🦀 PT Crab Issue 92 - What has changed?

Luke Hollomon -

I spent 40 of the first 42 hours of the week not sleeping as my wife spent three days in the hospital with quite the mysterious bacterial infection. I was suffering from a much milder version of the same. The kicker? The GI doc speculates that it came from contaminated rainwater runoff from an awning onto our food as we ate dinner in DC last weekend. Who would’ve thought? That’s an infection out of a TV show. It turned out to be some awfully aggressive campylobacter, that squiggly little devil.

She’s fine and home now and I’m on the mend too, but things were a bit dicey from Sunday night through Monday. That in mind, I’m not much use putting together a full edition. My brain’s just not back yet. While I could take the walk and give two next week, I do want to continue to provide some value to you, so I decided to provide a couple updates on previous work in the Crab.

Unsurprisingly, these will focus on acute care interventions cuz that’s where my brain is, by focusing on PT in the ED. King Crab supporters got a second one of these updates, focusing on what the PASS can predict. First is the original Crab blurb and what follows is a short history of similar research done since to see how the topic has advanced in the last two years.

Next week we’ll be back to our usual fare. For now, enjoy seeing where the research has gone over the past 18 months.

With that, let’s dive in!

Original 1: Does PT Work in the ED? Probably, Yea.

The Gist - This feasibility study assessed whether integrating a PT into the emergency department and having them treat and prescribe exercises could actually make an impact on the patients they saw. And it did! Yay! 30 ED patients with acute low back pain were evalled by an ED PT, given instructions and home exercises, then discharged home with instructions to report back after a week. When they came back, they demonstrated the exercises to the PT and reported on their at-home compliance. Patients reported performing home exercises 3 times between visits and 20 of the 27 who came back could show off all three exercises they were prescribed. This may be feasible after all.

Tell Me More - The goal of the study was just to see if patients would come back and if they’d do exercises in the meantime, it wasn’t about the physical progress they made. Though ED PT’s are common in the UK and Australia, they’re not yet popular here in the United States. This research group wants to change that, but it comes one step at a time. In this one, they did a 45 minute eval and discharged patients with exercises, with the promise of a $50 gift card if they came back. 27 of the 30 came back (hey, $50!), which isn’t too exciting, but 20 of those 27 could perform all three exercises they were prescribed and more reported actually doing the exercises when presented with an online survey. This is a small, basic study that will need to be fleshed out more in the future, but promising for the future of acute care PT.

Paper? Here ya go.

The update is just below:

UPDATE: PT in the ED is still gold

The Gist - The above was a pilot study and they haven’t finished their full piece yet but other authors have been working hard on this topic. So far, everything’s coming up physical therapy.

This piece in PTJ was a prospective observational study of ED-PT for acute LBP with 101 participants. 43 received ED-initiated PT and 58 got usual care. The median age was about 41 and 60% were women. People who got PT in the ED had greater improvements on their two outcome measures (ODI and PROMIS-PI) at 3 months and had lower use of “high-risk medications.”

Meanwhile, this piece in Academic Emergency Medicine did an RCT in Canada on PT in anyone 18-80 presenting with an MSK disorder in the ED. The intervention group got direct access to a PT prior to a physician in the ED and the control got usual care without a PT. They had 78 patients total with 40 in the PT group. Those who saw PTs first had significantly lower pain at 1 and 3 months, had fewer return visits to the ED, and less prescription medication was used at 1 month, through there were no differences at 3. There were also no differences for imaging and hospitalization rates. So some difference, not nothing, not incredible.

That’s all I’ve got this week. I hope you enjoyed this variation in format. If so, lmk by replying to this emails and I’ll do it for some other conditions and areas of practice. As you know, we’ve got new research all the time and it’d be fun to see what has changed in the last two years. All of these results were similar to or confirmed the previous data but it’s certainly possible that wouldn’t be the case elsewhere. I love negative results so I’d love to find them out there too.

Now it’s time to lay low and recover a bit. Next week we’ll be back with normal coverage.

Cheers,
Luke

Here’s this week’s bibliography:

  • Evaluating the Feasibility of an Emergency Department Physical Therapy Intervention for Acute Low Back Pain. (n.d.). Retrieved April 27, 2022, from https://oce.ovid.com/article/01592394-202007000-00003/HTML
  • Gagnon, R., Perreault, K., Berthelot, S., Matifat, E., Desmeules, F., Achou, B., Laroche, M.-C., Van Neste, C., Tremblay, S., Leblond, J., & Hébert, L. J. (2021). Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Academic Emergency Medicine, 28(8), 848–858. https://doi.org/10.1111/acem.14237
  • Kim, H. S., Ciolino, J. D., Lancki, N., Strickland, K. J., Pinto, D., Stankiewicz, C., Courtney, D. M., Lambert, B. L., & McCarthy, D. M. (2021). A Prospective Observational Study of Emergency Department–Initiated Physical Therapy for Acute Low Back Pain. Physical Therapy, 101(3), pzaa219. https://doi.org/10.1093/ptj/pzaa219