News Category: General

Muscles can be stimulated electrically by putting current to the muscles. Special pads, called electrodes, are placed on the skin over the muscle. When the electrical current is used to get muscles to contract, it’s called neuromuscular electrical stimulation (NMES). NMES is sometimes used to help patients gain strength after some types of knee surgery. It is also used by some elite athletes as part of training programs.

Studies have shown how intense NMES needs to be. But it is unclear how many NMES sessions a week are the most effective. These authors tested 27 healthy people who were doing no physical training. The subjects were divided into three groups. The control group got no NMES treatments. The second group got two NMES sessions each week for four weeks. The third group got three NMES sessions a week. NMES was applied to the quadriceps muscles on the front of the thigh. All NMES sessions lasted 10 minutes.

The subjects were tested for quadriceps strength every week. Strength increased significantly only in the group who got NMES three times a week. This group saw a strength increase of about 13 percent. The authors conclude that three NMES sessions a week may be needed to build strength. They also note that the relationship between intensity and number of sessions is very important. A different combination of intensity and sessions could change the results. The authors call for more research on people with weak thigh muscles.

Osteoporosis is a disease of low bone mineral density (BMD). People with osteoarthritis (OA) tend to have high BMD. That means people with OA don’t usually have osteoporosis–or so doctors have thought.

These authors looked at BMD, vitamin D and calcium levels, and health habits of 68 women. All the women were past menopause. All were getting hip replacement surgery because of severe OA. This means none of the women should have had osteoporosis, right? Wrong. Results showed that 25 percent of the women had both OA of the hip and osteoporosis. Apparently, the old theory is a myth.

The results also showed that 22 percent of all the women (both with and without osteoporosis) had too little vitamin D. The body produces vitamin D when exposed to sunlight. Vitamin D can also be found in some foods, including eggs. Vitamin D deficiencies did not seem to be related to osteoporosis, however.

The main message of this research is that doctors need to be aware that OA doesn’t protect women against osteoporosis. It is possible to for patients to have both conditions at the same time.

There’s a big difference between what should be done for the prevention and treatment of osteoporosis and what’s actually being done. This is the first report of a gap between guidelines and current practice in this area.

National guidelines for osteoporosis treatment and prevention are out. They come from the National Osteoporosis Foundation, the American College of Rheumatology, and the American Association of Clinical Endocrinologists. Many clinics make their own standards based on the national listings.

Doctors at the Oregon Kaiser Permanente Center for Health Research in Portland studied a group of 3,812 women in their health maintenance organization. All women were over 50 years of age. All had a fracture within the last six months. They found that less than half the women with fractures were treated by the clinic guidelines for osteoporosis. The guidelines advise measurement of bone mineral density (BMD) and treatment with drugs. Both steps should be done within six months of the fracture.

About 45 percent received drugs for osteoporosis, but most of them were already taking these before their fracture. Only five percent of the women had a BMD study in the 12 months before or six months after the fracture. Three-fourths of the women who did get the drug took it regularly. Younger women were more likely to follow the treatment on a regular basis.

The authors of this study report no change in the way doctors treated osteoporosis at their health care center from 1998 to 2001. They think something needs to be done about the gap between guidelines and practice for osteoporosis. Closing the gap is important as more and more people live longer. Just giving doctors guidelines probably isn’t enough. Suggestions include:

Researchers at the Human Mobility Research Center in Canada report that sleep apnea is common in people having a hip or knee replacement. They say this isn’t too surprising, since obesity is a risk factor for both sleep apnea and arthritis. Sleep apnea occurs when a person stops breathing during sleep.

Most patients don’t know they have obstructive sleep apnea (OSA). In this study, 254 patients planning to have a joint replacement were asked questions about sleep patterns. The authors found about seven percent of the patients had unknown OSA.

Knowing this is important for the patient’s safety. Serious problems can occur during and after the operation for anyone with OSA. The airway can get blocked, cutting off oxygen. The lungs can fill with fluid, a condition called pulmonary edema.

