text:
Beginning the week of March 30, APTA will conduct a survey of its physical therapist (PT) members to find out how direct access is being used in their practices, and what obstacles still exist. Your participation is key.
Surveys will be sent via email over the course of the week, so keep an eye out (and check those spam filters). And be sure that your member profile is set to receive surveys. Profile options can be checked and adjusted here.
While last year's achievement of some form of direct access to physical therapist services in all 50 states was a big win for the profession, there is still much work to be done to eliminate barriers. Your responses will guide the association's strategies for working with payers, legislators, and policymakers to remove direct access restrictions, and will help to shape APTA resources and educational offerings.]]>
The 2015 awards and winners are:
"Each of our service award recipients has played a vital role in the Foundation's ability to carry out its mission to fund and publicize physical therapy research," said Foundation Board of Trustees President Barbara Connolly, PT, DPT, EdD, FAPTA, in a Foundation news release. "We recognize that much of the hard work and support of these individuals and organizations occurs behind the scenes, and we are extremely appreciative."
This year's recipients will be recognized during the Foundation's gala on June 4, 2015, during the NEXT conference in National Harbor, Maryland.]]>
And in June, Billie Jean King will deliver the keynote address during the opening event of APTA's NEXT Conference and Exposition in National Harbor, Maryland, just outside of Washington, DC. King's keynote address will be a highlight of the NEXT opening event, Wednesday, June 3, at 7:00 pm ET.
Registration for NEXT is open, with early-bird discounts expiring April 2.
A trailblazer throughout her life, King is a perfect fit for NEXT, which is defined by its innovative content and access to the physical therapy profession's transformative thinkers.
King is remembered by many for her illustrious athletic career, which included a record 20 titles at Wimbledon, plus the famous match with Riggs that has been recognized for its profound effect on society and the women's movement. King's championship spirit stayed with her off the court, as a leader in the fight for LGBT equality and recognition, as an advocate for those infected by or at risk for HIV/AIDS, and as a member of the President's Council on Fitness, Sports and Nutrition, among other endeavors.
While at NEXT, join hundreds of PTs and PTAs to support the profession during PT Day on Capitol Hill, June 3-4. Registration deadline is May 14.]]>
Instead of the tiered system, all providers will receive an initial authorization for 6 visits, with additional visits approved when providers demonstrate medical necessity. According to Regence, the change is based on Regence data supporting 6 as the number of visits that covers most episodes of care.
Regence plans to send letters to providers informing them about the change at the end of March.
Chapter representatives from the 4 affected states and APTA staff began regular discussions with Regence and CareCore (Regence's UM vendor) about problems with the program since its launch more than a year ago. The discussions were aided by feedback provided by individual PTs through an APTA initiative calling for provider accounts of problems with UM systems.
"We think there will be many fewer gaps in patient care with the elimination of tiering," said Pete Rigby, PT, Washington Chapter payment chair. "We'll continue to work with Regence regarding the ideal number of preapproved visits."
Encountering difficulties with UM and utilization review (UR)? APTA is collecting your experiences to strengthen its advocacy efforts around third-party UM and UR administrators. Fill out the online feedback form, and staff will contact you for more information.]]>
Last week, PT in Motion News reported on a new study supporting the idea that initial referral to a physical therapist (PT) for new uncomplicated low back pain (LBP) resulted in lower overall costs and utilization than referral for advanced imaging. Since then, more articles have surfaced that question imaging as a "go to" strategy for the condition.
According to an article in HealthDay News, a March 17 study published in JAMA (abstract only available for free) concludes that for older adults, receiving diagnostic imaging for new back pain not only fails to produce better outcomes but actually tends to increase the costs associated with health care over time.
"Although early imaging is not associated with better pain and function outcomes, it is associated with greater use of health care services, such as visits [and] injections," study author Jeffrey Jarvik, MD, MPH, is quoted as saying in the HealthDay article, adding that it's a difference that "translates into a nearly $1,500 per patient additional cost, for no measurable benefit."
