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Physical Therapy for Older Adults With Arthritis: What is Recommended?: Future Perspective
Thursday, 20 May 2010 07:26

From International Journal of Clinical Rheumatology

Maura Daly Iversen

Posted: 05/12/2010; Int J Clin Rheum. 2010;5(1):37-51.  2010 Future Medicine Ltd.

Abstract

With the exponential growth of the aging segment of the population, physical therapy clinics are treating larger proportions of patients with arthritic conditions. Arthritis is a leading cause of functional restrictions and disability due to its associated pain, inflammation, cardiovascular and pulmonary involvement. These symptoms overlaid upon normal age-related declines in the musculoskeletal, neuromuscular, integumentary and cardiopulmonary systems place older adults with arthritis at higher risk of disability and loss of independence. Physical therapy interventions are recognized as an integral component of arthritis management and their benefits have been well documented. This article reviews the common findings of the physical therapy examination and evidence for physical therapy interventions for select arthritic conditions.

Introduction

Arthritis and musculoskeletal disorders are widespread and may result in joint pain, soft tissue contracture, restrictions in joint movement and activities of daily living, deformity, disability[1] and, in some instances, death.[2] Physiologic manifestations of arthritis, such as joint capsule thickening, inflammation, muscle atrophy and reduced cardiopulmonary reserve, are exacerbated with physical inactivity and may be compounded with side effects of pharmacotherapy. Unfortunately, approximately 70% of older adults in the USA report no regular exercise and among older adults with arthritis, the rates of leisure time physical activity are 7% lower than their healthy counterparts.[3]

There are more than 100 rheumatic conditions, of which the most common form is osteoarthritis (OA). Osteoporosis may be present at any age, but is more prevalent in older adults. Polymyalgia rheumatica (PMR) presents with advancing age, while ankylosing spondylitis (AS) often presents early in life. Diseases such as systematic lupus erythematosus (SLE) and rheumatoid arthritis (RA) may present early (patients aged in their 30s and 40s) or have a late onset (age of 55 years and older). The systematic and local manifestations of these conditions are compounded by the normal aging process and influence the physical therapy management of older adults with arthritis.[2]

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How come a simple ankle sprain can kill my passion for running?

It happens all the time: you turn your ankle on an overgrown pot-hole in the park and its really painful, and worse, thats your running schedule gone for a burton for the next three weeks. You do the rehab prescribed by your trainer, keep up your conditioning with tough swim sessions, start some gentle treadmill jogging, get back on the road... But it doesnt feel quite safe even after a month, six weeks, you are still constantly aware of the ankle, cautious, alert to any sign of pain, and its making your running a bit tense and even a bit lop-sided as you strive to avoid other pot-holes that might cause a repeat incident. Your back is a bit achy on the other side. One morning you realise that right now, running is no fun; instead of giving you that great post-run high and deep sense of relaxation, you seem to feel only relief that its over and slightly stressed out as you start your working day.

David Joyce, writing in the new SIB, offers explanation and reassurance for this typical scenario. His theme is reinjury anxiety. Its common, a logical result of injury and it can up-end anyone, from jogger to world-class athlete. Davids argument is that the rehab process is not actually complete when the client recovers full physical function, but only when they have also recovered psychologically and emotionally -- returning the brains heightened state of alert back down to pre-injury levels.

And it matters, not just because the client doesnt enjoy running any more but also because they are now at increased risk of injuring that ankle again the very thing their brain is now so determined to avoid. A vicious circle indeed.

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Ascension Day Message
Thursday, 13 May 2010 10:53

Once again it is time to celebrate the ascension of Jesus Christ, our Saviour .

Jesus' last words were of the greatest importance to Christianity .

"But you will receive power when the Holy Spirit comes upon you, and you will be my witnesses in Jerusalem, Judea and Samaria, and to the ends of the world" (Acts 1:8). 

We receive not only assurance of faith, but also the knowledge that we are children of God, cleansed by the precious blood of Christ. This naturally places upon us the obligation to tell others about Him and to therefore be part of the Great Commission of proclaiming Jesus as Lord and Saviour. 

Enjoy your Ascension Day!


 
Complex Operations for Spinal Stenosis Increasing Despite Complications
Thursday, 13 May 2010 09:59

From Medscape Medical News

Allison Gandey

May 4, 2010 Surgeons are recommending more invasive fusion procedures than ever before, and it is an expensive trend, researchers say, that is risking higher perioperative mortality, major complications, and rehospitalization.

An increasing number of older patients with spinal stenosis are undergoing lumbar surgery. Clinical trials suggest that for some decompressive surgery offers an advantage over nonoperative treatment.

But investigators led by Richard Deyo, MD, from the Oregon Health and Science University in Portland, point out that surgeons are increasingly recommending more invasive fusion procedures.

Reporting in the the Journal of the American Medical Association, they record a nearly 15% increase in invasive operations.

15% increase in invasive operations

The researchers conducted a retrospective analysis of Medicare claims and report it is unclear why more complex operations are increasing.

"It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years," they note. "The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications. Surgeons may believe more aggressive intervention produces better outcomes."

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Obesity Linked to Increased Risk for Fibromyalgia
Thursday, 13 May 2010 09:53

From Medscape Medical News

Laurie Barclay, MD

Information from Industry

May 5, 2010 Obesity is linked to an increased risk for fibromyalgia, according to the results of a longitudinal study reported in the May issue of Arthritis Care & Research. Independent risk factors for subsequent development of fibromyalgia in this study were the level of leisure time physical exercise and body mass index (BMI).

"Women who reported exercising 4 times per week had a 29% lower risk of FM [fibromyalgia] compared with inactive women," said lead author Paul J. Mork, DPhil, from the Norwegian University of Science and Technology in Trondheim, Norway, in a news release. "Similar results were found in the analysis of the summary score combining information on frequency, duration, and intensity of exercise; women with the highest exercise level had a somewhat lower risk than inactive women."

The goal of the study was to determine if there was a relationship between levels of leisure time physical exercise and a future risk for fibromyalgia and if being overweight or obese was an independent risk factor for future development of fibromyalgia. Data were collected from the Nord-Trndelag Health (HUNT) Study 1 (HUNT 1) from 1984 to 1986 and from HUNT 2 in 1995 to 1997.

Of 15,990 women who provided pertinent data for both surveys and who reported no fibromyalgia or physical impairment at HUNT 1, 380 went on to have incident fibromyalgia during the 11 years between HUNT 1 and HUNT 2.

Women who reported the highest exercise level had a relative risk (RR) of 0.77 for the development of fibromyalgia, and there was a weak dose-response association between level of physical exercise and the risk for fibromyalgia (P = .13). Compared with normal-weight women, overweight or obese women had a 60% to 70% higher risk for fibromyalgia. BMI was an independent risk factor for fibromyalgia (P < .001).

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