Ptpm014 Physiotherapy

PHYSICAL THERAPY PRINCIPALS & METHODS

PTP&M:014 Revision: 01 Page: 1 of 23

PHYSIOTHERAPY

NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject to recall by Mullsons Health & Wellness at any time.

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PHYSIOTHERAPY

SPEC. BY: Abdulrehman S. Mulla DATE: 03/21/2009 REVISION HISTORY REV.

DESCRIPTION

CN No.

BY

DATE

01 Initial Release PT0001 ASM 03/21/2009

Medicine: It's a Noble Profession, It serves Humanity



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TABLE OF CONTENTS PAGE 1.0 PHYSIOTHERAPY IN GENERAL: ............................................................................................................................................................ 4

1.1 SCOPE OF PRACTICE:............................................................................................................................................................ 4 1.2 HISTORY OF PHYSIOTHERAPY:............................................................................................................................................ 5 1.3 ASSESSMENT:......................................................................................................................................................................... 5 1.4 TREATMENT: ........................................................................................................................................................................... 6

1.4.1 MUSCULOSKELETAL PHYSIOTHERAPY: ............................................................................................................. 6 1.4.2 CARDIOPULMONARY PHYSIOTHERAPY:............................................................................................................. 6 1.4.3 NEUROLOGICAL PHYSIOTHERAPY: ..................................................................................................................... 6

1.5 PHYSIOTHERAPY EDUCATION:............................................................................................................................................. 7 1.6 QUALIFICATIONS IN THE UNITED STATES: ......................................................................................................................... 8

2.0 PHYSICAL THERAPY IN THE US: ........................................................................................................................................................... 9 2.1 SUMMARY: ............................................................................................................................................................................... 9 2.2 BACKGROUND:........................................................................................................................................................................ 9 2.3 THEORY: .................................................................................................................................................................................. 9 2.4 PHYSICAL THERAPY TREATMENTS: .................................................................................................................................. 10

2.4.1 (A) CATEGORY TREATMENTS:............................................................................................................................ 10 1.0 INCONTINENCE:............................................................................................................................................ 10

2.4.5 (B) CATEORY TREATMENTS:............................................................................................................................... 10 1. KNEE OSTEOARTHRITIS:............................................................................................................................. 10 2. PAIN:............................................................................................................................................................... 10 3. WHIPLASH: .................................................................................................................................................... 11 4. ACHILLES TENDONITIS: ............................................................................................................................... 11

2.4.5 (C) CATEORY TREATMENTS: .............................................................................................................................. 11 1. ACUTE LYMPHOBLASTIC LEUKEMIA: ........................................................................................................ 11 2. ANKYLOSING SPONDYLITIS: ....................................................................................................................... 11 3. ASTHMA: ........................................................................................................................................................ 11 4. BACK PAIN: .................................................................................................................................................... 11 5. BONE DENSITY: ............................................................................................................................................ 12 6. BRAIN INJURY: .............................................................................................................................................. 12 7. BREAST CANCER:......................................................................................................................................... 12 8. BRONCHITIS (CHRONIC):............................................................................................................................. 12 9. CARDIOVASCULAR CONDITIONS; .............................................................................................................. 12 10. CARPAL TUNNEL SYNDROME: ................................................................................................................... 12 11. CEREBRAL PALSY: ....................................................................................................................................... 12 12. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): ..................................................................... 13 13. CHRONIC PROSTATITIS:.............................................................................................................................. 13 14. CHRONIC VENOUS INSUFFICIENCY (CVI): ................................................................................................ 13 15. CIRCULATORY DISORDERS:....................................................................................................................... 13 16. COMPLEX REGIONAL PAIN SYNDROME:................................................................................................... 13 17. CONGESTION: ............................................................................................................................................... 13 18. CYSTIC FIBROSIS: ........................................................................................................................................ 13 19. DIABETIC NEUROPATHY: ............................................................................................................................ 14 20. DOWN'S SYNDROME:................................................................................................................................... 14 21. FALL PREVENTION: ...................................................................................................................................... 14 22. FATIGUE:........................................................................................................................................................ 14 23. FIBROMYALGIA: ............................................................................................................................................ 14 24. FRACTURES: ................................................................................................................................................. 14 25. FROZEN SHOULDER: ................................................................................................................................... 14 26. GUILLAIN-BARRE SYNDROME: ................................................................................................................... 15 27. HEADACHE: ................................................................................................................................................... 15 28. HEART FAILURE:........................................................................................................................................... 15 29. HIP FRACTURES: .......................................................................................................................................... 15 30. HIP PAIN:........................................................................................................................................................ 15 31. HYPERTENSION (HIGH BLOOD PRESSURE):............................................................................................ 15 32. JOINT PROBLEMS:........................................................................................................................................ 15 33. JOINT PROBLEMS (ROTATOR CUFF, SIJD): .............................................................................................. 15 35. KASHIN-BECK OSTEOARTHROPATHY:...................................................................................................... 16