In another small study e-published ahead of print in the journal Spine (abstract only available for free), researchers analyzed the results of 300 blinded MRI scans conducted by medical radiologists, chiropractors, and chiropractic radiologists to assess both the consistency of readings across disciplines and, secondarily, the ability to diagnose LBP in the first place based on imaging.
Their findings? There was "considerable misclassification in all 3 groups," and agreement between chiropractic and medical radiologists was "modest at best."
"This study supports recommendations in clinical guidelines against routine use of MRI in low back pain patients," authors write.
The findings contained in both articles echo the results of a study by physical therapist researchers Julie M. Fritz, PT, PhD, FAPTA, Gerard P. Brennan, PT, PhD, and Stephen J. Hunter, PT, PhD, OCS, that found initial referrals for physical therapy for patients with new episodes of low back pain (LBP) resulted in less than half the cost of an imaging-first approach, and generated lower costs associated with use of health care resources over time.
The study, published in the journal Health Services Research (abstract only available for free), cited average savings of nearly 72% when physical therapy was used as the first-referral option.
"This is one of many studies demonstrating that physical therapy is a cost-effective alternative to medication and surgery," said APTA President Paul Rockar Jr, PT, DPT, MS, in a news release about the research. "Patients benefit from an active approach to their care and, in turn, society is transformed through the benefits from reduced financial burdens on our health care system."
Available at the APTA Learning Center: pre-recorded CE on manipulation for LBP presented by study author Julie M. Fritz, PT, PhD, FAPTA. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
It's called the Health Care Payment Learning and Action Network (Network), and APTA will be there from the start.
On March 25, HHS debuted the Network, which it describes as "a forum for public-private partnerships to help the US health care payment system (both private and public) meet or exceed … Medicare goals for value-based payments and alternative payment models." Those goals call for 90% of Medicare payments to be tied to quality or value within 3 years.
Plans are for a series of (mostly) online meetings—1 or 2 per year for all participants and more for various work groups. APTA representatives are participating in the program, beginning with the March 25 kickoff meeting, which featured remarks from President Barack Obama and HHS Secretary Sylvia Burwell. Both stressed the importance of gaining input from providers and payers.
According to HHS, the participants in the Network will identify areas of agreement around how health care will move toward new payment models; collaborate to "generate evidence, share approaches, and remove barriers"; and develop approaches and implementation guides for payers, providers, and consumers. Participants will also be expected to help create definitions for various alternative payment models.
"The transition to alternative and value-based models is already happening and is only going to accelerate over the next 2 to 3 years," said Gayle Lee, JD, APTA senior director of health finance and quality. "The Network that CMS is offering is a good way for PTs to stay connected with the conversation about that transition and to contribute a provider's perspective."
The association will share information and other learning opportunities as the Network continues its work.
New ways of providing and paying for care are at the heart of APTA's transformative vision. Check out the association's Innovations in Practice webpage for the latest resources.]]>
Legislation now introduced in the US House of Representatives that would end the flawed sustainable growth rate (SGR) is missing a permanent repeal of the therapy cap. According to APTA advocacy staff, it's a troubling omission for physical therapists (PTs), and one that has sparked renewed calls for member action from APTA.
The bill ready for House consideration repeals the SGR, but only includes a 2-year extension of the therapy cap exceptions process. Supporters of therapy cap repeal believe that the best chance of ending the cap exists when it's tied to an SGR repeal bill.
Although APTA supports SGR repeal and other features of this particular bill, "We don't view a 2-year extension of this policy as a win," said Mandy Frohlich, APTA vice president of government affairs. "It separates the therapy cap repeal from the SGR repeal, which is problematic."
In an action alert issued on March 24, APTA warned that the exclusion of a permanent therapy cap repeal in the SGR legislation "is a missed opportunity for a long-term solution and puts beneficiaries in a dire situation when this [proposed 2-year] extension expires." Members are being urged to contact their legislators to call for a permanent repeal of the cap to be included with any bill that would repeal the SGR. APTA has posted the latest information on the issue at the association's therapy cap webpage.
