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October 2004

VITAMIN C: RHEUMATOID ARTHRITIS WEAPON
New research, published in the Annals of the Rheumatic Diseases, showed that high vitamin C intake may protect against the development of widespread rheumatoid arthritis. Previous research has shown that harmful free radicals have been found in the joint fluid of patients with rheumatoid arthritis and inflamed joint; vitamin C is a powerful antioxidant that takes care of the free radicals.

The results are based on 23,000 men and women, who were between the ages of 45 and 74 when they entered the ongoing European Prospective Investigation of Cancer from 1993 to 1997.

The diets of the men and women were assessed using food intake diaries, which they kept for 7 days. For the study, each of the 73 people who developed inflammatory polyarthritis between 1993 and 2001 were matched with two controls. Those with inflammatory polyarthritis tended to have a lower daily intake of fruits and vegetables than those who did not develop the disease. People with a low intake of fruit and vegetables had approximately double the risk of developing arthritis of those with a high intake.

Vitamin C intake made a significant impact: those with the lowest levels of vitamin C intake were three times more likely to develop inflammatory arthritis than those with the highest intakes. The recommended daily intake of vitamin C is 40 mg. Those with levels below this were at four times the risk of inflammatory polyarthritis; but those who consumed less than 56 mg a day were still at three times the risk.

RESEARCH FINDS GENDER DIFFERENCES IN BACK PAIN
A recent survey shows that though both men and women suffer from acute back pain, there are many differences between the genders when it comes to the causes of the pain-most men in the survey blamed their backache on job-related injuries, while the women cited child care, gardening, or housework as the source of their back trouble.

The survey, conducted by Harris Interactive for McNeil Consumer & Specialty Pharmaceuticals, questioned 200 primary care physicians who regularly treat back pain.

The participating physicians also reported that men complained of exercise- and sports-related back pain injuries more often than women. Weight lifting, golf, basketball, and football were the most common sports-related causes of back pain for men, while running, tennis, and weight lifting were the most common for women.

NEW THERAPY IMPROVES BLADDER CONTROL
In a study published in the July 2004 issue of the medical journal Urology, researchers found that nerve stimulation therapy for bladder leakage problems helps patients urinate better, improves their quality of life, and reduces depression. The treatment, called sacral nerve stimulation, involves the implantation of a small device that sends electronic signals to the nerves connected to the bladder. The signals help stabilize the bladder and prevent leakage.

Researchers evaluated the impact bladder problems had on the quality of life of 89 patients. Some of the patients were treated with sacral nerve stimulation during a 6-month period. In the beginning of the study, depression was observed in 73% of subjects, including a significant proportion with moderate to severe depression. In the nerve stimulation group, depression and quality of life scores improved significantly from the start of the study to 3 months, with the benefits maintained at a 6-month follow-up. Patients not treated with nerve stimulation experienced slight decrease in these scores that continued through both follow-up points.

According to the authors of the study, the results demonstrate that unresolved urination problems have a serious impact on patients' physical, social, and psychological quality of life, and that sacral nerve stimulation can dramatically improve the condition. The authors also note that the study may not be representative of the general population with urine incontinence, because many people do not seek treatment due to the perceived notion that the problem is embarrassing.

INACTIVITY MAY CAUSE LOW BACK PAIN
Contrary to intuitive notions that spine injuries are caused by strain during a physical activity, a new study by the European Space Agency in Berlin showed that prolonged inactivity can deactivate muscles that support and protect the spine, which may trigger unexplainable cases of lower back pain.

In the study, 19 young men spent 8 weeks in bed rest. Magnetic resonance imaging was used to find that the multifidus muscles of all of the young male volunteers in the bed-rest study had wasted and become inactive. Previous ultrasound studies have shown that in most cases of lower-back pain, either the lumbar multifidus muscles, which keep the vertebrae in place, or the transversus abdominis, which holds the pelvis together, or both, are inactive.

The researchers note that this is the first study to show that the muscles that protect the spine are switched off in de-loading. The study also shows that switching these muscles back on involves more than simply getting up and walking. For some participants in the study, their multifidus muscles had not recovered 6 months after taking part in the study.

ACADEMIC RECORDS IGNORE STUDENTS WITH DISABILITIES
A story published in the August 30 issue of The New York Times brought attention to a growing problem facing schoolchildren with disabilities-the lack of official documentation of test scores and overall achievement records for the schools they attend, thus not being fairly counted in performance rating measures of their schools. The article highlighted several cases where the academic progress of schoolchildren with disabilities is ignored within school systems, leading to a greater problem of inaccurate school progress reports.