Doctors at this research center suggest a few screening questions to help identify patients with OSA. Anyone planning to have a joint replacement should be asked:

If you’ve got your health, you’ve got everything. Just ask one of the millions of Americans who suffer from painful arthritis. Arthritis is the most common disease reported among adults over 65. The National Arthritis Foundation (NAF) expects this number to increase as baby boomers age.

Research shows light to moderate physical activity can help reduce the effects of arthritis. The NAF has two group exercise programs for older adults with any kind of arthritis. One is on-land. The other is in the water. The on-land program is called People with Arthritis Can Exercise (PACE). The water-based program is called the Arthritis Foundation Aquatic Program (AFAP).

Both programs are set up around the United States. Each one offers a series of exercises to improve joint motion, mobility, posture, and balance. Improving endurance and function are natural by-products of these exercises. How well do these programs work? Few results have been reported.

This is one of the first studies to look at the effects of these two exercise programs. The researchers looked at the effect on functional fitness and activities of daily living (ADLs). Three groups were formed: on-land, aquatic, and control groups. The on-land and aquatic group met for exercise twice weekly for 45 minutes. The program lasted eight weeks. The control group didn’t engage in any exercise program. They just went about their usual activities.

The researchers measured grip and arm strength, balance, and eye-hand coordination. Both exercise groups gained in strength, flexibility, and function. Researchers also measured endurance of the heart and lungs. There was no change in these areas for either group. Subjects in both groups reported reduced pain. The aquatics group had greater ease in performing ADLs.

Researchers conclude that the NAF exercise programs are effective in helping adult arthritis sufferers. Both the on-land and the aquatic program improve fitness. It’s assumed that these changes come about because of the exercise. The authors suggest the education and social side of the NAF programs may also be part of the good results. Further study is needed to find out which part of the program makes the most difference.

Researchers in the Netherlands are studying what causes bone loss in female endurance athletes. To do this, they monitored bone mineral density of the lumbar spine and femoral neck. The femoral neck is between the shaft of the thighbone and the round ball at its top. All women in the study were in good health and trained at least seven hours each week. Most were long distance runners.

The women were divided into three groups based on their menstrual status. Group one had less than six menstrual cycles in the last 12 months. This group is called amenorrheic. The second group had 10 to 13 menstrual cycles in the last 12 months. None of the women in this group used oral contraceptives. These women are called eumenorrheic. The last group, called estrogen supplemented, were using oral contraceptives.

Women in each group took a pill every day for two years. The pill was either vitamin K or a placebo made of cornstarch. Everyone was asked questions about their training status, age, dietary habits, and use of medications and food supplements.

After two years the bone density decreased in all three groups. Taking vitamin K didn’t seem to help. There was a very high rate of bone loss in the femoral neck. Bone loss in the spine wasn’t significant. The decrease in bone density was most noticeable in the amenorrheic group.

The researchers conducting this study conclude that intense training can have a negative effect on bone density. Vitamin K supplements don’t prevent bone loss. Taking estrogen supplements may help, but it won’t solve the problem.

They also point out that amenorrhea is a big risk factor for bone loss. Most of the amenorrheic athletes in this study started training at a much younger age than the women who were eumenorrheic. This means girls in endurance athletics who start at a young age are at a greater risk for bone loss than girls who start later. And if they have a long athletic career, the risk of higher bone loss is even greater.

What can be done to prevent bone loss in female endurance athletes? These authors say that something more than estrogen therapy must be found. Early, intensive training is not advised. More study is needed to find the best methods of training and treatment for this problem.

Cheerleading has been around for over 100 years. In the last 20 years it has become a sport that can cause severe injuries, and even death. Complex gymnastic moves such as the pyramid, throwing stunts, or basket toss increase the risk of injury. How often do injuries happen? What can be done to prevent them? These are the questions asked by researchers at the Orthopaedic Center in Rockville, Maryland. They teamed up with physical therapists at the University of North Carolina to find some answers.

