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Re: Laser therapy
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Re: Laser therapy - April 2, 2006 4:32:00 AM
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PTupdate.com
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From: Pittsburgh, PA USA
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I am kicking myself for not being able to find the article on Anodyne that I worked on...will look in my office when I get there later today. I personally felt it was very well done, and when added to what I have heard from reliable and skeptical therapists, was comfortable making the decision to try for myself.
The article using H-wave was:
DIABETIC PERIPHERAL NEUROPATHY: AMELIORATION OF PAIN WITH TRANSCUTANEOUS ELECTROSTIMULATION. Diabetic Care, Vol. 20, No. 11, November 1997
The study did not look at any physical parameters, such as point discrimination or reflex activity, but only pain and sleep interference. But, ask someone with neuropathy if they really give a crap about those factors. Most just want to get rid of the pain and get a decent nights sleep. As with the anodyne, symptoms returned without use of a home unit after the program was done.
As far as "the literature is not perfect"...much if it is not perfect. There are flaws and issues with most of the research I critique, and much of it is used by people as a reference when citing EBM practice. There is little material written out there that one could consider "the word of God". Plus, every PT practices with some certain skill or method that works for them very well, even though they could not produce a good, hard-core study that supports it.
Even if Anodyne gave improvement to 4 out of 10 persons with neuropathy, that's still 4 people who had something good added to their lives that was not there before.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Laser therapy - April 2, 2006 5:27:00 PM
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Randy Dixon
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For a patient to be right back in the same old boat in 32-38 days just isn't what physical therapy is about... SJ
You don't think an effort at maintaining function or improving function if it requires continous therapy is appropriate if the alternative is a loss of function? I agree that if there is a better way that it should be used, that isn't the issue.
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Re: Laser therapy - April 3, 2006 1:30:00 AM
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SJBird55
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You missed my point, Randy.
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Re: Laser therapy - April 3, 2006 2:48:00 AM
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Randy Dixon
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I saw several points: A)That the risk=benefit ratio of an Anodyne unit is unacceptable, especially since it's efficacy is unproven. B) That people are motivated and biased because it creates more revenue for them C) If patient improves, but regresses after 32-35 days then it is an inappopriate strategy.
I was addressing C.
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Re: Laser therapy - April 3, 2006 3:18:00 AM
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PTupdate.com
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"If patient improves, but regresses after 32-35 days then it is an inappopriate strategy." Issuance of a home unit can maintain the gains made. Plus, if every other alternative has been tried for these people, I still cannot see the issue with doing this. What are the options? "Stay in pain there Buddy, I won't do this treatment on you because the science is not up to my standards. I'll ignore the risks of falling that you may have, plus the physiological effects all the pain-induced stress have on your system"
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Laser therapy - April 3, 2006 5:41:00 AM
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SJBird55
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If the patient regresses after 32-35 days and the patient returns right back in the same boat and if the patient isn't a candidate for a home unit, then well... yeah, there is an unfortunate situation. Since it is an unknown if a patient will respond to the treatment, then technically, since physical therapy is about making gains and having gains maintained OR providing a solution to the situation (and a home unit would be a potential solution), then on the front end of business, technically the patients should initially be screened as to whether they ARE candidates for the home rental unit before the treatment is even provided. 1) will they be able to purchase the unit or will the insurance company purchase the unit for them IF they are responders 2) are they (or their caregiver) appropriate candidates who will be safe with utilizing the unit at home. In my opinion, these are front end questions that need to be considered before even providing the service. If the patient is a responder and they are not a candidate for the unit at home and if there is no way for them to have maintenance therapy, then, yes, I stand by my comment that at the discontinuance of physical therapy services, if the patient is in the same boat in 32-35 days, I don't believe that is what physical therapy is about.
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Re: Laser therapy - April 3, 2006 6:15:00 AM
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drbuddy
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If I am having symptoms, 32-35 days of relief might be worth it, no?
Perhaps you could offer these patients some sort of supportive care in the office (if they dont qualify for the home unit). Would it be so horrible if a patient has to come in a few times a month to keep their symptoms under control?
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Re: Laser therapy - April 3, 2006 8:03:00 AM
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SJBird55
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I don't believe it is horrible to assist with maintenance (but in the eyes of third party payers, the regulations are always written with improvement in mind.) So, if it is a Medicare patient, Medicare doesn't reimburse for maintenance therapy. So... you'd have to bill it out and indicate that it was maintenance therapy to get it denied AND you'd have to be up front with the patient about the service not being covered. Then, you'd have to have a discussion as to how the patient would pay for the service. That definitely is an option... as far as how often a patient with Medicare coverage would agree to that kind of arrangement is unknown to me - combined with the simple fact that in 32-35 days things go back to the same old, same old, well, what is the appropriate type of maintenance frequency? What is the least amount of visits required and when can that frequency be initiated? With the treatment of 12 visits, is that kind of at a plateau response and the response won't improve?
Mentally, I believe it would be unreasonable to give the 32-35 days of relief because we're all human and to know what it was like and the improvement that may have been acquired compared to the return of symptoms is kind of mean. That's just me though.
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Re: Laser therapy - April 3, 2006 3:22:00 PM
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Andrew M. Ball PT PhD
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SJ,
You assume that therapists using Anodyne don't try to screen patients in the way you describe. My clinic certainly does, but you assume otherwise. Why is that exactly?
