview
Professor Kim Bennell
ARC Future Fellow
Department of Physiotherapy
University of Melbourne
Parkville, Vic 3010 Australia

MedicalResearch: What are the main findings of the study?

Professor Bennell: In 102 people with painful hip osteoarthritis, we compared a ‘real’ physical therapy program involving exercise, manual therapy techniques,education and provision of a cane if appropriate to a sham physical therapy treatment that was made to look as though it was real but instead involved turned off ultrasound and gentle application of a hand crème to the hip region. Participants in both groups went to see a physical therapist on 10 occasions over 12 weeks and performed home exercises if in the ‘real’ physical therapy group or lightly applied the cream at home if in the sham group. Participants were followed for 9 months in total. We found that while both groups showed improvements in pain and physical function, the improvements were similar between the two groups. That is, the real physical therapy program did not show greater benefits over a sham treatment.  Continue reading

For Whiplash Treatment: Education and Advice As Good As Prolonged PT

MedicalResearch.com Interview with:
Zoe Michaleff
PhD Student, Musculoskeletal Division
The George Institute for Global Health
Sydney NSW 2000 Australia

MedicalResearch.com: What are the main findings of the study?

Answer: Our study showed that a 30 minute advice session with two phone call follow ups was as effective for chronic whiplash as the comprehensive physiotherapy exercise program in which participants received twenty, one-hour individually-tailored and supervised exercise sessions over a 12-week period. While people’s pain and activity improved in both treatment groups, the most important finding is that there were no differences between groups. This finding held true for all outcome measures except for two secondary outcome measures of self rated recovery (global perceived effect) and functional ability (patient specific functional scale) which were in favour of the comprehensive exercise program however the size of these effects were too small to be considered clinically meaningful.
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Total Hip Replacement Surgery: Exercise May Postpone Need

Ida C. Svege
 PhD student / Physical Therapist 
NAR Norwegian research centre for Active Rehabilitation
Department of Orthopaedics Oslo University Hospital / NIMI / Norwegian School of Sports Sciences
MedicalResearch.com Interview with:
Ida C. Svege
 PhD student / Physical Therapist 
NAR
Norwegian research centre for Active Rehabilitation
Department of Orthopaedics, Oslo University Hospital / NIMI / Norwegian School of Sports Sciences

MedicalResearch.com: What are the main findings of the study?

Answer: The main finding of the study was that exercise therapy in addition to patient education resulted in significantly higher 6-year cumulative survival of the native hip to total hip replacement compared with patient education only. Over the 6 year follow-up period the need for total hip replacement was reduced by 44% in the group who received both exercise therpay and patient education. Also, better self-reported physical function was demonstrated in the group who received exercise therapy and patient education, suggesting that the lower surgery rate in this group were due to better hip function, with or without the presence of pain.
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