According to the story, not only are a growing number of states excluding many special education students from reports on school progress on the assumption that those students count for only a small portion of enrollment, states and districts also are avoiding disclosing any information about the quality of education they provide to such students. For example, New York City's all-special-education district of 20,000 mentally or physically disabled students, District 75, discloses only fragments of the information the federal law requires for accountability, therefore reporting schools "in good standing" despite grim results. Advocates for students with disabilities argue that this trend toward avoiding academic accountability lowers academic standards for students with disabilities.

A San Diego resident, Allison Brenneise, faced negligence from the school system regarding her son, Tyler, a 10 year old who is autistic and mildly retarded, when eagerly awaiting his achievement tests results. The tests were the first that Tyler had taken that were the same as those of children with no disabilities. To her disappointment, Brenneise found that San Diego labels her son's school, Del Sol, a program and not a school, and therefore no report was given; California does not provide report cards for institutions it considers as programs that educate disabled children.

California, however, is not the only state dismissing students with disabilities. According to the article, federal officials say that approximately 10 states, including Delaware, Utah, Missouri, Colorado, and Hawaii, have failed to properly report the scores of children with disabilities on the special achievement tests and are receiving federal money under "special conditions" obligating them to do so in the future.

Without progress reports, parents of students with disabilities have no way of knowing how the students and the schools they attend measure up to overall standards. Some states claim that not including disabled students in school report cards is unintentional, blaming the problem on overwhelming efforts to comply with the federal No Child Left Behind Education Act. The law requires that schools must report on the test scores of children with disabilities to show they are meeting the goals of proficiency in reading and math by 2014; individual states determine what is proficient. States are also required to report test scores separately for various groups of students; however, many states have found multiple ways to manipulate compliance by raising the minimum number of disabled students that must be enrolled before reporting their progress as a separate group. Michigan reports progress of a particular group only when the group has met targets for proficiency and 95% participation in examinations.

The situation creates a problem for the parents of the students with disabilities as they try to make sure their children are progressing in an adequate learning environment. Without proper evaluations of the special schools or programs that children with disabilities attend, parents and taxpayers cannot judge the effectiveness of the education provided.

NEWS BRIEFS

BATRAC BENEFICIAL FOR STROKE VICTIMS
At the World Stroke Congress meeting in Vancouver, Canada, researchers presented results of a study that showed positive effects of bilateral repetitive rhythmic training intervention (BATRAC) for stroke patients who suffered from impaired arm movement. BATRAC appears to work by rewiring the brain's motor control circuitry.

For the study, 20 long-term stroke survivors engaged in 6 weeks of either standard physiotherapy or BATRAC. Standard physiotherapy involved physiotherapists passively moving patients' trunks, shoulders, arms, and hands. For BATRAC, patients pushed or pulled a T-bar in rhythmic time with a metronome for four, 5-minute periods per day. All of the participants had experienced a stroke an average of 9 years prior to the time of the study.

Researchers report that six of the eight patients in the BATRAC group gained improvements in arm function, while the 12 patients in the regular physiotherapy group showed no improvement in arm function. According to the researchers, by using magnetic resonance imaging they noted a change in the brain's motor control circuitry of the BATRAC group patients. They concluded that brain reorganization is the method by which BATRAC improves function in chronic stroke patients.

CHOOSING SAFETY OVER EFFECTIVENESS
In a report appearing in the June 28 issue of the Archives of Internal Medicine, elderly osteoarthritis patients showed a greater tendency to stick with less painful treatment methods, even if they were more ineffective than other available treatments.

Researchers at Yale University, New Haven, Conn, interviewed 100 patients with knee osteoarthritis and found that patients strongly preferred safer and sometimes ineffective alternatives to prescribed treatments for pain, especially if the prescribed medications suggested greater side effects. Traditional treatment to improve knee function includes surgery, weight loss, muscle-strengthening exercises, and joint protection techniques, as well as pain-decreasing drugs. According to the authors of the study, they aimed to know if patients were informed of all the available treatments, and which they would choose on the basis of the risks and benefits of each of the treatments.

The results of the study suggest patients get used to their long-term pain and fear additional side effects, note the researchers.

