Nov 4, 2020 3 min read Meta

Issue 18 Blue Crab - Losing Weight Doesn’t Help OA and PT for LGBT is Tougher than for Most

Weight Loss Doesn't Help Knee and Hip OA

The Gist - A systematic review and meta-analysis from JOSPT shows that weight loss may not help hip and knee OA as much as we'd think. Nor spinal pain neither. The researchers grabbed 22 trials with 3600 participants and dug into the data. The results were a bit surprising, at least for me.

They found low evidence that weight loss interventions helped with pain and disability, compared to minimal care in PT. In Knee OA specifically, weight-loss interventions were not more effective than exercise only for pain and disability. Weight loss could help in many areas of life, but it looks like Hip and Knee OA aren't those.

Tell Me More - Excess weight is often blamed for OA, and people who are overweight or obese have 3x increase knee OA incidence, according to the paper. Because of this, weight loss is often recommended for treatment. The researchers did a comprehensive synthesis of all weight loss interventions, hoping to capture all data possible on it. They grabbed a lot. Here are the highlights.

Weight loss vs. minimal intervention for pain: <1 level change on 1 - 10 paint scale
Weight loss vs. minimal intervention for disability: small effect (-3.7pts on WOMAC)
Weight loss vs. minimal intervention for weight: Large effect! So, that's good.
Weight loss vs. Exercise only: No difference on pain or disability. Small difference on weight loss.
Diet and exercise vs. exercise only: Small effect on pain, disability, and weight loss.

Looks like weight loss helps you lose weight. That's about all the study found. It doesn't help with OA or LBP treatment. It could prevent those conditions (the researchers don't comment on this), but won't really help them.

Alright, gimme the paper. Done.

What’s it like to be LGBTIQ+ in PT? Difficult.

The Gist This one comes from the Journal of Physiotherapy that featured a report on a questionnaire about the experiences of LGBTIQ+ patients in PT in Australia. The whole thing deserves a read, but I’ll summarize it for you here because that’s like the whole point of this. 114 people who identify as LGBTIQ+ and had recently attended PT were recruited online and given a survey to answer about their experiences and what PTs could do to make the clinic a more comfortable environment for them.

The major pinch points for them were unsurprising, but could be fairly easy fixes for the compassionate PT. They had difficulty with PT’s assumptions about their sexuality and/or gender identity (e.g. asking a homosexual male “How’s your wife?” Or only having boxes for male and female under gender on intake forms) and with PT’s lack of knowledge about transgender-specific health issues. Others feared discrimination due to what they identified as unfriendly environments, and many also commented on the discomfort associated with disrobing and physical touch (both common things in PT) in an unwelcoming environment.

Tell Me More - I’d love to! You should also read the article though, hearing it in these people’s own words is quite powerful and illuminating. There are multiple suggested ways for PTs to improve, and some would be easy to implement in any clinic environment or personal practice approach. PTs becoming more aware of LGBTIQ+ specific health conditions received the most favorable ratings from the surveyed. The display of images with a range of people of different genders and sexualities was second most favorable, while most also favored the display of a small rainbow flag in the reception area and the option for “non-binary” in the gender section of intake forms. Most surveyed were also in favor of PTs switching to gender-neutral language, especially when discussing significant others of unknown gender, rather than using heteronormative pronouns.

Once again, there are some limitations to this survey. The largest are the applicability to the US, as this was done with Australian patients who wen to Australian PTs, and the recruitment method, via LGBTIQ+ networks that could be pulling in people who are more active in LGBTIQ+ issues than the general LGBTIQ+ population. Still, this provides a window into what some of our patients could be experiencing in the clinic and how we could improve their healthcare outcomes. There’s a dark future ahead if we don’t as LGBTIQ+ outcomes are much worse than the general population’s.

Alright, you convinced me, I’ll read the paper - Good. It’s here, it’s short, and it’s worth your time.