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Continuous Passive Motion
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Accreditation
OrthoRehab is accredited by the Community Health Accreditation Program (CHAP),
a national body that focuses exclusively on community and home health
care providers. CHAP accredited providers are committed to consumer choice and
involvement in the delivery of their health care. Accredited providers are continually
evaluated against CHAP’s “Standards of Excellence”, which challenges an organization
to excel in all areas of clinical and operational performance. It is because of this
commitment that many HMO’s, insurers, and government agencies require CHAP
Accreditation as a condition for doing business.
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Biological Concept of CPM
The originator of the biologic concept of continuous passive motion was
Robert B. Salter, OC, MD, MS, FRCSC, a pioneer in the field of orthopaedic surgery
who served as Chief of Orthopaedic Surgery at Toronto’s Hospital for Sick Children
for over forty years.
Dr. Salter has published more than 150 articles as well as a major textbook,
Diseases of the Musculo-Skeletal System. His honors include the 1969 Gairdner
International Award for Medical Science for his contributions to the understanding
of cartilage degeneration and necrosis of the epiphyseal plate, induction into the
Canadian Medical Hall of Fame, and the 1997 F.N.G. Starr Award, which is the highest
award the CMA can bestow upon a member.
Recognized as a world-renowned surgeon, teacher, and scientist, Dr. Salter now
serves as the surgeon-in-chief emeritus and senior orthopaedic surgeon emeritus at
the Hospital for Sick Children.
In 1994, Dr. Salter published The Physiologic Basis of Continuous Passive Motion
for Articular Cartilage Healing and Regeneration, in which he presented an overview
of the first 23 years of basic research on the biologic concept of CPM and the first 15
years of his experience with the clinical application of CPM to a variety of disorders and injuries.
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Basic Premises and Hypotheses of CPM
The basic premises that led Dr. Salter to the concept of continuous passive motion were that:
- Synovial joints were meant to move and actually deteriorate when not allowed to do so,
- Motion enhances nutrition to the articular cartilage surface of synovial joints by facilitating the
movement of synovial fluid into and out of the cartilage matrix,
- The synovial membrane should glide over the articular surface and becomes adherent to the
underlying cartilage if prevented from doing so, and
- Synovial joints were meant to last a lifetime.
With these premises in mind, Dr. Salter hypothesized that continuous passive motion should have the
following effects on synovial joints:
- Enhance metabolic activity and joint nutrition,
- Stimulate pluripotential cells to differentiate into hyaline cartilage rather than fibrocartilage or
bone, thereby leading to healing and regeneration of hyaline cartilage, and
- Accelerate healing of articular cartilage and periarticular structures, such as tendons and
ligaments.
Overview, Results, and Conclusions of Basic Research
Dr. Salter and a succession of Basic Research Fellows have conducted experimental
investigations in both adult and adolescent rabbits on the effects of CPM on full and
partial-thickness defects, intra-articular fracture, acute septic arthritis, intra-articular
fluid pressures, clearance of hemarthrosis, wound healing, muscle atrophy, immobilization, tendon
and ligament healing, autogenous and allogenic intra-articular periosteal grafts,
and chondral shaving and subchondral abrasion.
This basic research led Dr. Salter to the conclusions that CPM:
- Is well tolerated,
- Has significant stimulating effects on articular cartilage and peri-articular tissues,
- Prevents adhesion formation and joint stiffness,
- Does not interfere with, and actually enhances, healing of incisions over a moving joint, and
- Regeneration of articular cartilage through neochondrogenesis is possible under the influence
of CPM.
Note: This information is intended for educational purposes only. The data is based
on animal laboratory studies and may not represent human clinical situations.
Clinical Applications and Results
In 1978, Dr. Salter began to apply CPM to humans following procedures such as
ORIF of intra-articular, metaphyseal, and diaphyseal fractures, surgical release of
extra-articular joint contractures, arthrotomy and incision with drainage for acute
septic arthritis, synovectomy, biologic resurfacing, ligamentous repair and reconstruction,
tendon repair, tibial osteotomy, and total joint replacement.
Results from these clinical applications include: CPM is well tolerated,
maintenance of an increased ROM, normal wound healing, absence of complications,
and shortened period of hospitalization and rehabilitation.
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Why Prescribe CPM
- Managed Care Restrictions:
- The number of authorized physical therapy visits patients receive has drastically
reduced over the last several years. CPM used at home during the early stages of
rehabilitation helps make the most of these limited visits; if a patient achieves their
range of motion goals at home, physical therapy visits can focus on strengthening
and return to function.
- Medicare Reimbursement:
- Shorter lengths of stay in both the hospital and transitional care unit,
i.e. skilled nursing facility (SNF) mean that patients receive less physical therapy
during the immediate post-operative period.
- SNFs are now under a capitated reimbursement system which can mean
fewer resources allocated to the care of a patient.
- There is now a $1,500 cap on outpatient physical therapy.
- Physicians are left with the dilemma of being responsible for
favorable post-operative outcomes, but with significantly reduced available resources.
The use of home CPM can ensure good outcomes and reduced rehabilitation costs:
Robert Worland, MD, et al: “Home Continuous Passive Motion Machine Versus
Professional Physical Therapy Following Total Knee Arthroplasty:
- A prospective, randomized study on 103 consecutive post-TKR patients
- No differences in ROM, knee score, flexion contracture, or extensor lag between the two groups at 6 months post-op
- Comparative costs: CPM = $286 per patient; PT = $558 per patient
- Authors found CPM an acceptable alternative to PT with no significant differences in results but markedly reduced cost
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