Correlation of disease comorbidity with prescribed treatment among insured U.S. lymphedema patients.

OBJECTIVE: The objective of this study was to define the current forms of treatment in a contemporary population of lymphedema (LED) patients for LED related to breast cancer, the most prevalently diagnosed LED comorbidity in Western countries, and phlebolymphedema with venous leg ulcer (PLEDU), a sequela of chronic venous disease. The goals of LED therapy are to reduce edema, thereby improving function and related symptoms, and to improve skin integrity to prevent development of infection. Treatment is generally nonsurgical: conservative care, including complex physical therapy, manual lymphatic drainage, and compression bandaging; or pneumatic compression device (PCD) therapy by a simple nonprogrammable device or an advanced programmable device. METHODS: To determine the frequency of individual types of treatment for LED and their relationship to breast cancer-related lymphedema (BCRL) and PLEDU, we queried claims from a deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative insurance database with >165 million members. A total of 26,902 patients identified with LED who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016 were separated into four treatment categories: no treatment, conservative care, simple PCD (SPCD), and advanced PCD. LED treatment was related to the BCRL and PLEDU comorbidities. RESULTS: BCRL patients, who represented 32.1% of all study patients, made up 41% of all patients receiving conservative care and 24% of patients receiving PCD therapy. By contrast, PLEDU patients (9.6% of study patients) were proportionally under-represented in the conservative care group (7.8%) but composed a disproportionately high share of the PCD therapy group (17.7%). PLEDU patients represented 23.5% of all LED patients prescribed SPCD therapy, whereas BCRL patients composed 10.3% of total LED patient SPCD prescriptions (P < .001). CONCLUSIONS: Our analysis of a large health care administrative database showed clear differences between the way BCRL and PLEDU patients are treated. Compared with BCRL patients, PLEDU patients were less likely to receive conservative care and more likely to be prescribed SPCDs for pneumatic compression therapy. These differences suggest that lymphatic therapy may be undervalued for treatment of chronic venous swelling and prevention and treatment of PLEDU.

24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country.

OBJECTIVES: Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. METHODS: Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. RESULTS: Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. CONCLUSIONS: A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a cost-benefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.

A Technology-Enabled Concussion Care Pathway Reduces Costs and Enhances Care.

BACKGROUND: The standardization of care along disease lines is recommended to improve outcomes and reduce health care costs. The multiple disciplines involved in concussion management often result in fragmented and disparate care. A fundamental gap exists in the effective utilization of rehabilitation services for individuals with concussion. PURPOSE: The purpose of this project was to (1) characterize changes in health care utilization following implementation of a concussion carepath, and (2) present an economic evaluation of patient charges following carepath implementation. DESIGN: This was a retrospective cohort study. METHODS: A review of electronic medical and financial records was conducted of individuals (N = 3937), ages 18 to 45 years, with primary diagnosis of concussion who sought care in the outpatient or emergency department settings over a 7-year period (2010-2016). Outcomes including encounter length, resource utilization, and charges were compared for each year to determine changes from pre- to post-carepath implementation. RESULTS: Concussion volumes increased by 385% from 2010 to 2015. Utilization of physical therapy increased from 9% to 20% while time to referral decreased from 72 to 23 days post-injury. Utilization of emergency medicine and imaging were significantly reduced. Efficient resource utilization led to a 20.7% decrease in median charges (estimated ratio of means [CI] 7.72 [0.53, 0.96]) associated with concussion care. LIMITATIONS: Encounter lengths served as a proxy for recovery time. CONCLUSIONS: The implementation of the concussion carepath was successful in optimizing clinical practice with respect to facilitating continuity of care, appropriate resource utilization, and effective handoffs to physical therapy. The utilization of enabling technology to facilitate the collection of common outcomes across providers was vital to the success of standardizing clinical care without compromising patient outcomes.

