When you think about a person going into intensive care, you probably picture someone who’s very ill and likely fighting for their life. They may be on a ventilator or other equipment that’s keeping them alive. When you’re in that situation, surviving would be a win. But what happens after these people survive? Do they recover and go back to life as it was? What’s the road to recovery look like?
Fortunately, medical advances have led to higher survival rates for people who end up in intensive care units – it’s now between 71% and 90%, which is great. But, survival is not the end goal, and getting out of the ICU is not the end of the battle. Many patients show significant losses of physical, mental and cognitive abilities after discharge. It makes sense – if you don’t use it, you lose it! This cluster of problems is called Post-Intensive Care Syndrome or PICS.
PICS is now recognized as a public health burden. Interventions against PICS need to start in the ICU. Then they need to continue after discharge.
Physical declines often include significant losses of strength, endurance, and mobility. These can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. This may keep some people from returning home. For others, it means they need a caregiver to safely return to their previous setting. 50% of ICU survivors have limitations in daily activities 1 year later, so this is a serious and long-lasting problem.
Mental health is also a very real concern for ICU survivors. They show significant rates of depression – the mean is 28%. 24% of survivors have anxiety and 21% report PTSD. Again, these conditions have a real impact on the quality of life after leaving the ICU.
Last, declines in cognitive abilities are very common in ICU survivors. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues after discharge can include poor memory, slower thinking, problems making decisions, or difficulty concentrating.
Physical therapists play a significant role in the fight against PICS. PT typically begins while the patient is in ICU, focusing on getting the patient up and walking early. Patients begin a progressive exercise program as soon as it’s safe for them. We expect a rise in PICS due to the number of people who COVID-19 has put into critical care and/or on a ventilator.
While we can’t prevent every problem that critical illness causes, recognizing the losses that remain after discharge from the ICU is an important step. Physical therapists play an important role in combating the effects of PICS and helping people return to higher-quality lives.
Finally, Some Good News About Back Pain
Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The
current estimate is that 80% of people will experience back pain at least once. It is the single
biggest cause for disability, the third most common reason for doctor visits, and one of the most
common reasons for missing work.
It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US,
totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes —
$111 billion in spending — and ischemic heart disease at $89 billion.
Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can
both lead to other major problems, require long term medication, could require surgery, and
both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and
usually doesn’t require surgery either. Why is it so expensive?
The first reason is that it’s so common. The second reason is that our current system isn’t very
good at treating it. Current recommendations include starting with activity modification, and
active treatments like physical therapy. Research backs this up, showing better outcomes and
lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and
only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people
with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of
diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things
go against current practice guidelines for treatment of back pain.
A new pilot program being rolled out by TRICARE, the insurance system used throughout the
US military is waiving the payment owed by the patient for up to three PT sessions in an attempt
to improve the use of what the Defense Health Agency calls “high value” treatment for low back
pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go
back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix
offers, free samples poured in wineries and craft breweries, or the folks you see standing
around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works
just as well for healthcare as it does for other businesses. In a press release they state that
once people attend one session of physical therapy, they’re likely to go back for more, no matter
what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying
that first visit. For the group of patients with the highest co-pays in the system, only 38% of the
people prescribed PT attended the first visit. That’s about half the rate of attendance found in
the lowest co-pay group.
The fact that such a major insurer is looking into the value of PT is great news for everyone. If
TRICARE can show that lowering the cost of PT for patients can improve outcomes and save
insurance companies money, other major insurers will likely follow. This could improve the lives
of millions of people every year while reducing the huge cost of treating low back pain for the
country. That seems like a win for everyone involved.
#GetPT1st For Back Pain
Chances are, you or someone you know has had back pain. Each year 15% of the population
has their first episode of back pain, and over the course of our lives, 80% of us will have back
pain. Even though back pain is common, the medical community does a poor job managing it.
Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too
common.
Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:
Medication
Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC
recommended against the use of opioids for back pain in favor of “non-drug treatments like
physical therapy.”
Imaging
Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful.
Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.
● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not
● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge
● Just getting an image increases the chances that you’ll have surgery by 34%
Surgery
The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher
than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the
outcomes are terrible!
A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t.
The surgical group had:
● A 1 in 4 chance of a repeat surgery
● A 1 in 3 chance of a major complication
● A 1 in 3 chance of never returning to work again
Physical Therapy
● Current clinical practice guidelines support manual therapy and exercise
● Research proves that early PT lead to better outcomes with lower costs, and decreases
the risk of surgery, unnecessary imaging, and use of opioids
● A study of 122,723 people with low back pain who started PT within 14 days found that it
decreased the cost to treat back pain by 60%
● Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT
within 90 days.
Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!
Ask a Physical Therapist To “Screen” Your Movements This Spring
Let’s talk about the last time you—or someone close to you—interviewed for a new job. Chances are that the first step was a phone screen with your potential employer, and when you passed that portion of the process with flying colors, you were then invited for an in-person interview. At that stage, the employer probably asked you to answer a series of questions and to demonstrate your skills through a test or two. The process is set up in a way that narrows down the options until the most suitable candidate is found. Makes sense, right?
Just as job recruiters screen applicants to find the best fit for
an open position, your PT will ask you to perform a series of exercises so that she can observe and understand your body
mechanics to uncover any issues or limitations. Used in combination with a full evaluation and assessment, these so-called movement screens are just one tool in identifying the most appropriate treatment or prevention program for you. But unlike that test you may have taken during a job interview, the screen is not testing your skills or abilities, it’s simply a way of identifying how your body functions during a variety of movements.
Now that spring is in full swing, it’s the perfect time of year to make an appointment with a physical therapist for a movement screen. The warmer weather means more time spent outdoors participating in sports and other recreational activities that may be physically demanding. A PT checkup that includes a movement screen will ensure that you’re physically able to engage in popular spring and summer adventures, whether it’s exploring in the woods, tending to your garden, or swimming at your family’s lake house.
Physical therapists perform movement screens for a variety of reasons, including:
• To identify areas of strength and weakness
• To uncover issues or rule them out
• To determine readiness to begin a safe exercise program
• To improve sport performance (for both novice and elite athletes)
A movement screen is something that you can have done whether you have a nagging injury or are simply ready to kick-start your activity level after a long hiatus. Gaining
an understanding of how your body performs during basic exercises such as squats and lunges helps your PT ensure that you can safely jump on a bike or into a pool this summer. And just like an employer screens candidates to identify the one individual who is likely to thrive on the job for many years to come, a movement screen can help you
develop a lasting and fulfilling relationship with the activities you enjoy most.
Call us today to schedule your FREE screening!