Some cheerleading injuries are reported to the National Center for Catastrophic Sports Injury Research. In this study ,29 of 39 reported incidents from 1982 to 2002 were reviewed. The researchers found that college cheerleaders are at greatest risk. They are five times more likely to be injured than high school cheerleaders. The injuries include skull fractures, concussions, spinal cord injuries, and, in two cases, death.

The authors contacted each injured cheerleader. Questions were asked about what caused the injury, what stunt was being done, and whether spotters were being used. The researchers were hoping to find ways to prevent future injuries. Most of the injuries took place indoors on a hard gym floor without a landing mat.

Spotters are important in preventing injuries, but having a spotter doesn’t mean trauma won’t occur. In this study, some injuries happened when the spotter wasn’t ready, misjudged the timing, or stumbled before the catch. Sometimes there are unavoidable accidents. One cheerleader was hurt when a basketball player who got shoved out of bounds pushed the cheerleader into a cement wall.

Some ways to prevent accidents are offered in this article. Spotters must always be present for any stunts. Improving spotter’s training is key to injury prevention. Floor mats must be used for all stunts. Stunts must not be done on a wet or hard surface. Cheerleaders must have advanced training before trying these stunts; cheerleaders with the least experience are hurt most often.

To prevent injuries, cheerleaders and coaches should know and follow rules for pyramids, dismounts, and tosses. These rules come from the American Association of Cheerleading Coaches and Advisors, which can accessed online at http://www.aacca.org. A qualified coach is also important. Other key prevention strategies are given in this report of cheerleading injuries.

The authors suspect that many more serious injuries have affected cheerleaders than are currently reported. Reporting isn’t consistent across the country. Studies on this topic are very limited. They conclude that more attention is needed to this area of sports.

What do you do when you sprain your ankle? You put an ice pack on it. Jam your finger? Ice it. Overuse your elbow? Ice.

The cold of an ice pack reduces swelling and pain in the injured area. But ice packs can be inconvenient to use. You have to hold the ice pack on the area for up to 20 minutes. And ice can sometimes make the skin too cold, causing discomfort or even frostbite. And some people just can’t handle the cold of an ice pack.

That’s where this cold gel comes in. The gel uses menthol and ethanol to give a cold effect. These researchers studied using the gel for soft tissue injuries such as sprains. Half of 74 injured patients were given the gel. They rubbed the gel on the injury four times a day for two weeks. The other half of the patients had no treatment other than anti-inflammatory drugs as needed.

The two groups were checked one week, two weeks, and four weeks after the injury. Both groups improved over the four weeks. But the gel group had less pain and better function. The gel group was also happier with their treatment.

So the cold gel looks promising as a convenient treatment for minor injuries. The next step is to test the gel against ice packs.

When it comes to serious problems after an operation, you can’t get more serious than death. Before having an operation, many patients want to know their chances of dying. They don’t always ask the question, but they may wonder and worry about it. The doctor reviews the risks and counsels each patient.

What do we know about the risk of death after joint replacements? According to the Mayo Clinic, the risk of death within 90 days of the operation varies based on the joint that is replaced.

There is a shift happening in the world of orthopedic care. Those in the field call it a shift toward a “patient-centered” approach. This means that what patients need and expect from medical care is becoming more important. Reports have shown that patients who are more involved in their care tend to follow rehab programs better and have better outcomes.

These authors wanted to find out more about which patients are most satisfied with their care. They looked at the records of almost 8,000 patients. The records came from hospitals all over the country. All patients had a knee or hip replaced or a hip or leg fracture. They all had rehab in the hospital.

Not surprisingly, the results showed that patients who had better function were happier with their care. Patients who were older also tended to be more satisfied. Patients who did not speak English or who had to check back into the hospital were generally less happy.

This study raises more questions than it answers. For example, does poor function cause patients to become unhappy with their care? Or does a bad attitude about rehab from the beginning mean that patients don’t follow the rehab programs well?

The authors note that measuring patient satisfaction is tricky. This research is only the first step to understanding what makes patients feel like they are getting good medical care. And that will be the first step in truly making rehab “patient centered.”