A novel technique with double catheter suctioning for clearing away the left lung atelectases: Selective left bronchial aspiration (SeLBA).

INTRODUCTION: Atelectasis is a common problem in intensive care units. It usually occurs due to airway obstruction caused by pulmonary secretions. As the left main bronchus angulates from carina more sharply, suctioning of the secretions from left side is less effective, causing failure in treatment of left lung atelectases. If chest physiotherapy and medical treatment fail, bronchoscopy should be considered; but it requires experience, time, effort and a higher cost. OBJECTIVES: To evaluate the success of a novel method "selective left bronchial aspiration (SeLBA)" in the treatment of left lung atelectases. METHODS: The study consisted of 10 patients who suffered left lung atelectasis and treated with double catheter suctioning technique, SeLBA in Pediatric Intensive Care Unit of Hacettepe University Ihsan Dogramaci Children's Hospital between June 2017 and February 2019. The outcomes were evaluated by comparing the chest X-rays before and after the procedure. RESULTS: All of the patients' atelectases resolved successfully by SeLBA procedure. CONCLUSION: We introduce this novel technique of reopening the atelectased left lung as a rapid, safe and practical alternative for bronchoscopic clear away.

The use of physiotherapy in nursing homes internationally: A systematic review.

BACKGROUND: Physiotherapy can improve functional ability, prevent falls and reduce pain for older adults in nursing homes. However, there are no legislations or guidelines that specify the parameters of physiotherapy required in nursing homes. With the increasing healthcare demands of ageing populations worldwide, it is important to understand the current use of physiotherapy services to ensure they are both evidence-based and promote equity. OBJECTIVES: (1) When and how are physiotherapy services used by older adults living in nursing homes? (2) What are the factors associated with use of physiotherapy services in nursing homes? (3) How are physiotherapy services in nursing homes documented and monitored? METHODS: Several databases and grey literature (including MEDLINE, PubMed, Pedro and EMBASE) were searched following PRISMA guidelines in March 2018. Searches were limited to English language publications from 1997. Assessment for inclusion, data extraction and quality assessment were completed by two investigators independently using standardised forms. Studies were included if they considered any type of physiotherapy service that involved a qualified physiotherapist (such as exercise, massage and staff education) with older adults (aged 60 years and older) that were primarily permanent residents of a nursing home. Data extracted included proportion of clients that used physiotherapy services, type, frequency and duration of physiotherapy services, and factors associated with physiotherapy service use. RESULTS: Eleven studies were included. Between 10% and 67% of nursing home clients used physiotherapy services. Factors associated with greater use of physiotherapy services included larger size facilities, and if clients had a physical impairment and mild or no cognitive impairment. Types of physiotherapy services reported were pain management and pressure ulcer management. CONCLUSIONS: Physiotherapy service use in nursing homes varied widely. The development of physiotherapy benchmarks and quality standards are needed to support older adults in nursing homes. PROSPERO registration number: CRD42018082460.

What Are the Costs of Cervical Radiculopathy Prior to Surgical Treatment?

