ProfilePoints™ measure the overall completeness of a provider's profile, including items like having a photo, a biography, insurance, payment options, etc. A full breakdown of points can be seen by providers with Doctor.com accounts when editing their profile on Doctor.com. By showing providers with higher ProfilePoints™ first, we make it easier for you to quickly identify the most informative profiles on Doctor.com Description Treatment may include active and passive modalities using a variety of means and techniques based upon biomechanical and neurophysiological principles. Policy Policy Guidelines
Augmented soft tissue mobilization is considered INVESTIGATIONAL because it has not been proven to be more effective than standard soft tissue mobilization. There is no reliable evidence that outcomes of soft tissue mobilization (myofascial release) are improved with the use of hand-held tools (so-called "augmented soft tissue mobilization"). Kinesio taping/taping is considered INVESTIGATIONAL for all conditions because its clinical value has not been established. MEDEK therapy is considered INVESTIGATIONAL because its clinical value has not been established. Hands-free ultrasound and low-frequency sound (infrasound) are considered INVESTIGATIONAL because their clinical values have not been established. Hivamat therapy (deep oscillation therapy) is considered INVESTIGATIONAL because its clinical value has not been established. NOTE: Homebound status is defined as an individual who normally would be able to leave the home, but due to illness or injury, leaving the home will now require considerable and taxing effort. An aged person who does not travel from his or her home because of feebleness and insecurity brought on by advanced age is NOT considered homebound. PLEASE SEE CAM 191 MEDICAL RECORDS DOCUMENTATION STANDARDS. Benefit Application Many Plans have visit or dollar maximums for PT services, or these services may be provided as a separate contractual benefit. Sessions
Plan of Care
Rationale
See also: Research was limited to English-language journals on humans. Augmented Soft Tissue Mobilization: In a case report, Melham et al. (1998) described their finding on the use of ASTM in the treatment of excessive scar tissue around an athlete's injured ankle. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, ASTM was administered. It used ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis, followed by a stretching and strengthening program. Upon the completion of six weeks of ASTM, the athlete had no pain and had regained full range of motion and function. Kinesio Taping/Taping: Halseth et al. (2004) examined whether Kinesio taping the anterior and lateral portion of the ankle would enhance ankle proprioception compared to the untaped ankle. A total of 30 subjects (15 men, 15 women, aged 18 to 30 years) participated in this study. Exclusion criteria included ankle injury less than six months before testing, significant ligament laxity as determined through clinical evaluation or any severe foot abnormality. Experiment used a single group, pre-test and post-test. Plantar flexion and inversion with 20° of plantar flexion reproduction of joint position sense (RJPS) was determined using an ankle RJPS apparatus. Subjects were bare-footed, blind-folded and equipped with headphones playing white noise to eliminate auditory cues. They had five trials in both plantar flexion and inversion with 20° plantar flexion before and after application of the Kinesio tape to the anterior/lateral portion of the ankle. Constant error and absolute error were determined from the difference between the target angle and the trial angle produced by the subject. The treatment group (Kinesio-taped subjects) showed no change in constant and absolute error for ankle RJPS in plantar flexion and 20º of plantar flexion with inversion when compared to the untaped results using the same motions. The application of Kinesio tape does not appear to enhance proprioception (in terms of RJPS) in healthy individuals as determined by measures of RJPS at the ankle in the motions of plantar flexion and 20º of plantar flexion with inversion. The authors stated that in order to fully understand the effect of Kinesio tape on proprioception, further research needs to be conducted on other joints, on the method of application of Kinesio tape and the health of the subject to whom it is applied. In addition, further research may provide vital information about a possible benefit of Kinesio taping during the acute and sub-acute phases of rehabilitation, thus facilitating earlier return to activity participation. In a pilot study, Yasukawa and colleagues (2006) described the use of the Kinesio taping method for the upper extremity in enhancing functional motor skills in children admitted into an acute rehabilitation program. A total of 15 children (10 females and five males, 4 to 16 years of age), who were receiving rehabilitation services at the Rehabilitation Institute of Chicago, participated in this study. For 13 of the inpatients, this was the initial rehabilitation following an acquired disability, which included encephalitis, brain tumor, cerebral vascular accident, traumatic brain injury and spinal cord injury. The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to measure upper-limb functional change prior to use of Kinesio tape, immediately after application of the tape and three days after wearing tape. Children's upper-limb function was compared over the three assessments using analysis of variance. The improvement from pre- to post-taping was statistically significant, F(1, 14) = 18.9; p < 0.02. The authors concluded that these results suggested that Kinesio tape may