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35. KNEE PAIN (REHABILITATION): ................................................................................................................... 16 36. KNEE REPLACEMENT SURGERY: .............................................................................................................. 16 37. LUNG FUNCTION:.......................................................................................................................................... 16 38. LYMPHEDEMA:.............................................................................................................................................. 16 39. MULTIPLE SCLEROSIS (MS): ....................................................................................................................... 16 40. MUSCLE ATROPHY:...................................................................................................................................... 16 42. MUSCLE SPASTICITY: .................................................................................................................................. 16 42. MUSCLE TENSION: ....................................................................................................................................... 17 43. MUSCULOSKELETAL CONDITIONS: ........................................................................................................... 17 44. MYOFASCIAL PAIN (TMJ): ............................................................................................................................ 17 45. NECK AND SHOULDER PAIN: ...................................................................................................................... 17 46. NERVE DISORDERS: .................................................................................................................................... 17 47. NEUROLOGICAL DISORDERS: .................................................................................................................... 17 48. ORTHOSTATIC HYPOTENSION: .................................................................................................................. 17 49. OSTEOARTHRITIS:........................................................................................................................................ 17 50. PARKINSON'S DISEASE: .............................................................................................................................. 18 51. PERIPHERAL ARTERY DISEASE: ................................................................................................................ 18 52. PLANTAR FASCIITIS: .................................................................................................................................... 18 53. PNEUMONIA: ................................................................................................................................................. 18 54. PREGNANCY PROBLEMS (PELVIC GIRDLE PAIN): ................................................................................... 18 55. PULMONARY CONDITIONS:......................................................................................................................... 18 56. QUALITY OF LIFE: ......................................................................................................................................... 18 57. REHABILITATION (CARDIAC): ...................................................................................................................... 19 58. REHABILITATION (GERIATRIC): .................................................................................................................. 19 59. REHABILITATION (VESTIBULAR):................................................................................................................ 19 60. RHEUMATOID ARTHRITIS: ........................................................................................................................... 19 61. SCIATICA:....................................................................................................................................................... 19 62. SKIN ULCERS: ............................................................................................................................................... 19 63. SPINE PROBLEMS: ....................................................................................................................................... 19 64. SPRAINS AND STRAINS: .............................................................................................................................. 19 65. STRENGTH ENHANCER: .............................................................................................................................. 20 66. STROKE: ........................................................................................................................................................ 20 67. SURGICAL RECOVERY: ............................................................................................................................... 20 68. TENDONOPATHIES:...................................................................................................................................... 20 69. TENNIS ELBOW:............................................................................................................................................ 20 70. THYROIDITIS: ................................................................................................................................................ 20 71. TINNITUS:....................................................................................................................................................... 21 72. VERTIGO: ....................................................................................................................................................... 21 73. WOUND CARE: .............................................................................................................................................. 21 74. LOW BIRTH WEIGHT:.................................................................................................................................... 21

2.5 TRADITION: ............................................................................................................................................................................ 21 2.6 SAFETY: ................................................................................................................................................................................. 21 2.7 WHAT IS THE ROLE OF HANDS ON PHYSIO IN PALLIATIVE CARE?............................................................................... 23




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1.0 PHYSIOTHERAPY IN GENERAL:

Physical therapy (also known as physiotherapy) is a health profession concerned with the assessment, diagnosis, and treatment of disease and disability through physical means. It is based upon principles of medical science, and is generally held to be within the sphere of conventional (rather than alternative) medicine. Physiotherapy is practiced by physiotherapists (also known as physical therapists, e.g. in the United States), though aspects may also be practiced under supervised delegation by physiotherapy assistants or other health professionals. 1.1 SCOPE OF PRACTICE:

Physiotherapists' scope of practice varies considerably across the world, both in terms of the degree of professional autonomy enjoyed and the range of conditions managed. Physiotherapists in some jurisdictions, such as the Australian states, enjoy professional autonomy, with the ability to act as primary care providers and to determine — and be responsible for — a patient's management plan. Physiotherapists in some other jurisdictions work primary upon referral from other professionals (typically medical practitioners). The major conditions managed by physiotherapists can be broadly grouped into three categories:

Musculoskeletal, Cardiopulmonary Neurological.