STUDY DESIGN: Retrospective, observational study. OBJECTIVE: To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: While the costs of operative treatment have been previously described, less is known about nonoperative management costs of cervical radiculopathy leading up to surgery. METHODS: The Humana claims dataset (2007-2015) was queried to identify adult patients with cervical radiculopathy that underwent ACDF. Outcome endpoint was assessment of cumulative and per-capita costs for nonoperative diagnostic (x-rays, computed tomographic [CT], magnetic resonance imaging [MRI], electromyogram/nerve conduction studies [EMG/NCS]) and treatment modalities (injections, physical therapy [PT], braces, medications, chiropractic services) in the year preceding surgical intervention. RESULTS: Overall 12,514 patients (52% female) with cervical radiculopathy underwent ACDF. Cumulative costs and per-capita costs for nonoperative management, during the year prior to ACDF was $14.3 million and $1143, respectively. All patients underwent at least one diagnostic test (MRI: 86.7%; x-ray: 57.5%; CT: 35.2%) while 73.3% patients received a nonoperative treatment. Diagnostic testing comprised of over 62% of total nonoperative costs ($8.9 million) with MRI constituting the highest total relative spend ($5.3 million; per-capita: $489) followed by CT ($2.6 million; per-capita: $606), x-rays ($0.54 million; per-capita: $76), and EMG/NCS ($0.39 million; per-capita: $467). Conservative treatments comprised of 37.7% of the total nonoperative costs ($5.4 million) with injections costs constituting the highest relative spend ($3.01 million; per-capita: $988) followed by PT ($1.13 million; per-capita: $510) and medications (narcotics: $0.51 million, per-capita $101; gabapentin: $0.21 million, per-capita $93; NSAIDs: 0.107 million, per-capita $47), bracing ($0.25 million; per-capita: $193), and chiropractic services ($0.137 million; per-capita: $193). CONCLUSION: The study quantifies the cumulative and per-capital costs incurred 1-year prior to ACDF in patients with cervical radiculopathy for nonoperative diagnostic and treatment modalities. Approximately two-thirds of the costs associated with cervical radiculopathy are from diagnostic modalities. As institutions begin entering into bundled payments for cervical spine disease, understanding condition specific costs is a critical first step. LEVEL OF EVIDENCE: 3.

The economic cost of robotic rehabilitation for adult stroke patients: a systematic review.

OBJECTIVE: The objective of this review was to examine the economic cost of robotic therapy compared to conventional therapy for adult stroke patients, from the perspective of hospitals. INTRODUCTION: It is important to identify appropriate treatment methods that not only reduce the disability experienced by stroke survivors but also do so cost effectively. While robotic devices enable a high-intensity training regime for patients, robotic training equipment involves a significant capital outlay for healthcare providers. Hence, the decision to introduce robotic devices into clinical settings and offer robotic stroke rehabilitation to patients has an important cost consideration for hospitals. INCLUSION CRITERIA: This review included rehabilitation trials of adult stroke patients (18 years and older) involving robotic devices and comparing the economic outcomes to control groups that used conventional physiotherapy. METHODS: We searched major databases such as PubMed, Embase and CINAHL for trial studies conducted from year 2000 and published in English. Included studies were critically appraised, and data were extracted and synthesized using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). RESULTS: Five studies with 213 patients were included in this review. Four studies examined upper limb interventions, and one study evaluated both upper limb and lower limb interventions. Of the five studies, two included acute/sub-acute patients and three included chronic patients. The overall methodological quality of the studies was of a moderate level. The included studies compared the cost of providing robotic intervention against the cost of providing conventional therapy in dose-matched therapy sessions and computed the cost measures in terms of cost per patient session or cost per patient. We performed a cost comparison of the various studies and reviewed the data based on two approaches: the dominance ranking framework and the dominance ranking score. By comparing the cost outcome of each study, four of the five studies showed better cost benefits for the robotic intervention group. Under the dominance ranking framework and the dominance ranking score, the overall dominance levels for most sub-groups favored robotic intervention. CONCLUSIONS: Our review indicated that robotic therapy had a better economic outcome than conventional therapy. For patients with severe disability from significant stroke, a moderate dominance favoring robotic therapy for health benefit was found, and a strong dominance for robotic therapy for cost benefit was found. However, the limited number of studies in the review required us to view the results with caution. Key sensitivity factors affecting robotic therapy were the number of patients who could be treated per robotic session and the time therapists spent with patients during a robotic session. Robotic therapy could be prescribed primarily for patients with severe impairment after stroke. To maximize the cost economics, hospital providers may wish to organize their robotic therapy programs based on cost-sensitivity factors. For further research, we suggest better collaboration in methods within this field to enable a more comparable cost computation across studies.

Trends in Aging-Related Services During Nephrectomy: Implications for Surgery in an Aging Population.

