martedì 28 maggio 2013

A cost-effective rehabilitation: the CPM therapy as first step for knee and shoulder rehabilitation

Economic and physical benefits of CPM therapy for lower and upper limbs
"Concrete" usefulness of continuos passive motion methodology


After joint surgery, the range of motion is the first function to regain, according. Generally surgeons prescribe continuous passive motion (CPM) because enable patients to get back quickly-or never lose-good motion, for example for outpatients shoulder surgeries and instability cases: it is also used CPM following distal clavicle excisions and acromioplasties, if a rotator cuff repair is not done.

Generally, procedures that are high risk for developping stiffness are recommended to be treated prescribing CPM following total knee replacements, ligament reconstructions, and fractures. CPM has also produced significant benefits following newer articular cartilage resurfacing procedures that result from isolated chip fractures on the ends of bone. CPM not only helps prevent stiffness, but promotes nutrition of the articular cartilage that you are trying to heal.

The benefits of CPM are recognized, although quantifying its value has been difficult. Its use early in recovery, has a significant impact overall. People who use CPM very early versus those who do not, can verify theirselves a quicker, less costly rehab process.

CPM keeps the joint region stretched and warm, increasing blood flow and elasticity. It has been verified that patients get their motion back faster, and they are off crutches sooner. They also find that it relaxes the area and provides pain relief. Patients are recommended to spend 4 to 6 hours a day in the machine

Additional increased motion and stretching exercises are demonstrated to patients during visits in the first and third weeks following surgery. With good motion after the first 3 weeks following the procedure, patients are well ahead in the healing curve when they begin physical therapy. Up until that time, patients should not be doing any active motion, just passive motion and stretching.

Studies have also been unreliable in determining CPM's impact on healing the joint.
Most have looked at patients 1 or 2 years after surgery, another mistake according to these physicians. Accurate short-term studies require testing a single surgical procedure, as well as splitting patients into those who receive and those who do not receive CPM. Studies have shown CPM's value in pain reduction and its benefits after certain procedures: in fact they have showed that CPM therapy is beneficial for articular cartilage healing.

Economics reasons to support CPM therapy

The ability to shorten recovery time by 2 months is significant in return-to-work claims. Getting a patient back to work in 3 months rather than 4 to 6 months is important to everyone:

1)      there is a huge amount of money saved;

2)      the patient is back and healthy

The end costs in time, pain management, and physical therapy are reduced. Some patients require very little or no physical therapy, just stretching and time in the CPM machine. Fighting that stiffness early also eliminates a setback in what PTs are trying to do-strengthen muscle around the joint. The result, benefits everyone.
Patients benefit because they are active in less time, payers pay less, and therapists end up with a patient at 6 to 8 weeks who has good passive motion.
In the past, managed care companies eyed CPM with cost-cutting scrutiny. The mistake, was thinking money saved by eliminating CPM would outweigh money saved in the duration of physical therapy or additional surgeries if scar tissue developed. Attaining 110° to 120° of motion prior to physical therapy is usually the goal, and while many procedures have become more packaged, CPM's use varies.


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