January 30, 2019

It’s not all sunshine and roses: Closing the rehab gap

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By Christopher S. Walter, PT, DPT, PhD
AGEC Geriatric Fellow
Assistant Professor
Department of Physical Therapy
University of Arkansas for Medical Sciences – Fayetteville

 

Have you ever considered that your current treatment of drug therapies is not working for you? If you have, you aren’t alone. In fact, the top-ten highest grossing drugs in the United States only benefit 4-33% of the people who take them1.  Unfortunately, research suggests that motor rehabilitation therapies are no different2.

Rehabilitation is the action of restoring someone to health or normal life through therapy after an injury, illness, or disease process. Generally speaking, we know that rehab works.  For example, an individual who gets therapy following an injury (e.g., fractured hip, stroke, etc.) is more likely to improve faster, and to a greater extent, than someone who does not get therapy.  This is good news for those getting therapy and those in the rehab field.  However, a closer, individualized look at the process shows that it’s not all sunshine and roses. Some individuals have very good results after rehabilitation, while others show little to no improvement2.  This problem is made worse by the fact that the rehab clinician (i.e., physical therapist, occupational therapist, and/or other allied healthcare provider) is unable to predict who might or might not respond to therapy.

The problem is clear; the solution is not.  Science has yet to develop a process that predicts who will respond to therapy and who will not respond.  We do know that age is a factor.  The older the patient, the less they respond to the given therapies3-5.

There is good news, though. Just because an individual does not respond to one intervention does not mean he/she will not respond to all interventions.   To put this into perspective, consider the following example.  If a medication prescribed by your doctor to lower your cholesterol does not have the desired effect, your doctor could 1) prescribe a larger dose of that medication, or 2) choose a different drug all together.  The goal to lower cholesterol is the same only the method has changed.   Rehabilitation is no different.

There are steps that rehab therapists and professionals can take to ensure that therapy is successful for as many people as possible. First, our treatments should only be selected after thoughtful examination of the patient’s individual characteristics. Further, it is important that our interventions are evidence based with documented effectiveness.  This is where we need your help. You can help by signing up to be a participant in rehab research trials.  Reach out to the local university to see if there is an open study for people like yourself.  Additionally, ARresearch.org is a secure website that allows the community a first-hand look at the research being conducted at UAMS.  Volunteers can provide their information if interested in participating in research. The researchers are then able to contact potential volunteers for their studies.

The goal of rehabilitation is to restore health and quality of life following an injury. To meet this goal, rehab professionals must work to identify characteristics that separate those who will respond to therapy from those who will not.  With passionate professionals and an enthusiastic community willing to volunteer, we can close the gap on rehab success.

 

 

  1. Schork NJ. Personalized medicine: Time for one-person trials. Nature. 2015;520:609-611.
  2. Winstein C. Translating the Science into Neurorehabilitation Practice: Challenges and Opportunities (The Kenneth Viste, Jr. MD Lecture). American Society of Neurorehabilitation Annual Meeting. Washington, DC.2013.
  3. Dobkin BH, Nadeau SE, Behrman AL, et al. Prediction of responders for outcome measures of locomotor Experience Applied Post Stroke trial. J Rehabil Res Dev. 2014;51:39-50.
  4. Rodeghero JR, Cleland JA, Mintken PE, Cook CE. Risk stratification of patients with shoulder pain seen in physical therapy practice. J Eval Clin Pract. 2017;23:257-263.
  5. Walter CS, Hengge CR, Lindauer BE, Schaefer SY. Declines in motor transfer following upper extremity task-specific training in older adults. Exp Gerontol. 2018;116:14-19.