OBJECTIVES: To characterize the extent to which geriatric and related healthcare services are provided to older adults undergoing surgery for kidney cancer, a potential growth area in geriatrics and oncology. DESIGN: Population-based observational study. SETTING: Surveillance, Epidemiology, and End Results cancer data linked with Medicare claims. PARTICIPANTS: Adults aged 65 and older with kidney cancer treated surgically from 2000 to 2009 (N = 19,129). MEASUREMENTS: Receipt of geriatric consultation, medical comanagement during the surgical hospitalization, inpatient physical or occupational therapy (PT/OT), and postacute PT/OT during the surgical care episode. Multivariable, mixed-effects models were used to identify associated participant and hospital characteristics, examine trends over time, and characterize hospital-level variation. RESULTS: Geriatric consultation occurred rarely in the perioperative period (2.6%). Medical comanagement (15.8%), inpatient PT/OT (34.2%), and postacute PT/OT (15.6%) occurred more frequently. In our mixed-effects models, participant age and comorbidity burden appeared to be consistent determinants of use of services, although hospital-level variation was also noted (P < .001). Use of geriatric consultation increased modestly in the latter years of the study period (P < .05). In contrast, medical comanagement (183%), inpatient PT/OT (73%), and postacute PT/OT (71%) increased substantially over the study period (P < .001). CONCLUSION: Although geriatric consultation remained sparse, use of medical comanagement and rehabilitation services has grown considerably for older adults undergoing surgery for kidney cancer. Efforts to reorganize cancer and surgery care should explore reasons for variation and the potential for these service elements to meet the health needs of an aging population.

Current Trends in the Management of Lateral Ankle Sprain in the United States.

OBJECTIVE: To characterize trends in the acute management (within 30 days) after lateral ankle sprain (LAS) in the United States. DESIGN: Descriptive epidemiology study. PATIENTS: Of note, 825 718 ankle sprain patients were identified; 96.2% were patients with LAS. Seven percent had an associated fracture and were excluded from the remaining analysis. SETTING: Primary and tertiary care settings. INTERVENTIONS: We queried a database of national health insurance records for 2007 to 2011 by ICD-9 codes for patients with LAS while excluding medial and syndesmotic sprains and any LAS with an associated foot or ankle fracture. MAIN OUTCOME MEASURES: The percentage of patients to receive specific diagnostic imaging, orthopedic devices, or physical therapy treatments within 30 days of the LAS diagnosis and the associated costs. RESULTS: Over two-thirds of patients with LAS without an associated fracture received radiographs, 9% received an ankle brace, 8.1% received a walking boot, 6.5% were splinted, and 4.8% were prescribed crutches. Only 6.8% received physical therapy within 30 days of their LAS diagnosis, 94.1% of which performed therapeutic exercise, 52.3% received manual therapy, and 50.2% received modalities. The annual cost associated with physician visits, diagnostic imaging, orthopedic devices, and physical therapy was 152 million USD, 81.5% was from physician evaluations, 7.9% from physical therapy, 7.2% from diagnostic imaging, and 3.4% from orthopedic devices. CONCLUSIONS: Most patients with LAS do not receive supervised rehabilitation. The small proportion of patients with LAS to receive physical therapy get rehabilitation prescribed in accordance with clinical practice guidelines. The majority (>80%) of the LAS financial burden is associated with physician evaluations.

Out-of-Pocket Spending for Ambulatory Physical Therapy Services From 2008 to 2012: National Panel Survey.