Many areas of physiotherapy, e.g. rehabilitation or pediatrics, cross all three areas. Depending on the local healthcare system, physiotherapists may be involved in all areas, or may only manage certain aspects (e.g. in some United States jurisdictions, respiratory therapists manage many aspects of cardiopulmonary therapy). Depending on the structure of the local healthcare system, physiotherapists may function either privately (e.g. in a private clinic) or publicly (e.g. in a hospital or community setting). Furthermore, physiotherapists may work as generalists managing a wide range of conditions, or may specialize in certain fields. The process of determining career structure and specializations varies geographically.




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1.2 HISTORY OF PHYSIOTHERAPY:

Physiotherapy has its origins in late Victorian England. In 1894 the British Medical Journal raised concerns about the practices of some masseuses and masseurs who were offering massage as a euphemism for sex. The BMJ called for an institution to be formed to regulate massage practice. Well-meaning nurses and midwives who were keen to see their massage practices authenticated formed the Society of Trained Masseuses.

Quickly, the English example was followed by most of the colonial countries, which adopted practices and regulatory systems suitable for their local conditions. In America, Australia, Canada and New Zealand 'authentic' massage became synonymous with a discrete body of treatment modalities including electrotherapy (and later actinotherapy - the application of heat and light for healing purposes), remedial gymnastic exercise and, of course, massage and manipulation.

A concern to provide an authentic alternative to the massage parlors, and a desire to court medical approval, saw early physiotherapy pioneers adopt a biomechanical view of the body in health and illness - something that dominates the physiotherapy 'philosophy' even to this day.

Massage became a vital service in both world wars and much was learnt about the rehabilitation of injured servicemen from these unfortunate events. Physiotherapy grew rapidly after the First World War with spinal injury units, orthopedic hospitals and chest clinics providing new challenges to the profession.

In most post-colonial countries, physiotherapy has become the largest allied health profession, and third only behind medicine and nursing in the number of graduating health care students.

1.3 ASSESSMENT:

A physiotherapist will initially conduct a subjective examination (interview) of a patient's medical history, and then go on to the objective assessment (physical examination). The subjective examination is guided by the presenting system and complaint, and the objective assessment is in turn guided by the history. This semi-structured process is used to rule out serious pathology (so called red flags), establish functional limitations, refine the diagnosis, guide therapy, and establish a baseline for monitoring progress. As such, the objective exam will then use certain quantifiable measurements to both guide diagnosis and for progress monitoring. These depend upon the system (and area) being managed, e.g. a musculoskeletal exam may involve, inter alias, assessment of joint range of motion, muscle power, motor control and posture, whilst a cardiopulmonary assessment may involve lung auscultation and exercise physiology testing.




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1.4 TREATMENT: Guided by the assessment findings, the physiotherapist will then develop and facilitate a treatment plan. Aside from the various physiotherapeutic techniques involved in therapy, the treatment regimen may include prescribing and advice regarding assistive walking devices; should consider functional progress; and include ongoing review and refinement. Patient education is a key aspect of all treatment plans. It is difficult to explore the many aspects of physiotherapeutic treatment options, especially considering their ongoing development in the face of an increasing research base. Nonetheless, some examples of treatment options are listed below.

1.4.1 MUSCULOSKELETAL PHYSIOTHERAPY: Various therapeutic physiotherapy modalities are available, including exercise prescription (strength, motor control, stretching and endurance), manual techniques, soft tissue massage, and various forms of so-called "electro physical agents" (such as cryotherapy, heat therapy and electrotherapy). In recent years, a growing number of physical therapists have employed the Alexander Technique, a movement re-education method. Despite ongoing research giving a clearer picture regarding the use of various modalities in specific conditions, the benefits of electrotherapy are widely debated. The use of modalities but rather the integration of examination, history, and analysis of movement dysfunction should not define the practice of physical therapy.