be associated with improvement in upper-extremity control and function in the acute pediatric rehabilitation setting. The use of Kinesio tape as an adjunct to treatment may assist with the goal-focused occupational therapy treatment during the child's inpatient stay. Moreover, they stated that further study is recommended to test the effectiveness of this method and to determine the lasting effects on motor skills and functional performance once the tape is removed. In a pilot study, Fu and associates (2008) examined the possible immediate and delayed effects of Kinesio taping on muscle strength in quadriceps and hamstring when taping is applied to the anterior thigh of healthy young athletes. A total of 14 healthy young athletes (seven males and seven females) free of knee problems were enrolled in this study. Muscle strength of the subject was assessed by the isokinetic dynamometer under three conditions: (i) without taping; (ii) immediately after taping; (iii) 12 hours after taping with the tape remaining in situ. The result revealed no significant difference in muscle power among the three conditions. Kinesio taping on the anterior thigh neither decreased nor increased muscle strength in healthy non-injured young athletes. In a prospective, randomized, double-blinded, clinical study using a repeated-measures design, Thelen et al. (2008) determined the short-term clinical efficacy of Kinesio tape when applied to college students with shoulder pain, as compared to a sham tape application. A total of 42 subjects with clinically diagnosed rotator cuff tendonitis and/or impingement were randomly assigned to one of two groups: therapeutic Kinesio tape group or sham Kinesio tape group. Subjects wore the tape for two consecutive three-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to evaluate for differences between groups. The therapeutic Kinesio tape group showed immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9 degrees +/- 23.2 degrees; p = 0.005) after tape application. No other differences between groups regarding ROM, pain or disability scores at any time interval were found. The authors concluded that Kinesio tape may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Use of Kinesio tape for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported. McConnell (2002) noted that the management of chronic low back pain (LBP) and leg pain has always provided a challenge for therapists. This researcher examined the influence of a repetitive movement such as walking as a possible causative factor of chronic LBP. Diminished shock absorption, as well as limited hip extension and external rotation, are hypothesized to affect the mobility of the lumbar spine, resulting in lumbar spine dysfunction. Treatment must therefore be directed not only at increasing the mobility of the hips and thoracic spine, but also the stability of the lumbar spine. However, the symptoms can sometimes be exacerbated by treatment, so the neural tissue needs to be unloaded to optimize the treatment outcome. This can be achieved by taping the buttock and down the leg following the dermatome to shorten the inflamed tissue. While taping has a role in the management of musculoskeletal pain and injuries, its use in the management of LBP has not been established. In a review of LBP in athletes, Baker and Patel (2005) stated that most of the adult population experiences LBP at some time in life. Athletes may be at increased risk, but outcomes are good. The majority of LBP in adult athletes is mechanical in nature. Herniated discs, spinal stenosis, sacoilitis and sacral stress fractures can also cause LBP in these individuals. Low back conditions mentioned above may be treated with rest, medication, as well as specific exercise programs. Surgery is indicated for severe spinal stenosis, pain with evidence of neurological compromise and some painful deformities. Newer treatments for back pain are emerging, but few controlled clinical trials are available. Taping was not mentioned as an option for managing individuals with LBP. Additionally, in a review of current concepts in the diagnosis and treatment of spondylolysis, McCleary and Congeni (2007) noted that treatment usually consists of rest and/or bracing to allow healing to occur, followed by rehabilitation that includes core strengthening. They stated that more large-scale controlled studies are needed to clarify the most effective diagnostic and therapeutic protocols. Furthermore, in reviews of treatment for subacute and chronic LBP (Chou, 2009) and occupational LBP (Kraeciw and Atlas, 2009), as well as review of rehabilitation program for the low back (Sheon and Duncombe, 2009), taping is not mentioned as an option. Greig et al. (2008) noted that greater thoracic kyphosis is associated with increased biomechanical loading of the spine, which is potentially problematic in individuals with osteoporotic vertebral fractures. Conservative interventions that reduce thoracic kyphosis warrant further investigation. These researchers examined the effects of therapeutic postural taping on thoracic posture. Secondary aims explored the effects of taping on trunk muscle activity and balance. A total of 15 women with osteoporotic vertebral fractures participated in this within-participant design study. Three taping conditions were randomly applied: (i) therapeutic taping, (ii) control taping and (iii) no taping. Angle of thoracic kyphosis was measured after each condition. Force plate-derived balance parameters and trunk muscle electromyographic activity (EMG) were recorded during three static standing tasks of 40-second duration. There was a significant main effect of postural taping on thoracic kyphosis (p = 