PT as good as surgery for torn meniscus

[facetguy]

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New study:

http://health.yahoo.net/news/s/ap/surgery-therapy-both-prove-good-for-knee-repair

http://www.nejm.org/doi/full/10.1056/NEJMoa1301408?query=featured_home

 

[DPTErudition]

New study:

http://health.yahoo.net/news/s/ap/surgery-therapy-both-prove-good-for-knee-repair

http://www.nejm.org/doi/full/10.1056/NEJMoa1301408?query=featured_home

Very cool. Thanks for sharing

 

[TarHeelPhil]

Thanks for posting... very interesting.

 

[_FNG_]

I saw this earlier but it got me thinking. I wonder if the 30% of patients assigned to PT that ended up having surgery had a certain type of tear or location? I would think a bucket handle tear would respond less favorably to PT than a degenerative or radial tear. A cost analysis between groups would also be interesting.

Also, would outcomes be different if manual therapy was also added into the treatment regimen for those receiving PT? Sometimes the benefit of both together is not always seen like in the article listed below. I
http://www.oarsijournal.com/article/S1063-4584(13)00003-4/abstract I can't seem to attach the pdf...

 

[NewTestament]

I wonder what the surgeons will say at their conference later this week. How do surgeons usually react? Will they open up to conservative management, or will they try to discredit the study? I wonder if they feel PT's are a threat to their business, or if they know what PT's can do. I'd like to hear what practicing PT's have to say.

Kevin

 

[Fiveoboy11]

I wonder what the surgeons will say at their conference later this week. How do surgeons usually react? Will they open up to conservative management, or will they try to discredit the study? I wonder if they feel PT's are a threat to their business, or if they know what PT's can do. I'd like to hear what practicing PT's have to say.

Kevin

Surgeons think they're above physical therapists and that physical therapists are incapable of practicing physical therapy without their involvement. They think physical therapists "can't diagnose" and can't rule out serious medical pathology, and thus couldn't possibly treat any patient at any point independently. This is despite the fact that PT's actually have more knowledge and capacity to diagnose NMSK conditions amenable to conservative care and that many physicians are flat out incompetent to do the same. Today I saw a patient who went into detail regarding her interactions with her physician who told her to "tell them to work on your back a little." I am unaware of another interaction between two "professionals" who "collaborate" where one relays what sounds like orders via a patient. Here in AZ it clearly states who's in charge of physical therapy, yet physician's are above that apparently. Referral power abuse and bullying goes a long way in healthcare.

This study will just be a way for physician's to say that physical therapy is yet another viable option for them to utilize at their discretion or as their beliefs and feelings dictate. Any mention of the outcome that a physical therapist directed intervention can provide for patients with meniscus tear will be absent. It's not physical therapy directed by a physical therapist, it's physical therapy "as prescribed by a physician" and one based on a gatekeeper referral model. To many physician's physical therapists are physical therapist assistants and physical therapy is physician therapy. They decide when the patient will "get it", not the patient, and not the physical therapist. A mala fide dictatorship in healthcare.

 

[facetguy]

Surgeons think they're above physical therapists and that physical therapists are incapable of practicing physical therapy without their involvement. They think physical therapists "can't diagnose" and can't rule out serious medical pathology, and thus couldn't possibly treat any patient at any point independently. This is despite the fact that PT's actually have more knowledge and capacity to diagnose NMSK conditions amenable to conservative care and that many physicians are flat out incompetent to do the same. Today I saw a patient who went into detail regarding her interactions with her physician who told her to "tell them to work on your back a little." I am unaware of another interaction between two "professionals" who "collaborate" where one relays what sounds like orders via a patient. Here in AZ it clearly states who's in charge of physical therapy, yet physician's are above that apparently. Referral power abuse and bullying goes a long way in healthcare.

This study will just be a way for physician's to say that physical therapy is yet another viable option for them to utilize at their discretion or as their beliefs and feelings dictate. Any mention of the outcome that a physical therapist directed intervention can provide for patients with meniscus tear will be absent. It's not physical therapy directed by a physical therapist, it's physical therapy "as prescribed by a physician" and one based on a gatekeeper referral model. To many physician's physical therapists are physical therapist assistants and physical therapy is physician therapy. They decide when the patient will "get it", not the patient, and not the physical therapist. A mala fide dictatorship in healthcare.

Or perhaps they'll be open to giving conservative treatment more of a shot prior to surgery.

 

[jesspt]

Or perhaps they'll be open to giving conservative treatment more of a shot prior to surgery.

👍

 

[_FNG_]

Also, would outcomes be different if manual therapy was also added into the treatment regimen for those receiving PT?

Apparently my ability to find the index the first time was off so I figured I'd attach it here to see the protocol used in the study.

http://www.nejm.org/doi/suppl/10.1056/NEJMoa1301408/suppl_file/nejmoa1301408_appendix.pdf