Financial impact associated with implementation of the low back pain clinical practice guideline in outpatient physical therapist practice at a large academic medical center.

INTRODUCTION: Low back pain (LBP) is the top health condition requiring rehabilitation in the United States. The financial burden of managing LBP is also amongst the highest in the United States. Clinical practice guidelines (CPGs) provide management recommendations and have the potential to lower health costs. Limited evidence exists on the impact of CPG implementation on downstream medical costs. OBJECTIVE: To examine the impact of CPG implementation in physical therapist (PT) practice on direct and downstream costs for patients with LBP. METHODS: A retrospective observational study examined billing data from 270 patients with LBP who were treated at multiple sites within one large academic medical center by PTs who participated in a multifaceted CPG implementation program. Costs were analyzed for direct PT services, downstream medical services, and PT utilization from September 2017 to March 2018 (pre-implementation group) and compared with costs from June 2018 to December 2018 (post-implementation group). RESULTS: Direct PT costs were significantly lower post-implementation than pre-implementation mean: $2,863 USD (SD: $1,968) vs. $3,459 USD (SD: $2,838), p = .05, 95% CI [11, 1182]. All downstream costs were lower post-implementation with statistically significant lower costs found in downstream imaging: p = .04, 95% CI [32, 1,905]; pharmacy: p = .03, 95% CI [70, 1,217]; surgery: p = .03, 95% CI [446, 9,152], and "other": p = .02, 95% CI [627, 7,920]. CONCLUSION: Implementing the LBP CPG in outpatient PT practice can have a positive impact on lowering downstream costs and the potential to increase the value of PT services.

The effect of monochromatic infrared energy on transcutaneous oxygen measurements and protective sensation: results of a controlled, double-blind, randomized clinical study.

Monochromatic infrared energy has been reported to restore protective sensation by increasing circulation. A controlled, double-blind, quasi-experimental, randomized clinical study was conducted to 1) examine the effects of monochromatic infrared energy treatments on tissue perfusion, 2) determine the effects of a published monochromatic infrared energy neuropathy protocol on sensation on the feet of patients with diabetes and a loss of protective sensation; 3) examine monochromatic infrared energy's effect on pain; and 4) examine the relationship between transcutaneous oxygen levels and loss of protective sensation. The study was conducted at a wound and hyperbaric treatment center in Norwalk, Conn; 18 adults (12 men, six women; mean age 65 +/-13 years, range 39 to 86 years) with diabetes and loss of protective sensation were recruited using convenience sampling methods. All patients served as their own control. Pre- and post treatment tests assessed sensation, pain, and transcutaneous oxygen measurements on two sites per foot. Participants underwent a series of 30-minute monochromatic infrared energy treatments (one foot active treatment, one foot sham). Monochromatic infrared energy was delivered at the manufacturer pre-set level of energy of 1.5 J/cm(2)/min at a wavelength of 890 nm; sham units delivered no energy. Scores were analyzed using paired t-tests and Pearson's correlation coefficient. No significant differences were observed between active and sham treatments for transcutaneous oxygen values, pain, or sensation. Both active and sham monochromatic infrared energy-treated feet had significantly improved sensation when compared to pretest baseline scores (P <0.05). No statistical relationship was found between transcutaneous oxygen and sensation. This small study did not demonstrate any effects of monochromatic infrared energy treatment on transcutaneous oxygen measurements, pain, or sensation in adults with diabetes and loss of protective sensation.

Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke.

BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. RESULTS: Among the 67,445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]=9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR=2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR=0.79; 95% CI, 0.73 to 0.85). CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.

Stress and compliance with a home exercise program among caregivers of children with disabilities.

PURPOSE: To determine the relationship between caregiver stress and compliance with home programs in caregivers of children with disabilities. METHODS: Sixty-six caregivers of children with disabilities responded to a mailed survey to determine their level of compliance with a prescribed home physical therapy program and the level of caregiver stress. Compliance was defined as the degree to which caregivers followed the prescribed frequency of the home program. RESULTS: Sixty-six percent of the caregivers reported some level of noncompliance with their home program. Linear regression analysis revealed a significant relationship between the caregivers' level of noncompliance with the home program and the level of stress that they reported. Correlation coefficients showed a significant relationship between family problems and noncompliance with home programs. As caregiver and family problems increased, noncompliance with home programs increased. CONCLUSIONS: Caregivers of children with disabilities experience stress that should be addressed by therapists to maximize compliance with home programs.