The association also joined the American Occupational Therapy Association and the American Speech-Language-Hearing Association in issuing a news release that calls the separation of a permanent repeal of the SGR from a permanent therapy cap repeal "a risky approach for Medicare beneficiaries." Occupational and speech-language-hearing therapies are also impacted by the therapy cap.
"If Congress fails to include a permanent solution for the therapy cap in this bill, it will have purposely missed the only significant opportunity in almost 20 years to fix this critical patient issue," said APTA President Paul Rockar Jr, PT, DPT, MS, in the joint news release. "A bipartisan solution has been negotiated. These policies were created together. They should be fixed together."
In the (likely) event that Congress does not complete its work on this bill before it recesses on March 28, it is unclear how lawmakers will respond to a looming March 31 deadline that would trigger 21% cuts in Medicare payments via the SGR. It is possible that legislators would approve a short-term extension of the current fixes, but no formal proposals have been released.
Even if the SGR bill is approved by the House in the coming days, the Senate would be pressed to take it up before Congress recesses. The break, coupled with some Democrats' concerns about other provisions in the legislation, could open a window that would allow grassroots and lobbying efforts to have a greater impact.
Though the current SGR legislation lacks the crucial therapy cap element, it does include some provisions that are generally supported by APTA. Among them:
However, the lack of a permanent repeal of the therapy cap represents a glaring flaw in the legislation, according to Frohlich.
"It's more important than ever for members to speak up on this issue," said Frohlich. "We will continue to work with Senate champions to slow this down to correct this policy."
The legislative landscape around the SGR and therapy cap continues to change. APTA will monitor the situation and update members as events warrant; however, the need for grassroots efforts on the therapy cap remains urgent. Find out how you can take action.]]>
The common thread? Something APTA has been stressing for years: more attention needs to be paid to all aspects of brain injury diagnosis and management.
In a widely covered announcement, 24-year-old Chris Borland, a successful rookie linebacker for the San Francisco 49ers professional football team, announced that he is retiring from the sport after 1 season because of concerns about potential health risks associated with head trauma.
"From what I've researched and what I experienced, I don't think it's worth the risk," Borland said in an interview for ESPN's "Outside the Lines."
"I just want to live a long, healthy life, and I don't want to have any neurological diseases or die younger than I would otherwise," Borland told ESPN.
According to an article in the New York Times (NYT), Borland's announcement "stands out because of how explicit he was regarding his concerns about head injuries." The frankness comes as the National Football League "scramble[s] to find a response" to mounting evidence "linking blows sustained on the field with long-term cognitive disability," according to the NYT.
Response to head injury was also the focus of a recent article in the Journal of Pediatrics (.pdf) that looked at public school principals' knowledge of concussion management, specifically around "return to learn" (rather than return to play) decisions.
In a survey of 695 high school principals in Ohio, researchers found that among the 465 administrators who responded, approaches to—and knowledge of—concussion management varied widely.
While 37.2% of the principals reported having received "some form" of concussion training in the past year and were supportive of providing training to faculty, researchers found that issues such as school size, funding, and available staff contributed to inconsistencies.
One example: only 32% of respondents said that they provide a written concussion plan to families and health professionals, with only 24.3% stating that the plan includes potential academic adjustments and accommodations. In contrast, authors write, research from Michigan found that 62% of school coaches provide a plan to families about postconcussion protocols for student athletes.
Authors cite progress in the ways schools respond to concussion in youth sports, but write that the academic environment needs to make up ground. "Not all concussions are sports related, and not all students with concussions are athletes," authors write. "Schools and health professionals must be prepared to monitor and accommodate students with concussion, regardless of athlete status."
