Managing musculoskeletal complaints with rehabilitation therapy: Summary of the Philadelphia Panel evidence-based clinical practice guidelines on musculoskeletal rehabilitation interventions
The Journal of Family Practice. 2002 December;51(12):1042-1046
GEOFFREY R. HARRIS, MD JEFFREY L. SUSMAN, MD Cincinnati, Ohio From the Kaiser Foundation Research Institute, Oakland, California, and the Prostitution Research and Education, San Francisco Women’s Centers, Inc., San Francisco, California (M.F); Institute for Health & Aging, University of California, San Francisco (J.M.G.); Kaiser Permanente Family Medicine Services, Division of Endocrinology, Santa Rosa, California, and the Department of Family and Community Medicine, University of California, San Francisco (J.R.M.). This project was sponsored by the Direct Community Benefit Investment Program, Kaiser Foundation Hospitals California Division, and the Kaiser Foundation Research Institute. An earlier version of this paper was presented at the 109th annual meeting of the American Psychological Association, San Francisco, August 25, 2001. Please address requests for reprints to Jerome R. Minkoff, MD, Kaiser Permanente Family Medicine Services, Division of Endocrinology, 401 Bicentennial Way, Santa Rosa, CA 95403. E-mail: Jerry.Minkoff@kp.org.
In future studies, it will be necessary to specifically clarify the type and manner of an intervention, intervention intensity and duration, and progression of the intervention according to patient-specific outcomes. Further, a patient typically receives several rehabilitation interventions during a therapy session. These modalities change depending on the phase of recovery (ie, ice, rest, and compression initially, evolving to strengthening, stretching, and electrotherapy with progress). A more thorough means of standardizing this progression in a patient’s care is needed.
In addition, the guidelines did not address cost, patient preferences, or potential harm associated with each intervention for the specific conditions.
Overall, there is a pressing need for further work in the study of rehabilitation interventions, due especially to the increased use of physical therapy for the management of low back pain, knee pain, neck pain, and shoulder pain.
