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March 2004

Staying in Shape Helps Women with Rheumatoid Arthritis

A Finnish study that looked at women with rheumatoid arthritis concluded that a combination of aerobics and strength training allows them to better perform essential everyday tasks, such as getting up from a chair or climbing stairs.

The study, recently published in Arthritis & Rheumatism, was conducted by Arja Hakkinen, PhD, Central Hospital, Jyvaskyla, Finland. Hakkinen looked at 23 women, all of whom had no active inflammation. Half of the subjects were in the early stages of disease, with the other half exhibiting long-standing symptoms. The research team discovered that 21 weeks of riding a stationary bicycle or walking, in addition to resistance training, helped improve the women’s cardiovascular fitness and strength. Hakkinen noted that each subject’s exercise plan was overseen by health professionals.

All study subjects were undergoing treatment with standard rheumatoid arthritis drugs, although Hakkinen pointed out that supervised physical activity is an integral aspect of therapy and is recommended to begin in the early stages of the disease.

Shock Wave Therapy Successful in Treating Tendonitis A German research team has proven that sound waves can successfully control shoulder tendonitis, according to the November 19 edition of the Journal of the American Medical Association. Orthopedic surgeon Ludger Gerdesmeyer, MD, from the Technical University of Munich, recently studied 144 patients with chronic tendonitis of the rotator cuff, treating them with extracorporeal shock wave therapy (ESWT). This method delivers sound waves that possibly disrupt calcium deposits, increase enzyme spread across blood vessel walls, stimulate blood vessel growth, or promote the formation of new bone.

During his study, Gerdesmeyer divided the patients into three separate groups: a group receiving low-energy ESWT; a group receiving high-energy ESWT; and the rest receiving a fake procedure that had no therapeutic effect. All patients were given two treatments administered 2 weeks apart, and received more physical therapy following those treatments.

Over a 6-month period of follow-ups, the patients who had received ESWT reportedly showed significant improvement, compared with those who had not received the treatment. In addition, the research team found that those who received high-energy ESWT exhibited a greater rate of improvement than those who received the low-energy version. All the patients studied had undergone other therapies, such as massage therapy and steroid injections, which did not reduce the calcifying tendonitis.

“For the first time in the treatment of chronic calcifying tendonitis of the rotator cuff, we have found a nonsurgical technique that is effective,” said Gerdesmeyer in the report. “People with chronic pain of the rotator cuff should be treated with ESWT, not surgery.”

Recurrent Stroke Undertreated in Nursing Home Patients

Only about half of older Americans that live in nursing homes are treated for the prevention of recurrent stroke, according to a study published in the October 10 Internet edition of Stroke.

The study, which was led by Jennifer Christian, a postdoctoral fellow at Brown University’s Center for Gerontology and Health Care Research, Providence, RI, also showed that racial minorities dwelling in nursing homes receive blood thinners for recurrent stroke less often than whites. The research team studied nursing home residents hospitalized for ischemic stroke in Kansas, Maine, Ohio, New York, and Mississippi; 61% of those from Asia or the Pacific Islands did not receive treatment to prevent recurrent stroke, according to the study. In addition, 54% of Hispanics, 51% of blacks, 46% of whites, and 42% of American Indians were not treated. “It appears that minority populations in nursing homes are at greater risk for undertreatment, which is only partially explained by patient characteristics such as age, gender, physical and cognitive function, or other diseases,” said Christian, in a prepared statement. “Clearly, interventions are needed to improve and increase the use of treatments for recurrent stroke in all nursing home residents.” Fibromyalgia Patients Make Up Three Subgroups A new University of Michigan study suggests that patients suffering from fibromyalgia can be classified into three distinct subgroups, a discovery that could possibly lead to better treatment for this chronic disorder.

The study, led by a team of researchers under Thorsten Giesecke, PhD, was published in a recent issue of Arthritis & Rheumatism. Giesecke and a team of colleagues studied 97 patients with the disorder (85 women and 12 men), evaluating the patients over a 2-day period of testing. The patients responded to questions about their individual coping strategies and personality traits, particularly emotional well-being. In addition, they were tested for sensitivity to pressure and pain.

