Spending on Back Problems Almost Doubles in Decade
Monday August 16, 2010
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Treating back problems cost Americans more than $30 billion in 2007 — up from $16 billion in 1997 (in 2007 dollars), according to the latest News and Numbers from the Agency for Healthcare Research and Quality.
According to the analysis, about 27 million people (almost 12% of adults age 18 and older) reported having back problems in 2007 and more than 19 million sought treatment.
About $18 billion went to physicians, chiropractors and physical therapists for ambulatory care. And $4.5 billion went to prescription drugs. This is up from $9.3 billion spent on office-based care and $1.2 billion on prescription drugs in 1997 (in 2007 dollars).
The average expenditures for treatment of back problems were $1,589 per patient in 2007 ($1,146 for ambulatory care and $446 for prescription drugs).
According to the analysis, about 27 million people (almost 12% of adults age 18 and older) reported having back problems in 2007 and more than 19 million sought treatment.
About $18 billion went to physicians, chiropractors and physical therapists for ambulatory care. And $4.5 billion went to prescription drugs. This is up from $9.3 billion spent on office-based care and $1.2 billion on prescription drugs in 1997 (in 2007 dollars).
The average expenditures for treatment of back problems were $1,589 per patient in 2007 ($1,146 for ambulatory care and $446 for prescription drugs).
External Frame Successfully Treats Charcot Foot
An increase in morbidly obese diabetics is causing more new cases of Charcot foot. But a surgical technique that secures foot bones with an external frame has enabled more than 90% of patients to walk normally again, according to Loyola University Health System foot and ankle surgeon Michael Pinzur, MD, in an article in the journal Hospital Practice.
The device, called a circular external fixator, is a rigid frame made of stainless steel and aluminum. It contains three rings that surround the foot and lower calf. The rings have stainless-steel pins that extend to the foot and secure the bones after surgery. Patients are able to walk or at least bear some weight on the treated leg, and the device is removed after two or three months.
Pinzur treats about 75 Charcot patients each year with external fixators. A 2007 study by Pinzur found that after treatment, 24 of 26 patients had no ulcers or bone infections and were able to walk without braces.
Charcot foot typically occurs after a minor injury, such as a sprain or stress fracture.
An increase in morbidly obese diabetics is causing more new cases of Charcot foot. But a surgical technique that secures foot bones with an external frame has enabled more than 90% of patients to walk normally again, according to Loyola University Health System foot and ankle surgeon Michael Pinzur, MD, in an article in the journal Hospital Practice.
The device, called a circular external fixator, is a rigid frame made of stainless steel and aluminum. It contains three rings that surround the foot and lower calf. The rings have stainless-steel pins that extend to the foot and secure the bones after surgery. Patients are able to walk or at least bear some weight on the treated leg, and the device is removed after two or three months.
Pinzur treats about 75 Charcot patients each year with external fixators. A 2007 study by Pinzur found that after treatment, 24 of 26 patients had no ulcers or bone infections and were able to walk without braces.
Charcot foot typically occurs after a minor injury, such as a sprain or stress fracture.
New Surgery Improves Flat Foot Outcomes
A new surgery developed at the Hospital for Special Surgery in New York can improve outcomes in patients with severe adult flat foot deformity, according to a study presented at the annual meeting of the American Orthopaedic Foot and Ankle Society.
In the surgery for stage IV deformity, surgeons not only reconstruct the flat foot deformity, but they also reconstruct the deltoid ligament using the peroneus longus tendon or a cadaver tendon.
In stage I of the deformity, the tendon that runs along the inside of the ankle begins to degenerate. In stage II, the arch starts to fail, and a person develops a more severe case of flat foot. As the arch continues to collapse and the flat foot becomes more pronounced, mobility becomes difficult, and the foot becomes stiff, which is considered stage III. In stage IV, the most severe stage, the ankle starts tilting and is at risk of developing arthritis as a result of the deformity.
In the study, investigators conducted the new surgery in five patients, four men and one woman, with a mean age of 67 years. X-rays showed the surgery improved the alignment in the ankle and the effects were long-lasting. Patients had excellent mobility at eight to 10 years after the surgery.
Physicians also measured outcomes through several questionnaires including the Foot and Ankle Orthopedic Survey. The average FAOS scores (on a scale of 0-100, with 100 indicating no problems) were 61.4 for symptoms, 1.5 for stiffness, 78.3 for pain, 87.9 for function/daily living, 71.7 for function/sports/recreational activities, and 42.1 for quality of life.
