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Dx: OA R knee
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Dx: OA R knee - April 15, 2001 12:59:00 PM
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dawas99
Posts: 17
Joined: April 14, 2001
From: Riyadh,Saudi Arabia
Status: offline
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what is the role of P.T in treat the OA?
is it by Ther.Ex. or hydro. or what ?
because i think there is no improvment in OA case after some sessions.
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Re: Dx: OA R knee - April 15, 2001 4:53:00 PM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
Status: offline
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HI there,
We must remember that whatever we do, we are unable to dramatically alter the OA process. The damage has been done, and all we can do is to prevent and maintain a person's functional capacity.
Therefore, management aims to improve muscle control, strength and endurance, so that the they can take the load off the joints. Hence which ever method one uses (therap ex, hydro, PNF....), as long as you know that you are there to help them maintain and improve their quality of life.... not to cure the OA.
Henry***
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Re: Dx: OA R knee - April 15, 2001 6:09:00 PM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
Status: offline
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So...... we have a person with OA probably in advanced years and Medicare eligible. Improving strength involves repetative exercises...which, at last remembrance, Medicare does not cover. Hydro ? Again, no Medicare coverage unless we are debriding a yucky wound. But....Medicare lists OA as one of the 75% acceptable diagnoses for being on an acute rehab unit. What does MEdicare accept as an acceptable care plan/goals for OA's??
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Re: Dx: OA R knee - April 15, 2001 7:18:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Group:
Why is there so much question of PT for OA of the knee.
PT can be of great help for OA of the knee - in particular strengthening and ROM exercises.
There is research to prove it. In a recent study in the times article (A therapist's touch on arthritic knees) the PT group did better on several measures.
I am not the most flag-waving PT but honestly, if you guys don't think we can help a person with OA of the knee, then what exactly do you think we CAN help?????
J Rheumatol 2001 Jan;28(1):156-64
Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.
Fransen M, Crosbie J, Edmonds J.
Department of Rheumatology, St George Hospital, Kogarah NSW, Australia. m.fransen@med.usyd.edu.au
OBJECTIVE: To assess the effectiveness of physical therapy, given either as an individually attended treatment or in a small group format, in terms of pain, physical function, and health related quality of life for patients with osteoarthritis (OA) of the knee. METHODS: After 2 baseline assessments, 126 patients were randomized into one of 3 allocation arms: individual treatments (n = 43), small group format program (n = 40), and waiting list control (n = 43). After reassessment at 8 weeks, patients allocated to waiting list control were randomized into one of the 2 active treatment arms. Assessments included both self-report measures (WOMAC, SF-36) and objective measures of physical performance (gait analysis and muscle strength). RESULTS: Both physical therapy treatment allocations resulted in significant improvements in pain, physical function, and health related quality of life above the control group (standardized response mean 0.36 to 0.65). Improvements in the self-report measures were substantiated by significant correlated improvements in knee extensor strength and fast walking speed (rho 0.36-0.42). There were no significant differences in effectiveness between the 2 physical therapy allocations for any of the measured outcomes. Improvements gained were maintained for at least 2 months. Responsiveness to treatment was modified by loss of medial joint space width, the interaction being significant for physical function, gait, and knee extensor strength. CONCLUSION: Physical therapy, either as an individually delivered treatment or in a small group format, is an effective intervention for patients with knee O.A.
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Re: Dx: OA R knee - April 17, 2001 7:08:00 AM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
Status: offline
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Please understand that I am NOT saying we cannot help a person with OA in any joint they have...my question was exactly what is the careplan for OA that is covered as a "skilled" procedure. Strengthening alone is not covered by Medicare as it involves "repetitous exercises"...which an aide can be trained to do. We cannot cover hydro treatments anymore unless it is for debridement of a wound. "Osteoarthritis" is
in the 75% category for acute in patient ehab facilities..knee replacements is not.
I am asking what "skilled" procedures are involved in a care plan for a person with an osteoarthritic knee. As I stated..unless Medicare has changed their thinking, strengthening exercises are not covered if stganding alone....as an adjunct to other procedures it is....such as correction of a gait deficit...which in all probability is not going to change much with the knee destroyed by OA.
I can see the benefit of what you said and I agree.. I am a therapist !!!!! But the governmental and insurance gods have got to pay for what we do or we won't be around long to do it.
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Re: Dx: OA R knee - April 28, 2001 12:15:00 PM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
Status: offline
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I treat OA regularly and bill Therapeutic activities and Manual therapy. There has been no problem with payment as long as the other paperwork is appropriate.
Joint mobilization to re-nourish some of the end of range and slow the progression of loss of motion. Repetitive low impact exercise to increase muscle strength (absorbing more of the shock) and improving the physiological health of the joint. Get the patient in a community based aquatic program and home exercises. Most mild to moderately symptomatic patients have a good improvement in function if they stick with their home program.
Erik
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Re: Dx: OA R knee - April 28, 2001 6:09:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Rose:
I can sympathize with your reimbursement woes!!!!!
I just think that we needed to get the message across that PT was appropriate and indicated.
later,
Mcap
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Re: Dx: OA R knee - June 5, 2001 12:25:00 PM
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abid
Posts: 4
Joined: June 3, 2001
Status: offline
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dear friend,
you ask very difficult question b/c o.a is not reversable, its a type of degenration and human body do not regenrate. we r only able to build the souranding muscle to reduce loading on the joint. that the only solution or maintance. you asked for modilities they r just our helping hand they r not an actual treatment. these r for therapist help not baneficial for patient they provied some intervale in pain, so theapist can perfom his job. that is to build muscle.
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