The researchers discovered that the patients fell into three subgroups that bucked conventional thinking about the disorder. “It’s generally been thought that fibromyalgia patients who have higher distress have higher pain sensitivities,” said Giesecke. However, his research did not back that up. Instead, the study’s first subgroup (50 patients who had moderate levels of anxiety and depression) felt that they had moderate control over their pain, and experienced moderate to low levels of pain. The second group (31 patients with high levels of anxiety and depression) felt they had the least control over their pain, and suffered high levels of tenderness. Finally, the third group (16 patients) reported the lowest levels of anxiety and depression and the highest control over their pain, even though tests showed they experienced the highest levels of physical pain.

Giesecke suggested that the study’s findings might convince skeptics that fibromyalgia is a real disease, in addition to help customizing treatments. For example, he reported, antidepressants might not work well on the third group, whose members were not depressed. They could benefit from exercise therapy instead, he said.

APTA Sponsors National Toll-Free Arthritis Hotline

On February 7, the American Physical Therapy Association (APTA) sponsored a national toll-free hotline to address the subject of arthritis. People suffering from the disease, as well as friends and family of those affected, were encouraged to call in with questions.

Hosted by the APTA’s Sections of Geriatrics and Women’s Health and staffed by physical therapists who specialize in arthritis and related conditions, the goal of the hotline was to address the management of the disease, which affects one in every six Americans, according to the Arthritis Foundation. The hotline was created because while there is no cure for arthritis, APTA asserts that physical therapists can help their clients reduce pain, prevent disability, and restore function, strength, and flexibility.

Activists Pursue Lawsuits Claiming Violation of the ADA

Two recent cases are challenging the way the Americans with Disabilities Act (ADA) of 1990 is enforced by states.

The state of Tennessee is defending itself in a lawsuit brought by George Lane, a Tennessee native, who was forced to crawl up the steps of the Polk County courthouse when making an appearance in a reckless driving case because there was no elevator available. Lane refused to crawl for a second time and was then arrested for failing to appear in court. Lane claims the state of Tennessee violated the ADA and wants to sue for up to $100,000 for the humiliation of having to crawl up steps. Though Tennessee acknowledges the fact that the courthouse did not have an elevator, the state argues that Lane’s constitutional rights were not violated, and that he does not have the right to take Tennessee to court.

In the state of Texas, a legally blind associate dean and professor filed a case against the state when Texas Tech University, Lubbock, Tex, refused to place high-contrast tape on stairs. Defending the state is Texas Attorney General Greg Abbott, a wheelchair user. Civil rights groups in Texas are accusing Abbott of hypocrisy. Like Tennessee, the state of Texas is arguing that states should not be required to pay money damages for violations of the ADA.

The outcomes of both cases will have large implications for the future implementation of the ADA.

Study Explores Drug’s Efficacy Against Alzheimer’s Disease

Led by the nationally renowned Alzheimer’s research group at the University of Rochester Medical Center, Rochester, NY, 300 patients will take part in the “Valproate in Dementia” study, which aims to find out if valproate can be used to help people who suffer from Alzheimer’s disease.

Valproate has been used successfully to treat epilepsy, migraines, and bipolar disorder. Researchers in the latest study will determine if valproate reduces the occurrences of problem behaviors associated with Alzheimer’s, such as agitation and deterioration of memory.

The University Memory and Aging Center of Case Western Reserve University and the University Hospitals of Cleveland are among the 30 institutions participating in the national study.

Research Reveals Positive Results for Rheumatoid Arthritis Drug

According to a study, which appeared in the November 13 issue of the New England Journal of Medicine, a new, experimental drug may be an effective treatment for rheumatoid arthritis.

The drug, CTLA4lg, prevents T-cells from attacking their targets in joint tissue. The study showed that patients who took CTLA4lg in addition to the conventional therapy for rheumatoid arthritis were almost twice as likely to show a 20% decrease in symptoms such as joint pain and swelling.