The need for broad understanding of youth concussion management—and, in fact, all mild brain injury as well as TBI—was what brought APTA advocates and staff to Washington, DC, last week to participate in congressional briefings and provide information to legislators and congressional staff during a "Brain Injury Awareness Fair" on Capitol Hill. APTA representatives also spoke with lawmakers about the importance of the SAFE PLAY Act, now in congress, that aims to improve concussion management in schools. The act includes physical therapists in the list of professionals qualified to make return-to-play decisions.
Find more resources on APTA's Traumatic Brain Injury webpage, read the clinical summary on concussion available for free to members on PTNow, and direct patients and clients to the Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website. Looking for continuing education on concussion management in today's environment? Check out the prerecorded webinar "Managing Concussions with an Interprofessional Team" available through the APTA Learning Center.
Michael Hurlbut, right, APTA senior congressional affairs specialist, gets the APTA word out
during the Brain Injury Awareness Fair held on Capitol Hill last week.
The review, e-published ahead of print in the American Journal of Physical Medicine & Rehabilitation (abstract only available for free), examined 15 clinical trials focused on trigger points (TPs) in the upper trapezius (UT) muscle in patients with neck pain, comparing either IC (7 studies) or DN (8 studies) with other interventions. None of the studies compared DN with IC.
The studies themselves varied in size (from 39 to 117 patients), and some employed more than 1 intervention (for instance, the use of stretching exercises in all groups in some studies), but all were limited to randomized clinical trials in which all participants had neck pain with active or latent TPs in the UT—a feature of myofascial pain syndrome. Only studies that focused on the therapeutic effects of treatment were included, with articles about side effects or complications excluded.
Researchers found strong evidence that DN (which they defined as an intramuscular procedure that could include insertion of needles into the TP) reduced both pain intensity and the pressure pain threshold, although not necessarily any more than other treatments, including lidocaine injections, passive stretching, and muscle energy techniques (MET). Similar results were found for the IC studies, which presented moderate-to-strong evidence that both pressure pain threshold and pressure pain intensity were reduced.
The other area that returned moderate evidence of effectiveness had to do with range of motion (ROM)—specifically, side bending. Here, researchers found evidence, albeit sometimes weak, that both DN and IC were as effective as other approaches, and that in at least 1 study, IC seemed to have an effect over time as well. "The increase in side-bending ROM after IC was equal to MET and passive stretching immediately after treatment," authors write, "but it was significantly greater 24 [hours] and 1 [week] after treatment."
The review found little available evidence to support the interventions' effects on functionality or quality of life, including how the interventions may lessen depression.
Areas for future research abound. Authors noted, for example, that "there is strong evidence that DN has an analgesic effect," but that "the optimal dosage remains unclear and requires further research."
Also lacking--research on DN and IC compared with each other, as well as studies on the effectiveness of the interventions over time.
"Until now, most studies have evaluated the immediate effect of IC and DN, with only a few studies describing longer-term effects," authors write. "Although the goal of DN and IC is often rapid relief of pain so that patients can be progressed to other forms of therapy, further research of long-term effects is needed."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Late last week, House Speaker John Boehner and Democratic Leader Nancy Pelosi announced that they were working together on legislation that would permanently end the SGR formula instead of working out yet another temporary "doc fix" and punting the issue for another year. If Congress doesn't act on the SGR by March 31, Medicare providers would face a 21% cut to Medicare payments.
The final bill has not been introduced in the House, and APTA and other organizations have received conflicting reports about whether the proposed legislation would include full repeal of the therapy cap provisions or just an extension of the therapy cap exceptions process. Repeal of the therapy cap is a central focus of the association's advocacy efforts.
In an action alert issued this week, APTA's advocacy staff described therapy cap repeal as "in jeopardy" and urged members to take immediate action by contacting their legislators and telling them to insist that repeal of the therapy cap be included in any legislation that would end the SGR.
"For anyone who understands how the therapy cap impacts patient access to necessary rehabilitation services, now is the time for action," said Mike Matlack, APTA director of grassroots and political affairs. "If a full repeal of the therapy cap isn't included with a full repeal of the SGR, over 1 million beneficiaries will face a very real obstacle to receiving adequate care."