Many studies have shown that weight training and other weight-bearing exercises increase bone mass. Studies have suggested that women who are less fit actually get more benefit from such exercise. These authors tested that theory. They measured strength and bone mineral density (BMD) in women who had not yet hit menopause.

In this study, 31 women did one year of training. They exercised three times a week. Each exercise session included jumping exercises. The women also did squats, lunges, and calf raises using weights. Their BMD and strength was measured before and after the year of training.

The findings supported the theory. Women in the lowest range for strength had the biggest percentage improvement. In this group, strength increased two to five times as much as the group of the strongest women. It is important to note that women in the strongest group were still stronger. They had less room for improvement, so the exercise program didn’t show major gains.

This was a very small study. The subjects were similar in age and were all at low risk for osteoporosis. More research is needed to really understand how exercise affects women’s bones as they age. But it seems clear that weight-bearing exercise is very important for strong bones. The authors recommend that exercise programs be targeted to individual women. Women who are already strong might need different types of exercise programs to keep their bones as healthy as possible.

There are lots of unanswered questions in osteoporosis research. What is the best way to measure bone mineral density (BMD)? How exactly does the disease develop? Does it affect all bones the same way? Does weight-bearing exercise only improve BMD in certain bones? What kind of exercise is best to improve BMD? Does training too hard actually make bones weaker?

These authors tackled some of these questions. They studied BMD in 49 white female distance runners. All the women were serious about running. The researchers measured BMD in 10 different places in the women’s legs, arms, hip, ribs, and spine. This is many more measurements than are usually made in osteoporosis studies. Results showed that the runners had much higher BMD in the bones of the leg. This supports the theory that exercise improves BMD in the bones it works. The bones in the upper body had much lower BMD measurements.

The researchers looked at how BMD related to the women’s training programs. Women who ran longer distances had higher BMD. However, women who had been running for many years had lower BMD, especially in the upper body.

The researchers also studied the way BMD related to diet. The amount of calcium taken seemed to have different effects depending on the bone. They saw little benefit of calcium in the hip, which is where BMD is often measured. Calcium did seem to be related to higher BMD in the legs.

Taking all these results together, the authors question if building bone in the legs means that the body can’t build bone as well in other areas. It is an important question, especially for women athletes. The authors note that lifting weights for the upper body might help runners increase BMD in the upper body. More research is needed–and another question has been added to the study of osteoporosis.

Women who break a bone–any bone–are more likely to break a hip when they are older. In fact, certain types of fractures in the wrist or spine mean a woman could be twice as likely to have a hip fracture. The fractures are related to osteoporosis.

Is the same true for men? These authors went through 20 years of research to find some answers. They looked for research on people who had specific types of wrist and spine fractures. The authors ended up looking at data from nine different studies. Taken together, the studies included about 1,400 men and 7,000 women over 50 years of age.

Results showed that a spine fracture made women and men about equally likely to have a hip fracture. However, men who had a wrist fracture were much more likely than women to break their hip later in life. Overall, men suffer far fewer wrist fractures than women. But men who do have wrist fractures probably have especially low bone density or other problems with bone weakness.

This issue is important because men who break a hip tend to have more problems than women do. Men are much more likely to die after a hip fracture. They are also much more likely to become disabled and need long-term medical care. The authors recommend that doctors pay special attention to older men who have wrist fractures. These men could probably use a program to help them avoid breaking a hip in the future.

Do you think someone over 89 years of age is too old for a hip or knee joint replacement? Your answer may depend on which side of 89 you sit! This study from two joint replacement centers reports no greater risk for patients over 89 than for those over 79.

When carefully selected, very old adults can get help from joint replacement. The pain is less, and they are able to get around better. Just these two benefits mean their quality of life is improved. The patient may even live longer than would be possible without the operation.

One difference between an 80-something group and 90-something patients is the use of a walking aid. The over-90 crowd is more likely to end up using a cane or walker after joint replacement surgery. The length of stay in the hospital after the operation is also longer for adults over 89. They are more likely to have some amount of confusion after the operation. Death within the first 30 days after the operation happens in about 3.6 of very old patients. One-third of the patients in this study died within the first two and a half years after the joint replacement.

