🦀 PT Crab Issue 94 - Help Early, Help More

Did I choose that title because it rhymed? Yes, yes I did. And I’m not ashamed.

Sorry we’re late this week, it’s finals here at VCU and another semester has mercifully finished. Unmercifully, it did a number on my brain. I recommend not buying a house while going through finals. I thought the shopping part was hard. The closing part is much more boring and still hard. -2/10 would not recommend. But hey, at least it hasn’t fallen through yet. Am I jinxing it by talking about it before it’s done? Maybe. But I try to practice evidence-based-living and I don’t think jinxes exist. Except for how my wife always looks away right before Liverpool score and she misses it. Every damn time. That’s been proven.

Also, this is my dog, Kiwi.

I just thought you’d like to say hi. She’d certainly love to say hi to you.

With that, let’s dive in!

Help early, help more

The Gist - This retrospective paper lays out the case for more rapidly assessing the effects of your LBP treatments and being open to changing them early if they’re not working. They looked at Intake Function, Discharge Function, Progress Report Function, and more to show that 70% of functional change occurs in the first 45% of PT care in their sample of 11,945 patients. Interesting.

To make these determinations, they compared results on the Low Back FS patient-reported outcome measure, a 25 item outcome measure that’s sort of a combination of the Back Pain Functional Scale and the SF-36. It scores from 0 (low function) to 100. The data came from 122 outpatient clinics and no controls were applied about the treatment types or anything like that, it’s just strict medical chart observation.

So our top-line, 70% of total change in 45% of care is quite interesting, but there’s even more below the surface on this one.

Tell Me More - Unsurprising, but necessary to report is how much more quickly people with acute pain recovered. Patients with prior symptom durations of 0-7 days improved by about 21 points in the first four weeks of care while those with symptoms greater than 6 months improved by about 10 points. People with more acute pain also recovered more, with the 0-7s improving by 28 points on average and the 6 monthers improving by 14 points on average after a full course of care.

Another interesting bit is the loss to followup. All of these patients got to their first progress report, at an average of four weeks into PT, but only about half (6,559) made it to two progress reports which allows us to get more data on these folks than the 5,000-odd dropouts. I could go on, but ya’ll know where to find more details, in the paper. Instead I’ll just pop in a takeaway here:

The results of this study yield further support for the importance of rapid functional improvements during a PT plan of care. This study may help clinicians identify if they need to alter their plan of care secondary to lack of early functional improvements.

Or as I like to say, “Early to measure, early to apprise, keeps patients healing, good feeling, and wise.” Or something.

Enough shitty rhymes, paper? Sure, but you don’t have to be mean about it sniff, I was proud of that.

Did you notice that was just one article? Did you notice it had a bit more content in it? PT Crab is testing out 1 article per week for free subscribers and 3 for King Crab supporters. It’s based on a combination of feedback about the amount of content each week (sometimes a bit much) and the load that PT Crab has represented for me over the last few months. More subscribers coming on all the time is great! But it’s meant more subscriber and tech management that have made things a bit harder. So I’ll be trying 3 and 1 for now with a bit more depth in each article. Let me know what you think of this or anything by tapping the reply button on this email.

And if you do ever want more, remember that I’ve summarized more than 300 articles in the past and they’re at PTCrab.org. The full archive and 3 articles per week editions are available for King Crab supporters at just $5 per month. Sign up here.

Have a great week,

Luke