Although the proposal under discussion will likely emerge in the House first, APTA and the Therapy Cap Coalition are calling for supporters of therapy cap repeal to contact legislators in both the House and the Senate—and to stress the importance of talking with House and Senate leaders.
"Right now, House and Senate leaders are the primary drivers of the negotiations around this issue," said Matlack. "It's important that supporters request that their legislators weigh in with those leaders and voice their support for a full, permanent repeal of the therapy cap."
The need for grassroots efforts on the therapy cap is urgent. Find out how you can take action.]]>
It's time once again for members to help PT in Motion magazine decide the design to be used on the cover of the upcoming issue. For May, editorial staff is proposing 2 designs and asking members to vote on their favorite cover to illustrate physical therapists' use of dry needling.
Vote by March 27. Just pick the design you think is likely to get you to open up the magazine, and then check out the May issue to see which cover was most popular.]]>
Researchers Julie M. Fritz, PT, PhD, FAPTA, Gerard P. Brennan, PT, PhD, and Stephen J. Hunter, PT, PhD, OCS, analyzed utilization records and other health information for 841 individuals who consulted with a primary provider about uncomplicated LBP and were referred for management outside primary care within 6 weeks. Of those individuals, 385 received advanced imagining and 377 received physical therapy (the remaining 79 patients received a physician specialist visit or "other care," including chiropractic). The study focused on records obtained from 21 different providers around Salt Lake City, Utah, between 2004 and 2010.
What they found was that across the board, physical therapy was the less costly approach. Initial referral for physical therapy cost $504 on average (for an average 3.8 visits), compared with an average of $1,306 for magnetic resonance imaging (the technology used in "almost all" of the imaging, according to authors).
Even more dramatically, average subsequent costs over the next year were over 66% lower for the patients who began with a physical therapy referral--$1,871, compared with $6,664 charged to the imaging group over the same time period. Those differences remained largely in place even when researchers matched individuals for covariates including prior surgery, use of medication, osteoporosis, and mental health issues. Results of the study appear in the journal Health Services Research (abstract only available for free).
Authors found that patients who receive imaging as a first referral often follow a different path than those who receive physical therapy, writing that referral to imaging "increased the odds of surgery, injections, specialist, and emergency department visits within a year."
Researchers attribute some of the variation to perceptions around imaging. "Advanced imaging often 'labels' a patient's LBP that might otherwise be viewed as nonspecific and uncomplicated, causing heightened concern in some patients and providers and motivating additional care-seeking," they write.
On the other hand, they write, "physical therapy may avoid the negative consequences of a labeling effect from imaging" by "provid[ing] patients with an active approach to LBP, enhancing patients' perceived ability to self-manage their condition."
"This is important research, because it provides even more evidence that physical therapy is a less costly alternative to medication, surgery, and other invasive medical procedures," said Nancy White, PT, DPT, APTA executive vice president of professional affairs. "Not only do patients benefit from the improved outcomes resulting from an active approach to care, society benefits from the reduced financial burden on our health care system. The cost savings Fritz and her colleagues describe here are significant enough to be recognized by health policy makers, payers, and other health professionals."
Authors acknowledge that their study was limited to newly reported and uncomplicated LBP, and that patient-centered function or satisfaction outcomes were not recorded. Still, they write, for individuals with this type of LBP who have expectations for additional care beyond a primary provider, "physical therapy may be the preferred initial step instead of advanced imaging."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
According to Premera, the breach of its encrypted files began in May 2014 but was not detected until January 29, 2015. Potentially affected files include those of customers, employees, and others dating back to 2002.
In terms of number of people potentially affected, the Premera Blue Cross hack is the second-largest to date. In February, Anthem Blue Cross Blue Shield announced that a breach of its system resulted in information theft from approximately 80 million current and former customers.
