Article by CA Speed in The Journal of Bone and Joint Surgery (British Volume)Posted by Jan R. on 6/03/04 at 12:09 (151898)
After all of have read Mrs. Buchbinders recommendations how to treat recalcitrant plantar fasciitis adequately please have a look at the differentiating view Prof. Speed gave in his review article on ESWT:
Extracorporeal shock-wave therapy in the management of chronic soft-tissue conditions.
J Bone Joint Surg Br. 2004;86:165-171.
'ESWT is a potentially helpful addition to the options for
the management of soft-tissue conditions. Currently, there
is evidence of benefit from some regimes of ESWT in calcific
tendonitis of the rotator cuff and chronic plantar fasciitis.
However, there is a need for further proper research into
the effects of ESWT on soft tissues, for randomised, controlled
trials in other soft-tissue conditions and investigation
of the technical factors relating to the treatment and
optimal regimes of dosage in specific conditions.'
I would appreciate your comments.
Re: Article by CA Speed in The Journal of Bone and Joint Surgery (British Volume)elliott on 6/03/04 at 13:12 (151903)
Dr. Jan R:
In case you are not aware that our situation may be different from yours, I'll point out that most of us here don't have access to professional medical journals, so it is difficult to offer the comment you seek when we cannot freely obtain the articles to which you refer. And no, I'm definitely not willing to pay $20 for this one.
Can I ask you something else? The Blues Tech document
had two main criticisms of your studies as evidence for ESWT efficacy for insurance purposes:
1) It claimed that there is such a big difference in the control group's improvement depending on whether it was a single-blind or double-blind study (e.g., 4% for the Rompe 2002 study vs. 47% for the Dornier 2002 FDA study; see text and table on page 9, and also last paragraph on pg 22) that it views single-blind studies as having a fatal flaw and hence they receive a 'poor' quality rating with regards to proving ESWT efficacy.
2) It gave the Rompe 2003 (running athletes) study only a 'fair' rating because an intent-to-treat analysis [what does that mean?] was not reported and that after the 6-week followup patients were permitted to undergo other treatments; see footnote, pg 12.
I am curious as to how do you respond to that. I am not looking for obscure references as an answer, just your own words on the matter, understandable to laymen. Thanks.
Re: Article by CA Speed in The Journal of Bone and Joint Surgery (British Volume)Ed Davis, DPM on 6/03/04 at 16:04 (151920)
Thank you as I had heard much talk about but did not have a copy of the document (Blue Cross/Blue Shield) itself.
Don't you find it a bit odd that the level of evidence being requested to approve a relatively harmless conservative treatment is so much more significant than that evidence it takes to cover a surgical procedure? The Blues give a greeen light to virtually any surgical procedure for any reason, no questions asked. Plantar fascial release surgery, poor track record and all, is paid for without question by most insurance companies. EPF hit the market and got the green light for reimbursement almost immediately.
Re: Article by CA Speed in The Journal of Bone and Joint Surgery (British Volume)Dr. Z on 6/03/04 at 16:07 (151921)
Re: Article by CA Speed in The Journal of Bone and Joint Surgery (British Volume)Ed Davis, DPM on 6/03/04 at 16:36 (151926)
Years ago there was so much litigation surrounding plantar fascial release surgery that the major hospital in San Diego, Sharps Memorial, instituted a policy that plantar fascial release surgery could not be performed at their hospital if it was not shown that at least one year of conservative treatment was applied first.
The insurance industry marches to a different 'drummer' and is literally answerable to no one in its actions. It can make arbitrary coverage decisions without consequence. There has always been a strong bias toward surgery in the insurance industry.
Lets face it, you and I could probably do a decent plantar fascial release blindfolded, collect about $750 to $900 for less than 10 minutes worth of work and not have any grief from the third parties. It takes a few of us to get out there and speak up. It is too bad the insurers have so much power and immunity from liability for their bad decisions.
Re: Article by CA Speed in The Journal of Bone and Joint Surgery (British Volume)Dr. Z on 6/03/04 at 16:47 (151932)
You are on the money !!