The authors conclude that joint replacement is an option for some patients over 89 years of age. Patients must be chosen carefully. Risk factors for complications must be minimized and managed for a good result.

Did you know you can donate your own blood beforehand for use during a hip or knee replacement? This is called predonation. Since blood loss is a problem with replacement operations, blood transfusion is often needed. There are some problems with predonations. Scheduling conflicts is a big one. So is a limited shelf life for the blood. And if you’re almost anemic and you give blood, you could end up with a full-blown case of anemia.

There’s a new way to help cut your losses all the way around. It’s called
erythropoietin (EPO). EPO is a hormone produced by the kidney and released into the bloodstream. Its sole function is to increase red blood cells. EPO is already being used to treat kidney patients. It’s been tested and used with some kinds of anemia and during chemotherapy for cancer. Now it’s being tried for joint replacements.

In this study, patients getting a knee or hip replacement were divided into three groups. The first group received EPO and predonated blood. The blood was taken from the patient and given back before the operation. Group two had only EPO before the surgery. Group three predonated blood but didn’t receive any EPO.

The authors found the best results in group one. Getting both EPO and blood before the operation resulted in far fewer blood transfusions during the operation. The EPO actually increased the amount of available predonated blood. Together these two steps reduced the risk of anemia later.

The rate of transfusion increased quite a bit in patients who had both hips or both knees replaced at the same time. All three groups reported similar increases. The same was true for revision surgery (when the first joint replacement has to be done over).

This study shows a novel way to reduce blood transfusions for total hip and total knee joint patients. The patient gets his or her own blood before the operation while also taking EPO.

Infection in a joint after a joint replacement is a major problem. Doctors try to make sure the joint is bacteria-free before putting in an implant. This isn’t always possible. Sometimes the test results are a false negative, meaning the test says there’s no infection when there really is one.

Joint infection is one of two reasons why joint implants fail most often. (The most common reason is loosening of the implant from causes other than infection.) Preventing infection is important. In this study, doctors from the Infectious Diseases section of the Mayo Clinic review joint infections after a joint replacement. They present how often infections occur and what causes them. Some risk factors for implant infection are known. These include delayed wound healing, rheumatoid arthritis, diabetes, and cancer.

Once an infection starts, the bacteria firmly attaches to the implant. It produces small units called polymers. Polymers that mix with the bacteria form a layer of cells called a biofilm. The bacteria survives in this biofilm untouched by the body’s immune system. This makes it difficult to treat the infection. Sometimes the infected implant has to be removed. The joint is treated for the infection. Then a new implant is used to replace the infected one.

It’s also difficult to tell when a patient has a joint infection. The authors of this report review each step in the diagnosis to help doctors. Ways to kill the bacteria are also reviewed. The authors hope the future will bring better, more accurate testing to find bacteria that are causing joint infection. Also, effective treatments to dislodge and kill the bacteria need to be found.

After mom or dad or other family members have a total joint replacement, how do you know if they are ready to go home? Should they stay in the hospital a few more days or go to a transitional unit? These are the decisions made by patients with advice from the health care team. The health care team includes doctors, nurses, social workers, family members, and physical therapists.

Wouldn’t it be better if we had a way to tell if a patient is at risk for a longer stay in the hospital? Then every step could be taken to prevent problems and teach the patient needed skills. This is what a group of physical therapists in Australia have been working on. They developed a scoring method called the Risk Assessment and Prediction Tool (RAPT)
RAPT measures the risk for longer than normal care after hip or knee joint
replacement. The therapists tested it on a group of patients. Then they tested it again on another group to see if it was a valid test measure.

According to this study, RAPT is a good tool to use with patients who are going to have a knee or hip replacement. Instead of two groups of patients (going home or going to rehab), this tool shows a third group. The third group is made up of patients with an uncertain result.