BACKGROUND: Out-of-pocket (OOP) expenditures are incurred as insurers and employers shift some of the burden of health care costs onto consumers. As cost-sharing increases, OOP expenditures could be a barrier to physical therapy care. OBJECTIVE: The purposes of this study were: (1) to identify factors associated with any OOP physical therapy spending and (2) to identify factors associated with higher spending among individuals incurring OOP costs. DESIGN: The study was a retrospective analysis using the 4 most recently available panels of data from the Medical Expenditure Panel Survey (MEPS) encompassing 2008-2012. METHODS: A data file containing episodes of physical therapy care for 2,189 people was created. Logistic regression was used to identify factors related to having an OOP expenditure. A multivariable generalized linear model was used to identify factors related to mean OOP expenditures. RESULTS: On average, an episode of care encompassed 9.9 visits, with mean total expenditures of $1,708 (median: $792). Fifty-four percent of episodes of care had an OOP expenditure. For individuals with OOP expenditures, the mean OOP expenditure for an episode of care was $351 (median: $144). Being female or non-Hispanic and having a higher income were associated with higher odds of incurring an OOP expenditure, whereas being in worse general health, >65 years of age, or nonwhite and having public funding were associated with lower odds of incurring an OOP expenditure. Amounts of OOP spending were higher in urban areas and in all census geographic regions relative to the Northeast region. LIMITATIONS: Estimates are based on household-reported survey data, limited to ambulatory care, and do not include institutionalized individuals. CONCLUSIONS: At 54%, the proportion of individuals with OOP expenditures for physical therapy is lower than for general medical care. Several predictors were found of having OOP expenditures and of the magnitude of those expenditures.

Disability trends in Saudi Arabia: prevalence and causes.

Disability is a major challenge for the Saudi healthcare sector. Data about the incidence and prevalence of impairment and disability and sociodemographic characteristics of people with disabilities are scarce and incomplete and probably underestimate the actual burden of disability. Policies and legislation have supported the equal rights of persons with disabilities, but ineffective implementation of these laws has created a gap between the intended aims and the actual provision of services. Clearly, more research is needed to plan for appropriate management programs, effective implementation of primary prevention strategies, and proper allocation of health resources in this area.

[Physiotherapy and ergotherapy are indispensable. Concrete prescription of remedies - without recourse]. / Physio- und Ergotherapie sind unverzichtbar. Konkretes Rezeptieren von Heilmitteln - ohne Regress.

Physical therapy and occupational therapy are essential for the treatment of inflammatory rheumatic diseases equal in rank to any drug therapy. They have enough evidence and are part of all current guidelines even if mostly not specified. In the German social security system the doctor prescribing physical therapy or occupational therapy has to act according to the different rules and forms as described in the current "Heilmittel Richtlinie" (Remedy directive) effective since July 2011. The multiple formal conditions and requirements of prescriptions are described in detail. Of special interest is that the global diagnosis of rheumatoid arthritis can no longer be used as the reason or justification for the individual prescription but detailed sub-diagnoses, regarding the essential ICF domains of structural damage, functional impairment, activity limitation and participation restriction as well as individual context factors are necessary. Of special interest is the fact that the prescribing doctor is no longer responsible for the formal correctness of prescriptions but the performing therapist, who will not be reimbursed if the prescription shows even minor formal errors. Another important improvement is the newly introduced long-term prescription of physical and occupational therapy. This facilitates the application of these therapies in the multimodal treatment regimen of rheumatic diseases.

Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.