0.026), with a greater reduction in thoracic kyphosis after taping, compared with both control tape and no tape. There were no effects of taping on EMG or balance parameters. The authors concluded that these findings showed that the application of postural therapeutic tape in a population with osteoporotic vertebral fractures induced an immediate reduction in thoracic kyphosis. They stated that further research is needed to investigate the underlying mechanisms associated with this decrease in kyphosis. The American College of Occupational and Environmental Medicine's practice guidelines on "Evaluation and management of common health problems and functional recovery in workers" (Hegmann, 2007) did not recommend taping or Kinesio taping for acute, subacute or chronic LBP, radicular pain syndromes or other back-related conditions. González-Iglesias et al. (2009) examined the short-term effects of Kinesio taping, applied to the cervical spine, on neck pain and cervical ROM in individuals with acute whiplash-associated disorders (WADs). A total of 41 patients (21 females) were randomly assigned to one of two groups: (i) the experimental group received Kinesio taping to the cervical spine (applied with tension), and (ii) the placebo group received a sham Kinesio taping application (applied without tension). Both neck pain (11-point numerical pain rating scale) and cervical ROM data were collected at baseline, immediately after the Kinesio tape application and at a 24-hour follow-up by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. The group-by-time interaction for the two-by-three mixed-model ANOVA was statistically significant for pain as the dependent variable (F = 64.8; p < 0.001), indicating that patients receiving Kinesio taping experienced a greater decrease in pain immediately post-application and at the 24-hour follow-up (both, p < 0.001). The group-by-time interaction was also significant for all directions of cervical ROM: flexion (F = 50.8; p < 0.001), extension (F = 50.7; p < 0.001), right (F = 39.5; p < 0.001) and left (F = 3.8, p < 0.05) lateral flexion, and right (F = 33.9, p < 0.001) and left (F = 39.5, p < 0.001) rotation. Patients in the experimental group obtained a greater improvement in ROM than those in the control group (all, p < 0.001). The authors concluded that patients with acute WAD receiving an application of Kinesio taping, applied with proper tension, exhibited statistically significant improvements immediately following application of the Kinesio tape and at a 24-hour follow-up. However, the improvements in pain and cervical ROM were small and may not be clinically meaningful. They stated that future studies should investigate if Kinesio taping provides enhanced outcomes when added to physical therapy interventions with proven efficacy or when applied over a longer period. In a single-center, randomized and double-blind study, Karadag-Saygi and colleagues (2010) evaluated the effect of Kinesio taping as an adjuvant therapy to botulinum toxin A (BTX-A) injection in lower extremity spasticity. A total of 20 hemiplegic patients with spastic equinus foot were enrolled into the study and randomized into two groups. The first group (n = 10) received BTX-A injection and Kinesio taping, and the second group (n = 10) received BTX-A injection and sham taping. Clinical assessment was done before injection and at two weeks and one, three and six months. Outcome measures were modified Ashworth scale (MAS), passive ankle dorsiflexion, gait velocity and step length. Improvement was recorded in both kinesiotaping and sham groups for all outcome variables. No significant difference was found between groups other than passive range of motion (ROM), which was found to have increased more in the kinesio-taping group at two weeks. The authors concluded that there is no clear benefit in adjuvant Kinesio taping application with botulinum toxin for correction of spastic equinus in stroke. In a pilot feasibility study, Kalichman and colleagues (2010) evaluated the effect of Kinesio taping treatment approach on meralgia paresthetica (MP) symptoms. Men (n = 6) and women (n = 4) with clinically and electromyographically diagnosed MP received application of Kinesio tape, twice weekly for four weeks (eight treatment sessions in total). Main outcome measures were visual analog scale (VAS) of MP symptoms (pain/burning sensation/paresthesia), VAS global quality of life (QOL) and the longest and broadest parts of the symptom area were measured. All outcome measures significantly improved after four weeks of treatment. Mean VAS QOL +/- SD decreased from 69.0 +/- 23.4 to 35.3 +/- 25.2 (t = 4.3; p = 0.002). Mean VAS of MP symptoms +/- SD decreased from 60.5 +/- 20.8 to 31.4 +/- 26.6 (t = 5.9; p > 0.001). Length and width of affected area decreased from 25.5 +/- 5.5 to 13.7 +/- 6.7 (t = 5.1; p > 0.001) and 15.3 +/- 2.1 to 7.4 +/- 4.3 (t = 5.3; p >.001), respectively. The authors concluded that Kinesio taping can be used in the treatment of MP. Moreover, they stated that future randomized, placebo-controlled trials should be designed with patients and assessors blind to the type of intervention. Kaya et al. (2011) compared the effectiveness of Kinesio tape and physical therapy modalities in patients with shoulder impingement syndrome. Patients (n = 55) were treated with Kinesio tape (n = 30) three times by intervals of three days or a daily program of local modalities (n = 25) for two weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder and Hand scale. Patients were questioned for night pain, daily pain and pain with motion. Outcome measures, except for the Disability of Arm, Shoulder and Hand scale, were assessed at baseline, first and