1.4.2 CARDIOPULMONARY PHYSIOTHERAPY: Cardiopulmonary physiotherapists work with patients in a variety of settings. They treat acute problems like asthma, acute chest infections and trauma; they are involved in the preparation and recovery of patients from major surgery; they also treat a wide range of chronic cardiac and respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD), cystic fibrosis (CF) and post-myocardial infarction (MI). They work with all ages from premature babies to older adults at the end of their life. Physiotherapists are pioneering new management techniques for non-organic respiratory problems like hyperventilation and other stress-related disorders as well as leading the development of cardio-pulmonary rehabilitation and non-invasive ventilation. Cardiopulmonary physiotherapists use physical modalities to treat people. This may involve using manual techniques to clear infected mucus from a person's chest, or using non-invasive ventilation to help a person breathe, or prescribing exercises to improve a patient's functional exercise capacity.

1.4.3 NEUROLOGICAL PHYSIOTHERAPY: Treatment in neurological conditions is typically based upon exercises to restore motor function through attempting to overcome motor deficits and improve motor patterns. To achieve this aim various theoretical frameworks have been promoted, each based upon inferences drawn from basic and clinical science research. Whilst some of these have remained static, others are designed to take into account new developments, perhaps the most notable example being the "movement science" framework. The various philosophies often generate considerable debate.




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1.5 PHYSIOTHERAPY EDUCATION: As with many aspects of the profession, essential physiotherapy training varies considerably across the world. As a general rule, physiotherapy studies involve a minimum of four years tertiary education. Some examples are described here. In India the Bachelor of Physiotherapy Course is of 4 ½ years

Physiotherapist are employed in all general hospitals and also in specialty and super specialty hospitals run by the government and non-government organizations, with a role also in critical care, early intervention programs with the national health delivery system, emphasizing community based rehabilitation. Physiotherapists are also working at district levels and community health centers and will be engaged in primary health Centers in near future.

Today majority of Physiotherapists are engaged in Private Practice in polyclinics or their own clinics and carry out referral as well as first contact practice.

Foreign employment and professional up-gradation program are accessible to qualified physiotherapists.

In Australia, an undergraduate physiotherapy degree is typically undertaken over a four-year period, with the early components being predominantly theoretical and with an increasingly clinical focus throughout the latter stages. Postgraduate entry into physiotherapy in possible in some institutions, typically involving two years of study following the completion of a related (e.g. exercise physiology or science) Bachelor degree.

In New Zealand, there are currently two schools of physiotherapy offering four-year undergraduate programs. Many New Zealand physiotherapists work in the private health care system as musculoskeletal physiotherapists and the curriculum reflects the need to prepare graduates for autonomous practice. Students follow an educational program similar to Australia with an emphasis on biomechanics, kinesiology and exercise. Postgraduate study typically involves two years of subject specific learning.

In the UK University degrees tend to be three rather than four years in length, as historically British students specialize earlier in their education than in most developed countries. 35 universities and tertiary level institutions train physiotherapists in UK. In the UK the vast majority of physiotherapists work within the National Health Service, the state healthcare system.

In the United States an undergraduate student typically undertakes a science-related course (such as biology or physics) prior to gaining entry into a graduate program specializing in physical therapy in which they undertake their physical therapy training.

In South Africa the degree (B.PhysT) consists of four years of general practice training, involving all aspects of Physiotherapy. Typically, the first year is made up of theoretical introduction. Gradually, time spent in supervisioned practice increases until the fourth year, in which the student generally spends about 80% in practice. In the fourth year, students are also expected to complete a Physiotherapy research project, which fulfills the requirements of an Honors degree. Professional practice and specialization can only be entered into after the student completes a state governed, compulsory year of community service after graduation.

Following basic physiotherapy training, experienced practitioners may undertake further study towards certification as a specialist practitioner. For example, in the United States, experienced physical therapists may apply to take a specialty exam to earn board certification in any of seven sub-specialty areas: Cardiovascular and Pulmonary, Clinical Electro physiologic, Geriatric, Neurologic, Orthopedic, Pediatric, and Sports physical therapy.




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1.6 QUALIFICATIONS IN THE UNITED STATES: All States (in the United States) require physical therapists to pass a licensure exam after

graduating from an accredited physical therapist educational program before they can practice. According to the American Physical Therapy Association, there were 189 accredited physical

therapist programs in 1999. Of the accredited programs, 24 offered bachelor's degrees, 157 offered master's degrees, and 8 offered doctoral degrees. By 2002, all physical therapist programs seeking accreditation will be required to offer degrees at the master's degree level and above, in accordance with the Commission on Accreditation in Physical Therapy Education.