One difference in the Premera theft: hackers are believed to have accessed customer financial information and clinical data, as well as Social Security numbers, addresses, and birthdates. Anthem maintains that no financial or clinical health information was accessed when their files were breached.
Premera Blue Cross, which operates in Washington and as Premera Blue Cross Blue Shield Alaska, has affiliates including Vivacity and Connexion Insurance Solutions. Employer clients include Microsoftand Starbucks, according to the Wall Street Journal.]]>
The honorees include newly named Catherine Worthingham Fellows as well as recipients of the Lucy Blair Service Award. APTA also announced award recipients for excellence in education, practice, service, publications, research, and academic achievement.
Recipients will be recognized at the Honors and Awards Ceremony on Thursday, June 4, during the 2015 NEXT Conference and Exposition in National Harbor, Maryland, with a reception to follow. The winner of the Mary McMillan Lecture Award will also be announced at that time. Family, friends, colleagues, and conference attendees are encouraged to attend this important event to support and honor these members' achievements and contributions to the profession.
Nominations for the 2016 Honors and Awards Program will open September 2015.]]>
The report issued on March 16 tracks employment and earnings data across professions, and divides them in to major sectors. The PT pay disparities are smaller than the average for health care professions in general, which combined showed that women make about 70.3% of what is paid to men. Data on physical therapist assistants were not included as a distinct line item.
Among the data related specifically to PTs:
The disparity percentage in physical therapy was similar to that of occupational therapists, estimated at 88.7%.
The smallest disparity among health care professions was for dietitians and nutritionists, where women earn 97.4% of what their male counterparts earn. The greatest difference? Dentistry, where female dentists are estimated to earn only 67.8% of what male dentists earn.
More workforce resources, including supply and demand estimates for PTs, are available on APTA's physical therapy workforce data webpage.]]>
In an article published in the January issue of The Lancet (.pdf), researchers report on their study of 54,000 British men and women over a 14-year period (1996-2012), 8,166 of whom were diagnosed with PD at some point, and 46,775 who did not have the disease. By following health records over time, authors were able to trace several "prediagnostic features" that could have a connection to the earliest signs of damage from PD.
The features studied included not only tremor, rigidity, balance impairment, and neck and shoulder pain and stiffness, but also constipation, hypotension, erectile dysfunction, urinary dysfunction, and dizziness. Additionally cognitive-behavioral features including memory problems, late-onset anxiety or depression, cognitive decline, and apathy were traced over time.
Among the findings:
"The results of this study support the existence of a long prediagnostic phase of Parkinson disease, which comprises both motor and non-motor features," authors write.
"The features that we identified as occurring many years before diagnosis included those that are often regarded as symptoms of advanced Parkinson disease … [as well as those] that are non-specific … or that … are likely to be initially diagnosed as different disorders," they write. "Nevertheless, all of these symptoms are not only common in typical Parkinson disease, but also might represent the earliest stages of Parkinson disease."
The study was the subject of a New York Times article that also reported on efforts to identify biomarkers that could home in on the presence of disease early on, given that the prediagnostic conditions listed in the Lancet article can be "common and quite nonspecific," according to the NYT.
Authors of the Lancet article write that recognition of the prediagnostic conditions may prove to be useful not only in developing further research on the progression of PD but could also open the door to earlier intervention.
"Our finding of multiple prediagnostic symptoms and their pattern of presentation in the 10 years before diagnosis suggests that screening might be feasible in the general population," they write, noting that any screening program "would need to be carefully considered and several preconditions, such as benefit of early treatment, should be fulfilled."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The March 15 article asserts that "while old-school wisdom held that older adults were too frail to pump iron, a growing body of research is showing that strength training helps stave off age-related disability, preserve bone mass in women, and even boost brainpower."
The article relates the stories of 3 individuals who found relief through strength training: a 54-year-old man whose strength training regimen eased pain from a childhood back injury, a 75-year-old woman who participates in special exercise classes that have helped reduce arthritis pain, and a 75-year-old man who was able to regain his ability to walk without back pain after training for 6 months.