STUDY DESIGN: A retrospective cohort. OBJECTIVE: To describe physical therapy utilization following primary care consultation for low back pain (LBP) and evaluate associations between the timing and content of physical therapy and subsequent health care utilization and costs. SUMMARY OF BACKGROUND DATA: Primary care management of LBP is highly variable and the implications for subsequent costs are not well understood. The importance of referring patients from primary care to physical therapy has been debated, and information on how the timing and content of physical therapy impact subsequent costs and utilization is needed. METHODS: Data were extracted from a national database of employer-sponsored health plans. A total of 32,070 patients with a new primary care LBP consultation were identified and categorized on the basis of the use of physical therapy within 90 days. Patients utilizing physical therapy were further categorized based on timing (early [within 14 d] or delayed)] and content (guideline adherent or nonadherent). LBP-related health care costs and utilization in the 18-months following primary care consultation were examined. RESULTS: Physical therapy utilization was 7.0% with significant geographic variability. Early physical therapy timing was associated with decreased risk of advanced imaging (odds ratio [OR] = 0.34, 95% confidence interval [CI]: 0.29, 0.41), additional physician visits (OR = 0.26, 95% CI: 0.21, 0.32), surgery (OR = 0.45, 95% CI: 0.32, 0.64), injections (OR = 0.42, 95% CI: 0.32, 0.64), and opioid medications (OR = 0.78, 95% CI: 0.66, 0.93) compared with delayed physical therapy. Total medical costs for LBP were $2736.23 lower (95% CI: 1810.67, 3661.78) for patients receiving early physical therapy. Physical therapy content showed weaker associations with subsequent care. CONCLUSION: Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy. Further research is needed to clarify exactly which patients with LBP should be referred to physical therapy; however, if referral is to be made, delaying the initiation of physical therapy may increase risk for additional health care consumption and costs.

Physical therapy in a value-based healthcare world.

Musculoskeletal conditions are important contributors to United States healthcare spending and are certain to play an important role in the future as the population continues to age. Almost half of the population of the United States experiences a musculoskeletal condition annually. Meeting the needs of these individuals within a changing healthcare delivery and reimbursement environment prompted a recent Summit sponsored by the United States Bone and Joint Initiative (USBJI). The Summit dealt with a topic critical to the future of healthcare for clinicians, consumers, and payers alike: value. We do not operate within a value-based healthcare system. Our current delivery system continues to reward volumes, not value. Failure to focus on value has had devastating consequences. The challenge of shifting from a volume-based to a value-based system is central to the future of healthcare. Discussion and action will be critical for the physical therapy profession moving into the future.

Diferenças regionais e custos dos procedimentos de fisioterapia no Sistema Único de Saúde do Brasil, 1995 a 2008 / Regional differences and costs of physical therapy procedures in Brazil's Unified Health System, 1995 to 2008

OBJETIVO: Descrever os atendimentos ambulatoriais fisioterßpicos prestados pelo Sistema Único de Saúde (SUS) no Brasil quanto a sua distribuição geogrßfica, custos, tipos de procedimento e tipos de prestador. MÉTODOS: Foram utilizados dados do Departamento de Informßtica do SUS (DATASUS), referentes ao período de 1995 a 2008, que incluíam a quantidade e o valor dos procedimentos aprovados para pagamento pelas Secretarias de Saúde e a quantidade e o valor dos procedimentos apresentados para pagamento. Os coeficientes de atendimento (CoA) foram calculados dividindo-se o número de atendimentos no ano em uma região pela população estimada no mesmo ano e região. RESULTADOS: O CoA no Brasil em 2008 foi de 0,19 e as regiões Norte e Centro-Oeste apresentaram os menores coeficientes (0,13 e 0,10, respectivamente). Entre 1995 e 2007 houve um crescimento no coeficiente nacional de atendimentos de 33,7 por cento, sendo que a região Norte apresentou o maior aumento, de 143,8 por cento, a Centro-Oeste, de 62,1 por cento, e a Nordeste, de 56,1 por cento. O atendimento nas alterações motoras foi o procedimento mais realizado (61,8 por cento) e os valores de pagamento aprovados foram menores que os apresentados pelos gestores dos serviços em 2008 (10,4 por cento). Estabelecimentos privados com fins lucrativos prestaram 44,5 por cento dos atendimentos fisioterßpicos pagos pelo SUS em 2008. Os estabelecimentos municipais responderam por 26,6 por cento dos atendimentos e os federais por apenas 0,9 por cento. Entre 1995 e 2007, a quantidade de atendimentos oferecidos pelos estabelecimentos municipais cresceu 278,7 por cento. CONCLUSÕES: Observou-se que a oferta de atendimento fisioterßpico ambulatorial pelo SUS ainda é pequena e geograficamente desigual, embora regiões menos desenvolvidas apresentem um maior crescimento no CoA. O SUS remunera inadequadamente os serviços prestados em fisioterapia e ainda o faz, em grande parte, por meio de convênios...