Physical therapist programs start with basic science courses such as biology, chemistry, and physics, and then introduce specialized courses such as kinesiology, biomechanics, neuroanatomy, human growth and development, manifestations of disease, examination techniques, and therapeutic procedures. Besides classroom and laboratory instruction, students receive supervised clinical experience. Individuals who have a four-year degree in another field and want to be a physical therapist should enroll in a master's or a doctoral level physical therapist educational program.

Competition for entrance into physical therapist educational programs is very intense, so interested students should attain superior grades in high school and college, especially in science courses. Courses useful when applying to physical therapist educational programs include anatomy, biology, chemistry, social science, mathematics, and physics. Before granting admission, many professional education programs require experience as a volunteer in a physical therapy department of a hospital or clinic.

Physical therapists should have strong interpersonal skills to successfully educate patients about their physical therapy treatments. They should also be compassionate and possess a desire to help patients. Similar traits are also needed to interact with the patient's family.

Physical therapists are expected to continue professional development by participating in continuing education courses and workshops. A number of States require continuing education to maintain licensure.

According to the Indian Association of Physiotherapy, Physiotherapy means physiotherapeutic system of medicine which includes examination, treatment, advice and instructions to any person preparatory to or for the purpose of or in connection with movement dysfunction, bodily malfunction, physical disorder, disability, healing and pain from trauma and disease, physical and mental conditions using physical agents including exercise, mobilization, manipulation, mechanical and electrotherapy, activity and devices or diagnosis, treatment and prevention However, various other health professionals (e.g., Chiropractic, Osteopathy) use some physical therapeutic methods. A program of physical therapy will typically involve caregivers.

PT's utilize an individual's history and physical examination in diagnosis and treatment, and if necessary, will incorporate the results of laboratory and imaging studies. Electro diagnostic testing (e.g. electro myo grams and nerve conduction velocity testing) may also be of assistance. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, extended care facilities, homes, education or research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.




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2.0 PHYSICAL THERAPY IN THE US: Summary Background Theory Physiotherapy treatments Tradition Safety Role of Hands on Physio in palliative care 2.1 SUMMARY:

According to the American Physical Therapy Association, the goal of physical therapy or physiotherapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Special tools are used, such as hot or cold packs, crutches, braces, treadmills, prosthetics, compression vests, computer-assisted feedback, lasers, and ultrasound. Patients range in age from newborns to the elderly.

2.2 BACKGROUND:

Physical therapy was first documented in China around 3000 BC with the use of joint manipulation and massage to relieve pain. The ancient Greek doctor Hippocrates wrote about massage and hydrotherapy in 460 BC, and splints and exercises were used to treat wounded Roman gladiators. The modern discipline of physical therapy emerged to treat soldiers wounded in World War II.

Physical therapy (PT) is commonly used for musculoskeletal injuries, joint pain or disorders, low back pain, cerebral palsy, and rehabilitation after injury or surgery, including heart surgery or mastectomy. Physical therapy, especially early physical therapy, can be painful, and many patients use medications for pain during therapy.

In the United States, all states require physical therapists to graduate from an accredited physical therapy program and pass a licensing exam before they practice. A physical therapy program includes supervised clinical experience and coursework in biology, chemistry, anatomy, and therapeutic techniques. Physical therapists work in hospitals, clinics, nursing homes, schools, sports facilities, and patients' homes. Patients may be referred to a physical therapist by a doctor or may directly contact a physical therapist.

2.3 THEORY:

Physical therapy is tailored to the patient's condition and health issues. A common goal of physical therapy is to increase how the patient functions at home and at work.

Various types of physical therapy address specific problems. Musculoskeletal physical therapy uses massage and joint movement to increase strength, motor control, and flexibility. Cardiopulmonary physical therapy treats lung and heart conditions, such as cerebral palsy, asthma, and post-heart attack rehabilitation, by clearing the lungs of mucus, ventilating the lungs to ease breathing, or exercising to increase a patient's ability to move. Neurological physical therapy works to restore balance, coordination, and motor function through repeated exercises for patients with spinal injury, Parkinson's disease, Alzheimer's disease, and other brain and nerve disorders. Integumentary physical therapy uses wound cleaning, scar prevention, and scar reduction to help patients with wounds, burns, and other skin-related problems.




