Therapy for osteoporosis patients may be new trend in rehabilitation care
Multidisciplinary approach works for Maine facility
Osteoporosis is one of the most prevalent and expensive disabling diseases to strike the elderly, resulting in more than 1.5 million fractures each year and costing about $38 million per day in direct health care expenditures, according to the National Osteoporosis Foundation in Washington, DC. Yet, there’s been little interest among rehab providers in developing a specialized rehab therapy program.
That oversight is beginning to change. MaineGeneral Rehabilitation Services in Augusta has developed a new multidisciplinary osteoporosis program that includes physical therapy, occupational therapy, nutrition counseling, and consults with physiatrists when needed.
"The idea of the program is to educate people in medication aspects of their diagnosis and other options as well as nutrition counseling and exercise," says Cathy Bourque, PT, MBA, rehab manager for the facility, which is part of the MaineGeneral Medical Center. The osteoporosis programs provide patients with information about adaptive equipment, fall prevention, and home modifications, Bourque adds.
The rehab facility began the program at the suggestion of the medical director, who noted that while a large part of the patient population had the disease and would benefit from a combination of medication, education, and exercises, no such programs were available locally, Bourque says. "I think the diagnosis of osteoporosis is becoming more common," Bourque says. "A lot of people being diagnosed with osteoporosis seem to be advocates for their own health, and they are looking into options and things that can be done to help manage the situation."
The program’s therapy is designed specifically for patients with the bone disease, and the algorithm for the program is based on exercises taught by Sara Meeks Physical Therapy in Gainesville, FL, Bourque says.
When Sara Meeks, PT, MS, GCS, owner of Sara Meeks Physical Therapy, began four years ago to check Internet web sites and other sources for lists of coursework offered to therapists dealing with patients who have osteoporosis, she found nothing available. Because Meeks has provided therapy to patients with osteoporosis for nearly two decades, she decided to start her own educational courses and has since taught physical therapists her techniques for helping these patients build their strength and endurance through exercise and physical therapy.
Therapists taking her courses come from rehab facilities, home care agencies, nursing homes, and other health care settings. The program’s curriculum includes the following components:
- overview of condition and bone density reports;
- risk factors and first signs;
- results of treatment;
- presentation of comprehensive program;
- exercises for postural correction;
- gait training;
- balance exercises;
- evaluation procedures;
- site-specific exercise program;
- patient education;
- scapular stabilization;
- physiorollers for stretching of hip and knee;
- performing strengthening and balancing exercises on the physioroller;
- treatment modalities;
- identified patterns of postural change;
- guidelines for exercise classes/gym programs.
Providing therapy to osteoporosis patients is a crucial part of a public health strategy to reduce fractures caused by falls, Meeks says. "There’s a terrific risk of fractures occurring throughout the population, and the cost to our health system is phenomenal," Meeks adds. "My mission is I’d like to see everybody in this entire country have the opportunity to go into a physical therapy facility or a gym and be given an exercise program that’s safe for them, and that’s not the case today."
The exercises Meeks recommends for osteoporosis patients differ from other physical therapy exercises because of the fragility of these patients’ bones. For example, there are no exercises in which an osteoporosis patient is asked to bend the body forward, touch toes, or rotate or side-bend the trunk. The initial exercise is a simple decompression exercise in which the patient lies on the floor with knees bent and feet flat and arms turned up. This is done once a day to take pressure off the patient’s spine. "I’m also a yoga teacher, and I think some principles of yoga have been incorporated in my program," Meeks says.
The MaineGeneral Rehabilitation osteoporosis program provides six to eight weeks of one-on-one physical therapy in which a patient’s exercise program progress is monitored. Patients referred to the program typically are over age 50 and have been diagnosed through a bone density scan as osteoporotic, having a standard deviation of greater than 2.5 on a bone density scan. Patients often have had compression fractures in their spines and might already show signs of stooping.
Initially, patients are evaluated by a physical therapist who uses a functional assessment screening tool. During the assessment, the physical therapist might find that an occupational therapist consultation is needed, so the therapist will call the referring physician’s office to discuss OT involvement.
Also, a grid camera side-view picture is taken of new patients when they begin the program and again when they complete the program so they can see how much they’ve improved their posture. "A lot of people don’t realize they’re bent forward until they see that picture," Bourque says. The evaluation examines posture deficits, muscular imbalances such as decreased strength and flexibility, and fall potential.
During PT sessions, patients are taught exercises that will benefit anyone with osteoporosis or who has problems with muscle imbalance, poor posture, and difficulty in doing activities of daily living, Bourque says. By the end of the program, patients typically have strengthened their muscles and improved their flexibility. "A lot of elderly people with osteoporosis tend to have tight hip flexors, and that’s an area we spend time working on," Bourque says. "To improve their posture they need flexibility."
All osteoporosis patients and interested family members may attend an occupational therapist’s educational session in which the OT discusses body mechanics, home modifications to prevent falls, and adaptive equipment. Another group discussion is led by a dietitian who talks about the importance of nutrition and answers questions about diet, vitamin supplements, and other nutrition-related issues.
The program, which began in February 2001, is too new to have any data regarding outcomes, but there apparently is considerable interest in its services, Bourque says. "We’ve passed out brochures in the community and in the hospital, and we’ve had a lot of patients call for information," she notes. "We also sent out a letter to all area physicians, and the hospital here sponsors a show on the local cable station talking about health issues, and we’re being scheduled to appear on that," Bourque adds.
Medicare reimburses for the therapy services, but the OT educational sessions are not billed. For a nutrition consult, the facility has to obtain a prescription from the physician, and then the dietitian does the billing, Bourque says. "We’re excited about the program, and the patients say they have been encouraged with their improvement," Bourque says.
Need more information?
• Cathy Bourque, PT, MBA, Rehab Manager, MaineGeneral Rehabilitation Services, 10 Caldwell Road, Augusta, ME 04330. Telephone: (207) 621-2488.
• Sara Meeks, PT, MS, GCS, Owner, Sara Meeks Physical Therapy, 1842 NE 7th St., Gainesville, FL 32609. Telephone: (888) 330-7272. World Wide Web: www.sarameekspt.com. E-mail: [email protected].
• National Osteoporosis Foundation, 1322 22nd St. NW, Washington, DC 20037-1292. Telephone: (202) 223-2226. World Wide Web: www.nof.org.
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