Special to OWM: Whirlpool Use Makes List of Top Five Practices PTs and Patients Should Question

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Barbara Zeiger

  At the invitation of the American Board of Internal Medicine (ABIM) Foundation to participate in Choosing Wisely®, an initiative to foster conversations between providers and patients regarding frequently performed healthcare procedures, the American Physical Therapy Association (APTA) created a list of five healthcare practices PTs and patients should question.

   Included with avoiding practices such as use of passive physical agents, under-dosing strength training based on age alone, recommending bed rest after anti-coagulation therapy in persons with deep vein thrombosis, and using continuous passive motion machines postoperatively in uncomplicated knee replacement is a fifth recommendation: Do not use whirlpools for wound management.

  ABIM approached APTA to participate in the project, the first nonphysician group to be solicited. The invitation to APTA’s 88,000+ members yielded 170 suggestions. An APTA expert workgroup of PTs representing a broad range of clinical expertise, practice settings, and patient populations selected nine suggestions for extensive literature review of the evidence base. A modified Delphi technique was used to rank and prioritize the recommendations based on the Choosing Wisely criteria. APTA members then were surveyed and asked to select the top five questionable procedures. Underscoring the role of PTs in wound management, whirlpool use for wound care was noted to do more harm than good.

  Anthony Delitto, PhD, PT, FAPTA, Professor, Department of Physical Therapy; and Associate Dean for Research, School of Health and Rehabilitation Sciences, University of Pittsburgh (PA); and Choosing Wisely Workgroup Chair, summarized the literature: “Whirlpool offers a nonselective form of mechanical debridement. Utilizing whirlpools to treat wounds predisposes the patient to risks of bacterial cross-contamination (both patient-to-patient and to different areas of a single patient’s body); damage to fragile tissue from high turbine forces; and complications in extremity edema when arms and legs are treated in a dependent position in warm water.” He noted the literature supports use of other more selective forms of hydrotherapy, such as directed wound irrigation or pulsed lavage with suction.

  The final list was presented to the APTA Board of Directors for approval. The list was released September 15. The full article on the suggestion process and the five practices PTs and patients should avoid will be published in an upcoming issue of APTA’s journal. For more information about ABIM, visit www.abimfoundation.org. For more information about APTA, visit www.apta.org. For lists from additional medical specialties, visit www.choosingwisely.org.

HMP Author One of Top Ten Nutritionists to Follow

  HMP Communications, LLC proudly announces Nancy Collins, PhD, RDN, LD, FAPWCA, FAND, was recognized by the Eco Friendly Foods Initiative (EFFI) as one of the Top 30 nutritionists to follow on Twitter. Dr. Collins is Number 9.

  Dr. Collins is the author of Nutrition 411, a frequent column in Ostomy Wound Management; a regular speaker at the Symposium on Advanced Wound Care and other national conferences; and author of numerous feature articles that have appeared in OWM and ECPN (the latter a former HMP publication) and other acclaimed journals. In addition, HMP recently acquired Dr. Collins’ website, nutrition411.com, a well-respected, vibrant digital resource designed for healthcare professionals who integrate diet and nutrition into patient consultations. HMP is excited to assimilate this valuable nutrition portal across several of its healthcare departments to provide healthcare professionals unparalleled access to nutrition, dietetics, and culinary medicine education.

  Among the other professionals acknowledged by EFFI are Joy Bauer, the health and nutrition expert for NBC’s TODAY Show, Dr. Mehmet Oz (The Dr. Oz Show), and Dr. Andrew Weil, an internationally recognized expert on integrative medicine.

  Barbara Zeiger, OWM editor and long-time colleague of Dr. Collins, commented, “Dr. Collins is the consummate professional, constantly seeking innovative ways to proliferate the latest information in her field. She will probably view this well-deserved honor as incentive for creating more opportunities to get the word out about the importance of good nutrition to health and healing.”

  For more information about the Top 30 nutritionists to follow, please visit: www.effifoods.com.

This article was not subject to the Ostomy Wound Management peer-review process.