second weeks of the treatment. Disability of Arm, Shoulder and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder and Hand scale and VAS scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night and movement median pain scores of the Kinesio taping (20, 40 and 50, respectively) group were statistically significantly lower (p values were 0.001, 0.01 and 0.001, respectively) at the first week examination as compared with the physical therapy group (50, 70 and 70, respectively). However, there was no significant difference in the same parameters between the two groups at the second week (0.109, 0.07 and 0.218 for rest, night and movement median pain scores, respectively). Disability of Arm, Shoulder and Hand scale scores of the Kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. The authors stated that Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome, especially when an immediate effect is needed. The findings of this small study need to be validated by well-designed studies. Ankle sprains are common in sports, and the fibularis muscles play a role in providing functional stability of the ankle. Prophylactic ankle taping with non-elastic sports tape has been used to restrict ankle inversion, while Kinesio tape is elastic and has not been studied for that purpose. In a controlled study, Briem and colleagues (2011) examined the effect of two adhesive tape conditions compared to a no-tape condition on muscle activity of the fibularis longus during a sudden inversion perturbation in male athletes (soccer, team handball, basketball). A total of 51 male premier-league athletes were tested for functional stability of both ankles with the Star Excursion Balance Test. Based on the results, those with the 15 highest and those with the 15 lowest stability scores were selected for further testing. Muscle activity of the fibularis longus was recorded with surface electromyography during a sudden inversion perturbation. Each participant was tested under three conditions: (i) with the ankle taped with non-elastic, white sports tape, (ii) Kinesio tape and (iii) with no tape. Differences in mean muscle activity were evaluated with a three-way mixed model ANOVA for the three conditions across four 500-ms time-frames (within subject factors) and between the two groups of stable versus unstable participants (between subjects factor). Differences in peak muscle activity and in the time to peak muscle activity were evaluated with a two-way mixed model ANOVA for the three conditions (within subjects factor), between the two groups (between subjects factor). Significantly greater mean muscle activity was found when ankles were taped with non-elastic tape compared to no tape, while Kinesio tape had no significant effect on mean or maximum muscle activity compared to the no-tape condition. Neither stability level nor taping condition had a significant effect on the amount of time from perturbation to maximum activity of the fibularis longus muscle. The authors concluded that non-elastic sports tape may enhance dynamic muscle support of the ankle. The efficacy of Kinesio tape in preventing ankle sprains via the same mechanism is unlikely, as it had no effect on muscle activation of the fibularis longus. MEDEK Therapy: Hands-Free
Ultrasound: Hivamat Therapy (Deep Oscillation
Therapy): Aliyev (2009) noted that in Germany, approximately 2 million sports injuries occur per year. Most common are distortions and ligamentous injury going along with post-traumatic lymphedema. Deep oscillation therapy provided very good results in lymph drainage and in other indications. The purpose of this experimental study was the evaluation of the effects of deep oscillation therapy in immediate therapy and after-care of different sports injuries in addition to usual care (complex physical and medical therapy). Two soccer teams were supported by a sports medicine section of a rehabilitation hospital. In 14 people (mean age of 23.9 years), 49 sports injuries of different kinds were treated. Subjective rating of the symptoms by VAS improved significantly (p = 0.001) from 8.7 (baseline) to 2.1 points (post-treatment). Objective rating by the attending physician according to different clinically relevant parameters led to "very good" or "good" results in 90 percent of the patients. The authors concluded that deep oscillation therapy is an easy to use and comparably cost-effective adjuvant therapy option. These investigators already had good experience with it in other indications concerning re-absorption of edema, reducing pain, anti-inflammatory effect, promotion of motoricity, promotion of wound healing, anti-fibrotic effect and improvement in trophicity and quality of the tissue. All these mentioned effects can be confirmed in the treatment of patients with acute sports injury and trauma. The soft mode of action is the reason that in contrast to other electric and mechanical therapies it is no contraindication in immediate therapy. In general, the authors noted no side effects. Patients were highly compliant and rated this therapy as very good. Limitations of this small study (n = 14) were its retrospective and uncontrolled nature. Findings were also confounded by the concomitant use of usual care. Definitions:
Documentation Requirements: Therapeutic Procedure(s): CPT Codes 97110 through 97564. Timed Codes: Those modalities and therapeutic procedures that contain the phrase "each 15 minutes" in their code descriptors. For example, CPT Code is a timed code. The descriptor for CPT Code 97110 reads "Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility." General Requirements
Treatment Notes/Patient Encounter Notes
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