A new surgery developed at the Hospital for Special Surgery in New York can improve outcomes in patients with severe adult flat foot deformity, according to a study presented at the annual meeting of the American Orthopaedic Foot and Ankle Society.
In the surgery for stage IV deformity, surgeons not only reconstruct the flat foot deformity, but they also reconstruct the deltoid ligament using the peroneus longus tendon or a cadaver tendon.
In stage I of the deformity, the tendon that runs along the inside of the ankle begins to degenerate. In stage II, the arch starts to fail, and a person develops a more severe case of flat foot. As the arch continues to collapse and the flat foot becomes more pronounced, mobility becomes difficult, and the foot becomes stiff, which is considered stage III. In stage IV, the most severe stage, the ankle starts tilting and is at risk of developing arthritis as a result of the deformity.
In the study, investigators conducted the new surgery in five patients, four men and one woman, with a mean age of 67 years. X-rays showed the surgery improved the alignment in the ankle and the effects were long-lasting. Patients had excellent mobility at eight to 10 years after the surgery.
Physicians also measured outcomes through several questionnaires including the Foot and Ankle Orthopedic Survey. The average FAOS scores (on a scale of 0-100, with 100 indicating no problems) were 61.4 for symptoms, 1.5 for stiffness, 78.3 for pain, 87.9 for function/daily living, 71.7 for function/sports/recreational activities, and 42.1 for quality of life.
Early ACL Reconstruction Not Superior to Delayed
In young, active adults with acute anterior cruciate ligament tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction, according to a randomized, controlled trial by Lund (Sweden) University researchers. The latter strategy substantially reduced the frequency of surgical reconstructions.
The primary outcome of the trial, involving 121 young, active adults with acute ACL injuries, was the change from baseline to two years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score — pain, symptoms, function in sports and recreation, and knee-related quality of life (range of scores, 0 [worst] to 100 [best]).
Of 62 subjects assigned to rehabilitation plus early ACL reconstruction, one did not undergo surgery. Of 59 assigned to rehabilitation plus optional delayed ACL reconstruction, 23 underwent delayed ACL reconstruction; the other 36 underwent rehabilitation alone. The absolute change in the mean KOOS4 score was 39.2 points for those assigned to rehabilitation plus early ACL reconstruction and 39.4 for those assigned to rehabilitation plus optional delayed reconstruction.
In young, active adults with acute anterior cruciate ligament tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction, according to a randomized, controlled trial by Lund (Sweden) University researchers. The latter strategy substantially reduced the frequency of surgical reconstructions.
The primary outcome of the trial, involving 121 young, active adults with acute ACL injuries, was the change from baseline to two years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score — pain, symptoms, function in sports and recreation, and knee-related quality of life (range of scores, 0 [worst] to 100 [best]).
Of 62 subjects assigned to rehabilitation plus early ACL reconstruction, one did not undergo surgery. Of 59 assigned to rehabilitation plus optional delayed ACL reconstruction, 23 underwent delayed ACL reconstruction; the other 36 underwent rehabilitation alone. The absolute change in the mean KOOS4 score was 39.2 points for those assigned to rehabilitation plus early ACL reconstruction and 39.4 for those assigned to rehabilitation plus optional delayed reconstruction.
Exercise Guidelines for PAD Patients Offered
The Vascular Disease Foundation announced the launch of its free “Peripheral Arterial Disease Exercise Training Toolkit: A Guide for Health Care Professionals.” The toolkit was developed jointly with the American Association of Cardiovascular and Pulmonary Rehabilitation and may be accessed online at vdf.org/rehab-toolkit/index.php.
The resource offers health professionals information on developing supervised exercise programs for patients with intermittent claudication. Clinical practice guidelines for adults with PAD stress the importance of supervised exercise to improve functional capacity, decrease symptoms and achieve systemic risk-reduction benefits.
The Vascular Disease Foundation announced the launch of its free “Peripheral Arterial Disease Exercise Training Toolkit: A Guide for Health Care Professionals.” The toolkit was developed jointly with the American Association of Cardiovascular and Pulmonary Rehabilitation and may be accessed online at vdf.org/rehab-toolkit/index.php.
The resource offers health professionals information on developing supervised exercise programs for patients with intermittent claudication. Clinical practice guidelines for adults with PAD stress the importance of supervised exercise to improve functional capacity, decrease symptoms and achieve systemic risk-reduction benefits.
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Monday August 16, 2010