For the study, researchers gave a group of 339 men and women two different doses of either CTLA4lg or sugar pills. All patients were taking methotrexate and were monitored for 6 months. Results showed that 16% to 17% of the patients who received a high dose of CTLA4lg experienced a 70% improvement in arthritis symptoms compared to those on methotrexate alone. Patients who took CTLA4lg reported improvements in physical function, general health, and social and economic well-being. CTLA4lg is being developed by Bristol-Myers Squibb Co, New York, and is not yet approved for sale in the United States.

Industry update

ActiveForever Launches Redesigned Web site

ActiveForever, Scottsdale, Ariz, has launched a newly designed Web site, www.ActiveForever.com. The enhanced site features a wide selection of new products, improved functionality, and easier navigation. In addition, it has been designed in high-contrast colors and larger type for people with low vision. The site now categorizes products by specific conditions, such as arthritis, Parkinson’s disease, stroke/neurological rehabilitation, diabetes, low vision, foot care, back and neck pain, exercise therapy, and hand conditions. Visitors to the site can also access sections on bath safety, personal hygiene, bedroom and kitchen, relaxation, dressing, hobby and crafts, mobility aids, writing tools, and home health care. The site also includes links to appropriate disability and health care associations. Products can be ordered 24 hours a day, 7 days a week, with same-day shipping. Neurogenic Technologies Signs Agreement with NASA

Neurogenic Technologies Inc (NTI), Missoula, Mont, has announced a Space Act Agreement with NASA’s Johnson Space Center, Houston. Entitled “The Evaluation of Alternatives to Isokinetic Testing for Muscle Tone Assessment,” the agreement forms a research collaboration between NTI, the University of Montana, and NASA. Under the terms of the agreement, the collective group will examine alternative methods to assess muscle tone in microgravity environments and during prolonged bed rest. NTI manufactures and distributes the Myotonometer, an FDA-approved portable device that quantifies various muscle characteristics including muscle tone. NuStep Inc Announces Pinnacle Award Winners

NuStep Inc, Ann Arbor, Mich, announced the winners of the 2004 NuStep Pinnacle Awards, which recognize organizations that develop high-quality health and wellness programs and facilities for older Americans. This year’s winners are: Masonic Life Center, Elizabethtown, Pa, in the Senior Living Communities category; and Milwaukee County Department on Aging’s Wellness Works programs in Milwaukee, in the Wellness/Fitness Centers category. Both winners received a NuStep TRS 4000 Recumbent Cross Trainer, a trip to Orlando, Fla, and an inscribed NuStep Pinnacle Award. A third-party panel of judges selects the most innovative and comprehensive programs in the two categories. “Through innovation and commitment, the winners of the 2004 NuStep Pinnacle Awards actively promote the health and well-being of older Americans and help transform lives,” says Steve Sarns, vice president of NuStep. “In addition to improving fitness among seniors, these programs demonstrate a strong belief that older adults are of great value in our communities and that age should not be a barrier to a fulfilling and active life.”

Conference Calendar

The Oregon Physical Therapy Association presents its 2004 Spring Conference and Business Meeting on March 12-14 in Eugene, Ore. (503) 262-9247; www.opta.org. • The Missouri Physical Therapy Association sponsors its spring meeting at the Lodge of Four Seasons, Lake Ozark, Mo, on March 16-18. (573) 556-6730; www.mopt.org. • Medtrade Spring will take place on March 16-18 at the Las Vegas Convention Center in Las Vegas. (800) 241-9034; www.medtrade.com. • The Michigan Physical Therapy Association presents the MPTA Semi-Annual Conference on March 20 at the Comfort Inn, Okemos, Mich. (517) 347-0880; www.mpta.com. • Physical Therapy 2004: The Annual Conference & Exposition of the American Physical Therapy Association (APTA) will take place in Chicago on June 30-July 3. (703) 684-APTA (2782); www.apta.org. • The Florida Physical Therapy Association will hold its annual conference on August 12-15 at the Sawgrass Marriott, Ponte Vedra Beach, Fla. (850) 222-1243 x26; www.fpta.org.

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