Factors such as older age (over 65), gender (male), and inability to walk far without help put the patient at risk for a longer hospital stay. Having someone at home to help reduces the risk. The authors of this study conclude that discharge planning after a joint replacement shouldn’t be left up to chance or to any one person on the staff. The RAPT tool is an accurate way to measure a patient’s need for extra rehab.

A large study of total knee and total hip replacements is reported by the Veteran’s Administration (the VA). Studies like this have been done in the civilian world many times. This is the first VA study of its kind.

All the patients were veterans treated in VA hospitals. Both men and women were included. Almost 7,000 total hips and 12,000 total knees were followed for 30 days. Both minor and major problems were reported such as infections, blood clots, heart attacks, and death.

Differences between men and women were studied. It seems women were less likely to have a joint replacement done at a VA. When they did, they were more likely than men to have problems. Urinary tract infections and a blood clot to the lungs were more common complications in women.

Increasing age and the presence of other diseases were linked with serious complications during and after the operation. Patients with diabetes, lung disease, previous stroke, and wound infection before the joint replacement had longer hospital stays.

Blacks were more likely to have a longer hospital stay, too. They had more pain and more problems with healing than whites. Hispanics were more likely to have problems with wound healing.

The authors say that the findings in the VA group are similar to patients in civilian hospitals. In fact, complications and readmissions were less in the VA sample compared to private hospitals. They conclude that VA care is as good as the care given in non-VA settings.

Have you ever come to a stretch of water in a stream or a big puddle that you couldn’t jump over? When there’s no way to get across, we start looking for a bridge. Believe it or not, this problem sometimes comes up inside the body. For example, take a large bone fracture. The body tries to fill in the area with new bone cells, but it can’t quite reach all the way across. The gap is too large for healing to occur. In cases like these,
the doctor may have to operate.

A screw can be used to hold the two ends of bone together until they heal. Sometimes bone graft is used along with the screw. Researchers continue to seek for an easier way to bridge the gap. This study reports the progress being made in this area.

Proteins called bone morphogenetic proteins (BMPs) have the genetic code for growth factors (GFs). These GFs help new cartilage and bone cells grow. They also repair damaged cartilage and bone cells. BMPs have been used in animal and human studies. Researchers are exploring the use of BMPs with spinal fusion, large fractures, and nonhealing cartilage tears.

The authors of this report give a brief summary of these studies. Human clinical trials show that BMPs speed up spinal fusion and help heal large size defects in bone. BMPs seem to work better in animals than in humans. Scientists are trying to find out why this is true. Finding ways to get the BMP to the area of need long enough to do the work is the focus of new studies.

What do you think of evidence-based practice (EBP)? Is your first reply, “Huh?” Actually, EBP isn’t typically a hot topic for many people, but it tends to be for health care professionals. EBP is the use of research results to make decisions about patient care.

There’s been a shift from treating patients on the basis of opinion toward using cold, hard data instead. How does a health care worker keep up with the latest research? By reading articles in journals and searching for topics on-line.

Health professionals, including doctors, nurses, and physical therapists (PTs) have had to sit up and take notice when it comes to EBP. Insurance companies, managed care companies, and other third party payers are insisting on EBP before paying for a service.

What do physical therapists think about EBP? That’s the focus of this study done by physical therapists. They sent a survey to 1,000 members of the American Physical Therapy Association (APTA). A similar survey had been sent to medical doctors.

Questions were asked to find out about the therapists, the type of work they do, and their attitudes about EBP. The researchers found that most PTs think it’s a good idea, but they have too little time to look for the research. Many felt they don’t have the ability to tell if a study is a good one or not.

Younger therapists or PTs who have graduated in the last five years tend to be more comfortable with reading and understanding research studies. They also tend to be more likely to agree that EBP is necessary and improves care. Interest is often highest among those professionals who have on-line access to current research.

The authors conclude that as a profession, physical therapists want to improve patient care. They think EBP is a good way to do it. Computer access at home and at work can make a difference. Finding the time to do it may be the bottom line.