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At the first visit, a physical therapist reviews medical records, examines the patient, and talks with the patient. Physical therapists may spend up to 25% of a visit speaking or listening to a patient to identify current and potential problems. Depending on the patient's health, abilities, and goals, the physical therapist outlines a treatment plan, including the anticipated outcomes and a timetable for reaching goals. The physical therapist may also conduct tests to establish a baseline, to see how much the patient improves during therapy. The patient may be instructed on exercises to do at home. The American Physical Therapists Association recommends that a patient feel comfortable asking the physical therapist any questions about expectations and the proposed plan of care. According to some studies, patients may not follow a physical therapist's instructions for at-home exercises or other interventions, such as shoe inserts. Although not following instructions may be due to illness or disease, not following instructions may slow or reduce progress.

2.4 PHYSICAL THERAPY TREATMENTS:

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

2.4.1 (A) CATEGORY TREATMENTS:

1.0 INCONTINENCE: A variety of techniques have been used to improve incontinence (loss of urinary control), such as pelvic-floor neuromuscular electro stimulation combined with exercises, pelvic floor muscle exercises alone (Kegel exercises), vaginal cones, and vaginal balls. Outcome measures studied have included bladder volume, vaginal palpation, and perceptions of improvement. Overall, short-term improvements have been seen with pelvic floor exercises and vaginal balls. Physical therapy appeared more effective than biofeedback techniques based on one trial, but higher-quality trials and comparisons with placebo are needed to confirm these results.

2.4.5 (B) CATEORY TREATMENTS:

1. KNEE OSTEOARTHRITIS: Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Only one available study compared physical therapy to a sham group (sub therapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee. One method of physical therapy, infrared, short-wave diathermy-pulsed patterns and interferential therapy, showed more effectiveness than intra-articular hyaluronan drugs in two studies. More study using consistent treatment protocols and outcomes measures would be helpful.

2. PAIN:

Physical therapy has been used to treat a wide variety of pain syndromes including patellofemoral pain syndrome, wrist pain, post-operative pain, and chronic pain.




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Despite some mixed evidence, there are several trials that compare physical therapy techniques to placebo controls for the treatment of patellofemoral pain syndrome that have found beneficial effects. Also, continuous low-level heat wrap therapy may be helpful in common conditions causing wrist pain and impairment. Long-term studies with more standardized outcomes measures would help make a stronger recommendation.

3. WHIPLASH:

There is emerging evidence that physical therapy may be beneficial for reducing the time to heal following whiplash injury. Studies have found benefit of physical therapy and active exercises over standard of care. According to one study, manipulative treatment may shorten recovery time faster than physiotherapy treatment. Higher-quality trials with control groups would help make a stronger recommendation.

4. ACHILLES TENDONITIS:

Physical therapy (crutches, orthoses, and eccentric exercise training) has been used in the management of pain for Achilles tendinopathy and tendon ruptures. Results are unclear. More study is needed to drawn any firm conclusions.

2.4.5 (C) CATEORY TREATMENTS: 1. ACUTE LYMPHOBLASTIC LEUKEMIA:

Based on limited study, the combined use of physical therapy plus a home exercise program may be beneficial in children with acute lymphoblastic leukemia. Stretching, strengthening, and aerobic exercise may improve ankle dorsiflexion active range of motion and knee extension strength. More study is warranted.

2. ANKYLOSING SPONDYLITIS: Several clinical trials have compared supervised group physical therapy to unsupervised daily exercises at home for the treatment of ankylosing spondylitis. Further well-designed studies are needed before a firm recommendation can be made.

3. ASTHMA:

Chest physical therapy and physiotherapy breathing retraining have been studied in both children and adults to improve quality of life and improve lung function in severe and acute asthma. Early evidence is mixed. Studies often include combination treatment with drug therapy or are not well-designed, which make it difficult to assess the magnitude of benefit, if any, of physical therapy alone. More research is warranted.

4. BACK PAIN: Despite the large amount of research conducted on physical therapy cost-effectiveness and treatments for back pain (including chronic and acute low back pain, pregnancy-related back pain, work-related back pain), there is a lack of conclusive evidence that physical therapy is more effective than other treatments or placebo. Examples of specific techniques used include home- based exercise programs, mobilization and extension techniques, flexion exercise, breathing therapy, Masai barefoot technology, and the McKenzie method. There are questions in the literature as to whether physical therapy regimens should be tailored to fit the individual's back pain, as not all back pain




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is alike. However, despite these claims, the evidence is still unclear for all types of back pain. A firm conclusion cannot be reached until more well- designed trials are conducted.

