Issue 12 Blue Crab Edition- Why You Should Be Checking BP and KT for Back Pain

Luke Hollomon -

Please Check Your Patient’s BPs. Here’s Why and How.

The Gist - This exhortative article comes from PTJ and begs you to take a BP screening if you’re an outpatient therapist. The authors go through a ton of detail and arguments about why this is important and how to do it accurately and cost-effectively, so here are some notes in brief.

  • BP measurement should be in a routine exam of all patients
  • Only 10 - 15% of PTs measure BP, even in cases of direct access, where they may be the only healthcare provider the patient is seeing
  • BP screening is an effective strategy for early detection of HTN
  • HTN screening is an ethical duty of care due to HTN’s morbidity, disability, and mortality
  • HTN screening is fast and easy to do in outpatient clinics as part of a routine exam

I could go on (and they do and you should read it) but just start screening your patients, okay?

Tell Me More - I already made the major point, so here’s what you need to do it. 1 stethoscope per therapist, 1 standard BP cuff per 2 therapists, 1 small and 1 large cuff per clinic, and 1 thigh cuff just in case. Keep your equipment calibrated by checking it every 6 months (22% of PT’s gauges are inaccurate 😲) and follow a standard protocol when taking BP: seating, rested position for 5 minutes, feet flat on the floor and uncrossed with back supported. None of that legs off the plinth nonsense, it can throw you off by 8mmHg. Tell that patient to shut their mouth too, talking can mess things up by 15mmHg. Wow.

The paper also goes into some great discussion of why PTs should be measuring BP response to exercise. Mainly, PT is the only place that most patients will even have the opportunity to exercise near a healthcare provider (and the only place where many will exercise at all) so it’s a perfect time for screening that’s easier than a real stress test but can still show pathologies. The Crab has previously covered hypotension and why that’s a big problem, but obviously, hypertension is bad too. So take BP people! The paper has more details on when, how, and why. Give it a quick read, it’s worth your time.

Here’s that paper - It’s open access too. Yay!

KT for Non-Specific LBP? Yea, It Seems to Work

The Gist - A group of writers from PTJ got together to dig through the trials on kinesiotaping for chronic nonspecific low back pain and they found something pretty good. They had a small, heterogenous set of trials to work from, but most trials showed a positive, interesting result. They took 11 RCTs with 785 patients and were able to demonstrate that KT lowers pain intensity and improves disability when compared to control, sham taping, and KT with no tension. Multiple methods were used in the studies, but the most common was two strips, placed bilaterally over the erector spine muscles. Compared with the placebos, pain was reduced an average of 0.73 on a 0-10 scale and disability by 0.51 on ODI. Pretty good results for a simple intervention.

Tell Me More - The gold here lies in the subgroup analysis, since the studies are so heterogenous and some are pretty small. For example, the bilateral strips over the erector spinae showed pain reduction of 0.5 over all controls, KT vs. sham tape was a 0.84 difference in pain reduction, and KT vs. no tape was 0.74 different. I could dig deeper into the subgroups, but that’s poor reading for those who don’t want it all, so dive into the paper for more. Because of the risk for bias when pooling everything together, the authors gave KT interventions low-quality evidence for improvement in pain and disability in chronic non-specific low back pain. Good results so far and there may be more data on this in the future. I’ll be sure to report it when there is.

Can I read the whole thing? Yes! If you have access to PTJ. Here’s the PubMed link.