Alright, time to “toot” the physical therapy horn. I am obviously biased towards the benefits of PT as it is my chosen life’s work up until this point. At Rebound we get to see firsthand the benefits of PT on a daily basis. Patients regularly make significant positive changes in pain and performance and we often get to see how our practice makes an impact in people’s lives. Many people enter our clinic for the first time with a feeling of hopelessness, thinking they might always be in pain. When they complete the physical therapy intervention they are a changed person: full of hope and free of pain. Having the incredible opportunity to positively change people’s lives is a big reason many of us choose the profession, and one reason the profession consistently gets ranked as the best careers in the US (CNN link: http://money.cnn.com/pf/best-jobs/2012/snapshots/8.html).
Physical therapists are fortunate to see the benefits of physical therapy on a daily basis. We understand the anatomy and physiology, are experts in body movement, know why injuries occur and how to prevent them. Physical therapists spend many years in school and many have extensive post graduate training and education. Most physical therapy programs are Doctoral degrees due to the advanced training and education required for the profession. So therapists know the benefit of PT, but does the general public? The profession of physical therapy makes an ongoing effort to educate the population on the benefits of a physical therapy intervention.
In an effort to reduce costs and maximize effectiveness of medical interventions, recent health care research has been comparing various treatments for certain diagnoses. Recently, a randomly controlled trial compared the effectiveness of manual physical therapy to steroid injection for shoulder impingement after one year. The study found that manual physical therapy was as effective as cortisone injections but less costly than receiving an injection. The individuals who received an injection had significantly more consultations with their physician than those in the manual physical therapy group and many ended up referred to physical therapy after their injection (read the article here).
Another study by the New England Journal of Medicine (read here!) found that physical therapy intervention is just as effective as surgery in patients with a torn meniscus and arthritis of the knee. The study found that there was no significant differences in functional improvement after 6 and 12 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone. A recent systematic review and meta-analysis found that surgery for degenerative tears of the meniscus showed no benefit over non-surgical and sham treatments. The authors recommended non-operative treatment should be the first-line treatment for these patients. The British Medical Journal found that patients who received surgery for sciatica symptoms found quicker relief of symptoms, however, there was no difference between those who received conservative care versus surgery after one and two years (read this one here).
Above are a few studies I have come across after the past few weeks. They represents knee, shoulder, and back pathologies. With the changing health care climate, studies to come are sure to compare the effectiveness of various treatments and a cost-benefit analysis. The state of Colorado recently released a tool for consumers (patients) to shop around at hospitals to compare prices for various procedures (access the tool by clicking here: http://www.denverpost.com/news/ci_26251340/colorado-consumers-get-new-tool-compare-hospital-prices). Total knee replacement costs within the state can vary from $25,000 to $50,000. Non-cesarean births without complications can vary from $5,500 to $11,000. Many health care insurance experts believe this is the future of health care. Instead of accepting what your doctor tells you to do and where to do it, you will find yourself online shopping and researching for your procedure. The power of health care choices for treatment are likely moving away from the over-worked family physician and into the hands of the patient.
Additionally, imaging procedures will come under scrutiny as we continue to evaluate the cost vs. benefit of different procedures. Imaging technology has come a long way in the last few years. More and more people have MRIs of their backs, knees, shoulders, and hips. With improving technology, x-rays and MRIs are often the first line of treatment patients receive. However, they can be misleading and very costly. My friend and fellow physical therapist, Emily Soiney wrote a great blog about this very topic recently.
In the blog, Emily notes that:
- Degenerative changes in the lower back are present in 10% of the population at age 20, 50% at age 40, and 90% at age 60. The majority of people who possesses these changes do not have symptoms.
- In autopsy studies, 100% of the population over age 50 has detectable disc and joint pathology.
- Some degree of disc herniation/protrusion can be found in 50% of the population who have never experienced back pain.
She concludes that you are not your MRI report! Health care professionals need to treat the individual, not their MRI report. We are all aging on the outside: grey hair, wrinkles, skin changes, etc. We are also aging on the inside. An MRI gives us a glimpse of our internal aging. MRIs are great to rule in or out major pathologies. However, the cost vs. benefit of an imaging procedure will continue to be further analyzed to determine the most optimal treatment approach.
Recently, my sister took her young son to the doctor because he was having some gastrointestinal (GI) issues. Her physician suggested a stool sample to rule out giardia and any other infection. My sister, thinking the test would be $30-$40 for a routine stool sample went along with it. The test came back negative and they realized my nephew needed to switch formula while my sister was sent home with a bill over $1,000 for the test! The physician was doing her job and taking concern for the baby to rule out worst possible scenarios and my sister is grateful for that. However, the experience taught her to ask her doctor about different options and costs for treatments to avoid spending a month’s mortgage payment on another routine test.
With the power of future health care choices in the consumer’s hands, future studies linking effectiveness and cost-benefit for various interventions will continue to be investigated. More research and expert opinion will likely show the importance of preventative medicine/treatment over reactive treatment. Many experts agree that preventing disease and injury is the most cost-effective, common sense way to improve health in the United States. With health care choices shifting to the individual, the value of preventative and conservative techniques will likely be seen. An ‘amazon.com’ version of health care shopping is likely in our future; we will be forced to participate and thus be empowered with our health care decisions. With that said, leave the diagnosing to the experts (your doctor) and do not let Dr. Google determine what that funny growth is on your toenail. Once you get that diagnosis, ask about treatment options and consult with your insurance to determine the most effective treatment approach for YOUR body.
For physical therapists, this means we need to educate the general public on the benefits of physical therapy so that they know it is an effective and financially responsible treatment approach for many injuries and pains. The American Physical Therapy Association (http://www.moveforwardpt.com/) has a wealth of information for medical professionals and patients about the benefits and cost-effectiveness of a physical therapy intervention. The government and insurance companies will likely push for more research in the future on the cost vs. benefit for various treatment approaches for certain diagnosis. My prediction is that conservative treatment with a focus on preventative approaches will be emphasized in the future. This change in approach to healthcare will be driven by the patient due to the changing healthcare environment. The general public, not just physical therapists, will soon understand the importance and effectiveness of physical therapy.
So if you are experiencing a non-life threatening ache or pain, ask your doctor about seeing a physical therapist. If you have seen a physical therapist in the past, feel free to contact them to see if they think they can help with your current ailment. Many of our former patients email or call us to see if their current injury is appropriate for physical therapy. At Rebound, we are fortunate to see around 50% of our patients through direct access. That is, 50% come directly to physical therapy to address their injury without a referral from a physician. Most of them have realized the benefit of going directly to physical therapy rather than spending extra time and money on other procedures that would have likely resulted in them going to physical therapy anyway. So contact your doctor or physical therapist next time you are struck with an ache or injury to see if physical therapy is the way to go.
Alright, I will stop tooting the physical therapy horn for now. Come aboard!
This post was written by Craig Depperschmidt, DPT, PRC