5. BONE DENSITY: Supervised or home-based physical therapy has been used in combination with resistance and endurance training in physically frail elderly women taking hormone replacement therapy to improve bone density. Long-term high-intensity weight-bearing exercise programs have also been used in rheumatoid arthritis patients with some success. Although early study is promising, more studies are needed in this area.

6. BRAIN INJURY: Patients with chronic traumatic brain injury often have gait (movement) disorders. Physical therapy techniques such as treadmill training and weight-bearing gait training have been used with mixed results. Better-designed studies are needed to make a stronger recommendation.

7. BREAST CANCER: Physical therapy programs are often used following mastectomy (breast cancer surgery), which may include arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema, and education about arm function. One study suggested that immediate postoperative physical therapy may increase shoulder range of motion, but more high quality trials are needed.

8. BRONCHITIS (CHRONIC): Respiratory therapy has been used in the treatment of bronchitis, and the FLUTTER device has been studied for its beneficial effects. Results are unclear and additional research is needed.

9. CARDIOVASCULAR CONDITIONS;

Physical therapy has been studied to improve peak oxygen consumption, work rate, general cardiovascular health, and distance walked during six minutes. In particular, physical therapy has been used to treat coronary syndrome X (syndrome X), which is a chronic pain disorder with exercise-induced chest pain. Early evidence is promising, but additional study is needed to make a firm recommendation.

10. CARPAL TUNNEL SYNDROME:

Carpal bone mobilization and median nerve mobilization have both been studied for the treatment of carpal tunnel syndrome. Based on one study, no significant differences were found between treatments or compared with control groups. More study is needed in this area.

11. CEREBRAL PALSY:

Children with cerebral palsy are frequently referred for physical therapy, yet the effectiveness of treatment has not been well-documented. Numerous physical therapy techniques have been used to treat movement/motor disorders associated with




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cerebral palsy, including hippotherapy (physical therapy utilizing the movement of a horse), sensory-perceptual-motor training, neurodevelopmental physical therapy, and functional physical therapy. Conservative physical therapy regimens have also been used in combination with electrical stimulation, infant stimulation, botulinum toxin A, and selective dorsal rhizotomy. Results are inconclusive.

12. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD):

There may be a beneficial effect of respiratory rehabilitation in terms of improved tolerance to exercise and improved quality of life for COPD patients. Studies have investigated the use of physical therapy with drugs, as well as the difference between manual and mechanical techniques; few studies have compared respiratory physiotherapy to control groups. Examples of manual respiratory physical therapy techniques include postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique. Higher-quality trials are needed to make a firm recommendation.

13. CHRONIC PROSTATITIS:

There is insufficient evidence in this area. Additional studies are needed before a recommendation can be made.

14. CHRONIC VENOUS INSUFFICIENCY (CVI):

There is insufficient evidence in this area. Additional studies are needed before a recommendation can be made.

15. CIRCULATORY DISORDERS:

Various types of supervised and unsupervised physical therapy programs such as compression, cold-temperature stimuli, gymnastics, walking, and sauna have been used to improve circulation in the legs. Early evidence suggests small benefits when physical therapy is used in combination with drugs. More study is needed to make any firm conclusion.

16. COMPLEX REGIONAL PAIN SYNDROME:

Complex regional pain syndrome involves persistent pain, allodynia (light touch causing pain), and vasomotor signs. Early evidence suggests that physical therapy may have a better effect than occupational therapy or no treatment for the reduction of pain in some patients. Physical therapy, especially home-based programs, may also be more cost-effective. Additional research is needed.

17. CONGESTION:

Both manual and mechanical respiratory physiotherapies have been studied in cystic fibrosis and lobectomy patients. Results are mixed and it is unclear whether certain physical therapy shows benefits over standard drug therapy alone or over placebo treatments. More evidence is needed to clarify these findings.

18. CYSTIC FIBROSIS:

Cystic fibrosis is a genetic disorder affecting the mucus lining of the lungs, leading to breathing problems and other difficulties. Chest physical therapy (postural drainage,


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Ptpm014 Physiotherapy