CMS REVISES WHEELCHAIR POLICY, OT ASSISTANT RECOGNITION
In December 2003, the Centers for Medicare and Medicaid Services (CMS) released a new policy entitled "Power Wheelchairs and POVs-Policy Clarification and Medical Review Strategy." The policy limits Medicare coverage of power and manual wheelchairs by excluding patients who are able to walk without any assistance or walk with the assistance of an ambulatory aid such as a walker.

A national, consumer-led group called the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition is challenging the policy, stating that the restrictions hinder the ability of many patients to obtain wheelchairs, especially those who can walk minimally inside their home, but still need a wheelchair to maneuver safely outside their home. With more than 70 member organizations, the coalition is working to improve access to assistive devices, technologies, and related services.

CMS has also approved a request by the American Occupational Therapy Association to allow OT assistants employed in private practices to work under the same supervision levels as occupational therapists. CMS is accepting comments on this shift in policy.

APTA FUNDS PHYSICAL THERAPY RESEARCH
The Foundation for Physical Therapy received a $30,000 donation by the American Physical Therapy Association's Section on Health Policy and Administration. The donation will be paid over a 3-year period. The Foundation for Physical Therapy was established in 1979 as a national, independent nonprofit corporation dedicated to improving the quality and delivery of patient care. The Foundation does this by providing support for scientifically based and clinically relevant physical therapy research.

"The Section's very generous gift of $30,000 in unrestricted funds will allow the Foundation to continue to fund large projects such as the Clinical Research Network, as well as small research grants and scholarships," said Nancy T. White, PT, MS, OCS, president/chair of the Foundation.

EXTENDED REHAB IMPROVES HIP FRACTURE RECOVERY
A new study challenging current standard therapy for hip fractures may change the treatment protocol for elderly patients by requiring them to receive an additional 6 months of supervised outpatient rehabilitation. The study, conducted by the Washington University School of Medicine, St Louis, and appearing in the August 18, 2004, issue of the Journal of the American Medical Association, claims that longer rehabilitation periods improve hip fracture outcomes.

Ninety elderly hip fracture patients who had just completed the standard course of home-based therapy participated in the study. They were divided into two groups: the first group received 6 months of supervised physical therapy and exercise training. The second group received instructions and brief training in exercises that they performed at home, at least three times a week, for 6 months.

Researchers found that the patients who received the supervised therapy showed more significant improvement than those who performed the home-based therapy.

GROUPS PROVIDE RELIEF FROM WORKERS' COMPENSATION LAW
The Occupational Therapy Association of California (OTAC) and the American Occupational Therapy Association (AOTA) are coming together to help members who are experiencing financial repercussions because of the changes in California's workers' compensation rules and regulations. The California legislature recently passed a law that reduced all payments to providers as of January 1, 2004. This was aimed to minimize costs associated with workers' compensation.

The legislation requires that payments should be no lower than Medicare rates; however, historical errors and inconsistencies in the Official Medical Fee Schedule physical medicine and rehabilitation CPT code definitions have resulted in lower payments. Cases of erroneous denials of reimbursement for some occupational therapy services were also reported. Since the implementation of the new law, payors have also delayed or limited injured workers' access to timely services.

The leadership of the OTAC, AOTA's State Affairs and Reimbursement staffs, and the OTAC-AOTA lobbying staff are working to resolve these issues quickly, and have also hired an attorney to provide legal services and help develop a written argument for use with the California governor's office and the California Department of Industrial Relations in regard to prospectively and retrospectively fixing the errors made in the fees established for occupational therapy services.

PTS TREAT UNLIKELY CLIENT
The physical therapy patient at the Detroit Zoo is not one of the zookeepers, but a 46-year-old, 9,500-pound Asian elephant named Wanda, who was diagnosed with arthritis in 1998. It has now been 4 years since Wanda began a physical therapy routine of stretching and whirlpool therapy.

Wanda was first put on medications after her arthritis was diagnosed, but pain management did not completely help her deal with it. Wanda then began 20-minute physical therapy sessions, which involve various stretching routines. Keepers use a five-foot target pole with a plastic tip to help her focus on the action they want her to perform. Her diet is also monitored. Her incentive for completing her therapy? A bucket of chopped vegetables, fruits, and bagels. Wanda and her 51-year-old friend Winky, who suffers from mild arthritis, will soon be moved from Detroit to a wildlife sanctuary or preserve.

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