Besides, at $7 reimbursed for the service, the few patients that fall into that category are more than happy to sign an ABN and pay out of pocket --- and we get a happy, satisfied, FUNCTIONAL, person --- a very strong advocate for both our clinic, and the profession at large.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Laser therapy - April 3, 2006 7:32:00 PM
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Randy Dixon
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The primary screen for whether a home unit is appropriate or not would seem to be whether a clinical unit was effective or if there were adverse reactions, wouldn't it?
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Re: Laser therapy - April 4, 2006 4:29:00 AM
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PTupdate.com
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Billing may be crappy with the Anodyne itself, but the other treatment routines that are part of the program are reimbursable. Like moist heat with Medicare patients...you don't get paid for it, but it is an integral part of the program and you just suck it up and do it. Plus, as Drew indicates, you make someone feel better, perhaps for long term, and that is what builds your reputation. In fact, many people that are driven to a clinic for Anodyne discovered that clinic on Anodyne's website...they were surfing for some answers for their pain. And as Randy indicates, home unit is the optin when the clinic unit did the trick. Adding onto the program could be the ES as I noted in an above article, and that too would be a billing option.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Laser therapy - April 4, 2006 7:53:00 AM
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Shill
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From: Madison WI USA
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Man you're a funwrecker Junction. But I agree.
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Re: Laser therapy - April 4, 2006 8:14:00 AM
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SJBird55
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From: Michigan
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junction... now you've explained to me why the sales rep has never returned to share the research justifying his product. LOL I have always believed that actions always spoke more than words. So, yes, he did walk out the door - if he does have research, well he obviously wasn't prepared for my response and my needs - which technically, we ALL should have expectations of what I had. Why would a sales rep NOT come prepared with research to back his verbal claims? I assume it is not common practice to cut to the chase and ask for research to support claims.
Drew, probably because you alluded to the simple fact that DPT's should be prepared to answer the screening type of questions. If those in your clinic are already doing it, it seems weird that you would have had that above statement.
I think that because overall we do have hopes and do want to assist patients that have peripheral neuropathy secondary to diabetes and do want to reduce the risk of falls that maybe we aren't as diligent at being critical of new technology because we want to believe in it just as badly as the patient does. And, then, because we are human, we also want to sometimes get in the rat race and be able to offer something new to put us on the top of the list for referrals. It generates revenue. So, what is $7, nothing really in the big scheme of things, but what it represents is probably more important.
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Re: Laser therapy - April 4, 2006 2:01:00 PM
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tucker
Posts: 182
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From: Texas
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Thanks Junction. Good to know there are others who have a problem with the marketing strategy.
Funny thing...when I was first introduced to the unit I also thought it looked like something thrown together with parts from Radio Shack...and they charge $8000 for it? That's just riculously overpriced. It couldn't cost more than $200 to manufacture.
Darin
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Re: Laser therapy - April 4, 2006 10:23:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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Oh what the heck..I did try Anodyne in my office as my competition also has the equipment and is marketing it. I found Anodyne to be as good as moist heat and ultrasound without the added cost of $6000!!
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Re: Laser therapy - April 4, 2006 10:26:00 PM
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goodlooks58
Posts: 425
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From: CA
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Oh..and I am going to try out ML-830 laser on my patients and will give it a thumbs up/down depending on what my patients report to me. If the thumbs are down..ML-830 will be returned within 30 days. I am just an open-minded kind of a PT (only for 30 days!!)
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Re: Laser therapy - April 4, 2006 11:19:00 PM
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Randy Dixon
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Why, yes, I do have nothing better to do today, and yes, as a matter of fact, I do happen to be home sick with the flu. -Junction
I suggest you try nasal Anodyne treatments, the insertion is a little rough, but you will get great results, NO, circulation and all that stuff.
It's no worse than the "cough syrups" the pharmacies and doctors have been dishing out anyway.
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Re: Laser therapy - April 5, 2006 2:51:00 AM
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truthseeker
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lol
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Re: Laser therapy - April 5, 2006 5:50:00 AM
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drbuddy
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From: Pennsylvania
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You guys should test out a real laser, not these weak laser-pointer-from-radioshack equivalents. Try out something in the infrared range, around 900 nm and something at least 2-300 mW.
A unit like this is available from [URL=http://www.usalasertherapy.com]www.usalasertherapy.com[/URL]
I tried a laser like the ML830 with little noticeable effects.
Also, check out [URL=http://www.laser.nu]www.laser.nu[/URL] and the textbook by Tuner and Hode about laser therapy. If you take some time to learn the specifics about laser therapy, you will see why some lasers will do nothing and others will be better.
By the way, infrared and the lower powers lasers are ok for superficial problems and woundcare. So, if that is your intended use, then the ML830 and Anodyne will be fine.
Also, never listen to laser company reps. I've found very few who are honest about the technology. I even had one at a seminar try to tell me he could laser someones arm through a 200 page textbook. He tried to demonstrate, but I just laughed and walked away.
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Re: Laser therapy - April 6, 2006 11:59:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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Careful Junction, that's a serious accusation that you're making. I'm happy to provide articles and objectively collected outcomes data in support of Anyondye --- careful about accusing others of "simple greed" and "fundamental evil" espeically in a world where ultrasound, TENS, and craniosacral therapy are so common . . .
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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