Inpatient Rehab Pearls and Principles – Slater

CONSULT, CONSULT, CONSULT! When to consult? Patient is well below their baseline functional status with potential for this to improve in a reasonable amount of time. Medical needs beyond typical capability of subacute care (SNF). Rehab diagnosis:  60% have to have a "rehab diagnosis" stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, femur… Continue reading Inpatient Rehab Pearls and Principles – Slater

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Physical Therapy Does Not Benefit Simple Ankle Sprains

BMJ 2016 Nov 16;355:i5650 Most ankle sprains are simple grade 1 (stable) or 2 (mild joint laxity) sprains, but often result in some persistent impairment.  Physical therapy's role in improving recovery is unclear. n= 504 (ages 16-79) presenting with grade 1 or 2 presenting within 72 hours of injury Randomized to usual care (evaluation, home… Continue reading Physical Therapy Does Not Benefit Simple Ankle Sprains

Acute Monoarthritis

Most common diagnoses in primary care:  osteoarthritis, gout and trauma. Do not miss disorder:  septic arthritis.  Missed diagnosis can lead to sepsis, bacteremia, joint destruction or death. Focal bone pain or recent trauma requires X-ray imaging:  must rule out metabolic bone disease, tumor or fracture. Joint effusion with any sign of infection (redness, warmth, fever)… Continue reading Acute Monoarthritis

Total Knee Arthroplasty Superior to Non-Surgical Treatment for Pain from Knee Osteoarthritis

n = 100, Danish study; mod-to-sev knee OA eligible for unilateral TKA Randomized to TKA followed by 12 wks non-surg tx vs non-surg tx alone (exercise, education, weight loss advice, insoles, APAP/NSAIDs). Intent-to-treat analysis TKA pts had greater improvement in pain, function and QOL, but also more adverse events (3 had DVT) and need for… Continue reading Total Knee Arthroplasty Superior to Non-Surgical Treatment for Pain from Knee Osteoarthritis

Hyaluronic Acid Viscosupplementation Does Not Work for Knee Osteoarthritis (Again)

Hyaluronic acid = sham injections in patients with knee DJD Clinical Question: Do hyaluronic acid injections in patients with knee degenerative joint disease improve pain and function? Bottom Line: The highest quality studies, which are now fairly plentiful, show that hyaluronic acid injections are only minimally better than sham injections in improving pain and function in patients with knee… Continue reading Hyaluronic Acid Viscosupplementation Does Not Work for Knee Osteoarthritis (Again)

Do Not Recommend Calcium and Vitamin D Supplements to Increase Bone Density

Background: For patients > 50, 1000-1200 mg daily of calcium recommended to prevent fractures. 58 cohort studies of dietary calcium intake and fracture risk in >700K patients. 74% of studies reported no associated between dietary Ca intake and risk for total fx, hip fx, vertebral fx or forearm fx. Positive associations in the remaining studies… Continue reading Do Not Recommend Calcium and Vitamin D Supplements to Increase Bone Density

No Early Physical Therapy in Acute Low Back Pain

Background:  Imaging, opioids and surgical interventions for LBP is expensive and no associated with improved outcomes.  Clinical practice guidelines recommend against early PT use to avoid these interventions. (Ann Intern Med 2007; 147:478). Utah study of n = 220 adults (mean 37 yo) with LBP < 16 days duration without radicular sxs below the knees.… Continue reading No Early Physical Therapy in Acute Low Back Pain