OBJECTIVE: Describe the ambulatory physical therapy treatments provided by the Unified Health System (SUS) in Brazil with regard to their geographical distribution, costs, types of procedure, and types of provider. METHODS: Data from the SUS Information Technology Department (DATASUS) were utilized, drawing from the period from 1995 to 2008, which included the quantity and the value of the procedures approved for payment by the Secretariats of Health and the quantity and value of the procedures presented for payment. The treatment coefficients (CoA) were calculated by dividing the number of treatments in a particular year and region by the estimated population of that region in that year. RESULTS: The CoA in Brazil in 2008 was 0.19 and the North and Center-West regions presented the lowest coefficients (0.13 and 0.10, respectively). Between 1995 and 2007 there was an increase in the national treatment coefficient of 33.7 percent, with the North region showing the largest increase, 143.8 percent; the Center-West 62.1 percent, and the Northeast 56.1 percent. Treatment for motor disorders was the most widely performed procedure (61.8 percent), and the values of payments approved were lower than those presented by the managers of the services in 2008 (10.4 percent). Private for-profit establishments provided 44.5 percent of the physical therapy treatments paid for by the SUS in 2008. Municipal establishments accounted for 26.6 percent of the treatments, and federal establishments for only 0.9 percent. Between 1995 and 2007, the quantity of treatments offered by municipal establishments increased 278.7 percent. CONCLUSIONS: It was observed that the provision of ambulatory physical therapy treatment by the SUS remains small and geographically unequal, although lessdeveloped regions showed a larger increase in the CoA. The SUS remunerates inadequately the physical therapy services provided and continues to do so, in large part, by means of agreements...

Advances in upper limb stroke rehabilitation: a technology push.

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

[Regional differences and costs of physical therapy procedures in Brazil's Unified Health System, 1995 to 2008]. / Diferenças regionais e custos dos procedimentos de fisioterapia no Sistema Único de Saúde do Brasil, 1995 a 2008.

OBJECTIVE: Describe the ambulatory physical therapy treatments provided by the Unified Health System (SUS) in Brazil with regard to their geographical distribution, costs, types of procedure, and types of provider. METHODS: Data from the SUS Information Technology Department (DATASUS) were utilized, drawing from the period from 1995 to 2008, which included the quantity and the value of the procedures approved for payment by the Secretariats of Health and the quantity and value of the procedures presented for payment. The treatment coefficients (CoA) were calculated by dividing the number of treatments in a particular year and region by the estimated population of that region in that year. RESULTS: The CoA in Brazil in 2008 was 0.19 and the North and Center-West regions presented the lowest coefficients (0.13 and 0.10, respectively). Between 1995 and 2007 there was an increase in the national treatment coefficient of 33.7%, with the North region showing the largest increase, 143.8%; the Center-West 62.1%, and the Northeast 56.1%. Treatment for motor disorders was the most widely performed procedure (61.8%), and the values of payments approved were lower than those presented by the managers of the services in 2008 (10.4%). Private for-profit establishments provided 44.5% of the physical therapy treatments paid for by the SUS in 2008. Municipal establishments accounted for 26.6% of the treatments, and federal establishments for only 0.9%. Between 1995 and 2007, the quantity of treatments offered by municipal establishments increased 278.7%. CONCLUSIONS: It was observed that the provision of ambulatory physical therapy treatment by the SUS remains small and geographically unequal, although less developed regions showed a larger increase in the CoA. The SUS remunerates inadequately the physical therapy services provided and continues to do so, in large part, by means of agreements with private establishments.