Cancer Treatment Today » Physical Therapy in Cancer

M Levin, MD — Mon, 30 Sep 2013 14:31:54 +0000

Efficacy of chiropractic manipulation is supported for low back pain, neck pain and several other well defined conditions. In practice, however, chiropractors tend to offer longer sequences of manipulation than studies support, or they prescribe maintenance treatment. Only in low back pain is there goo evidence that maintenance improved outcomes. ODG does not generally support maintenance treatments. NYS neck guideline, on the other hand, says: ‘
A maintenance program of PT, OT or spinal manipulation (by a physician (MD/DO), chiropractor or physical therapist) may be indicated in certain situations, after the determination of MMI, when tied to maintenance of
functional status.’

S. Malqvist , Health maintenance care in work-related low back pain and its association with disability recurrence. J Occup Environ Med. 2011 Apr;53(4):396-404.

Descarreaux M, Blouin J-S, Drolet M, Papadimitriou S, Teasdale
Efficacy of Preventive Spinal Manipulation for Chronic Low-Back Pain and Related Disabilities: A Preliminary Study J MANIPULATIVE PHYSIOL THER. 2004 OCT; 27(8) pp.

ODG -TWC ODG Treatment Integrated Treatment/Disability Duration Guidelines Neck and Upper Back (Acute & Chronic) Back to ODG – TWC Index (updated 05/14/13)

New York Guidelines Neck Injury Medical Treatment Guidelines Second Edition January 14, 2013 Corrected February 22, 2013 Effective March 1, 2013

The Role of Physical Therapies in Muscular Dystrophies – pro

M Levin, MD — Mon, 20 Aug 2012 18:16:31 +0000

Muscular dystrophy (MD)is a group of genetic diseases that affect muscle function. There are more than 30 genetic mutations that can cause muscular dystrophy. Based on the clinical features, including inheritance pattern, muscles affected, and muscle biopsy features, dystriophis are dvivided into: Duchenne, Becker, Myotonic dystrophy, Facioscapulohumeral, Limb-girdle, Ocullopharyngeal, Congenital and Distal.

Physical therapy, especially regular stretching, is important in helping to maintain the range of motion(ROM) for affected muscles and to prevent or delay contractures. Strengthening less affected muscles to compensate for weakness in the more affected muscles may improve the patient’s ability to engage in activities of daily living(ADL), especially in earlier stages of milder MD. Regular exercise is important in maintaining good overall health, but strenuous exercise should be avoided because it can damage muscles. Age of the patient and degree of dysfunction are not determining criteria of employing physical therapy, as long as an improvement in ROM and ADL can be expected.

Turner, C; Hilton-Jones D. (2010). “The myotonic dystrophies: diagnosis and management”. J Neurol Neurosurg Psychiatry 81: 358–367.

Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, Kaul A, Kinnett K, McDonald C, Pandya S, Poysky J, Shapiro F, Tomezsko J, Constantin C, DMD Care Considerations Working Group. Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol 2010 Feb;9(2):177-89. [157 references]

Read the Layperson version here.

Pneumatic Pumps for Lymphedema – pro

M Levin, MD — Thu, 09 Aug 2012 18:30:15 +0000

Although pneumatic pumps have been used for many years to treat lymphedema, studies have conflicted on their effectiveness. For example, the 2009 McMaster University Evidence-based Practice Centre (building on an earlier study in 1998 by theBlueCrossBlueShieldTechnologyEvaluationCenter) comparing the efficacy of different types of pneumatic extremity pumps found there was ” insufficient evidence to permit conclusions regarding whether the efficacy of lymphedema pumps varied across pump type.” More recent studies suggest that they can be useful in treating lymphedema, chronic venous stasis ulcers/associated venous insufficiency (Cervantes, 2010), (Adams, 2010). Medicare wrote: “Our current policy covers the use of pneumatic compression pumps for patients with refractory edema from chronic venous insufficiency with significant ulceration of the lower extremities that have received standard therapy but have failed to heal after 6 months of continuous treatment. After review of all available published literature, we have found sufficient evidence to show that standard care for the treatment of chronic venous insufficiency, which results in ulceration, can be successfully treated by elevation, exercise and compression therapy.”

Cervantes, C., and Orphey, S. Pneumatic Compression for Venous Stasis Ulcers and the Implications of Lymphedema on Delayed Wound Healing. Today’s Wound Clinic, November 2010. However, this coverage decision is not specific to Pneumatic Pumps and is not binding on other entities and many insurers are not covering this service, insisting on manual massage, or on leasing rather than purchasing a pump.

Adams, K., Rasmussen J., et al. Direct evidence of lymphatic function improvement after advanced pneumatic compression device treatment of lymphedema, 2 August 2010/Vol. 1, No.1/Biomedical Optics Express.

Oremus M, Dayes I, et al. Diagnosis and treatment of secondary lymphedema.McMasterUniversityEvidence-basedPracticeCenterunder contract to the Agency for Healthcare Research and Quality Technology Assessment, Blue Cross of Idaho MP 1.01.18 Pneumatic Compression Pumps for Treatment of Lymphedema, 2009

CMS, Decision Memo for Pneumatic Compression Pumps for Venous Insufficiency (CAG-00075N)

Read the Layperson version here.