APTA has long supported strength training for older adults, and even included under-dosed strength training in its list of "5 Things Physical Therapists and Patients Should Question" released as part of the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign. The APTA recommendation advises "Don't prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual's abilities and goals."
Training experts and researchers interviewed for the story advised that individuals with preexisting injuries—a common condition for older adults—should consult with professionals who can monitor and adjust exercises.
The benefits go beyond the ways in which strength training can address pain and mobility, according to the article, which cites studies claiming that this type of exercise can serve as a complement to aerobic training to help keep brains sharp. Whereas cardio exercise can help strengthen the brain's ability in memory tasks, the article states, strength training has been found to help with higher-level brain functions that allow an individual to juggle multiple tasks.
Do you have patients or clients interested in starting a strength training program? Share MoveForwardPT.com's consumer-oriented information on strength training and how a PT can help.]]>
On Tuesday, March 17, the association partners with the American Psychological Association, the National Association of County and City Health Officials, the American College of Preventive Medicine, and other organizations to host a congressional briefing on how data can be used to prevent injuries and violence, including traumatic brain injury (TBI). Two speakers from the US Centers for Disease Control and Prevention will join researchers and public health experts to look at existing injury and violence surveillance efforts, and how those efforts inform research and policy.
The next day, APTA will participate in the Brain Injury Awareness Month Fair sponsored by the Congressional Brain Injury Task Force. The fair serves as a 1-stop information shop for legislators and staff, and the association's exhibit will combine materials on brain injury with resources on the physical therapist's (PT's) and physical therapist assistant's (PTA's) roles in management.
APTA's participants will also use their time at the Fair to advocate for the SAFE PLAY Act—legislation now in congress that seeks to improve concussion management in schools, and includes PTs among the professionals qualified to make return-to-play decisions for students.
The same day, association advocates and staff will attend another congressional briefing on "post-injury supports and services that make a difference." Speakers will include representatives from the US Public Health Service's Traumatic Brain Injury Team and the medical director of the inpatient TBI program at Walter Reed National Military Medical Center, as well as a TBI survivor and a caregiver for an individual with TBI.
"Physical therapy's power to truly transform lives is evident every day in the work PTs and PTAs do with individuals who have suffered brain injury," said Mandy Frohlich, APTA vice president of government affairs. "Awareness events like these help us to keep physical therapy at the forefront in policy discussions about brain injury, and that's key, because the profession brings a unique and essential perspective to the table."
APTA's efforts to educate policymakers on the role of PTs in TBI are ongoing. Last year, the association attended an invitation-only White House summit on concussions; additionally, concussion management awareness was the focus of a student-led Flash Action Strategy in 2014, which resulted in the largest concussion-related grassroots effort in APTA history.
Find more resources on APTA's Traumatic Brain Injury webpage, read the clinical summary on concussion available for free to members at PTNow, and direct patients and clients to the Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website.]]>
Articles in Bloomberg News, Modern Health Care, Engadget, and other sources report that organizers of the 5 research projects already created through ResearchKit were encouraged by the public's response to the new app, which turns iPhones into interactive monitoring devices and feeds data back to researchers.
Bloomberg News quoted Alan Yeung, medical director of Stanford Cardiovascular Health and member of one of the teams using ResearchKit as saying that "to get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers across the country." In the case of the Stanford study on cardiac health, that number was reached overnight.
The excitement is not universal. Almost as soon as the product was unveiled, criticism began.
In addition to reporting on excitement over the participant numbers being generated, recent stories cite some research experts' concerns about how representative the data will be, given that iPhone owners do not represent an accurate cross section of the general population.
Other critics worry about how the app's inability to ask open-ended questions of participants could skew the results, and cite possible problems with participants allowing others to use their phones during the research.
In the Modern Health Care article, Michael E. DeBakey VA Medical Center researcher Hardeep Singh voiced concern about how the sheer scale of data can have an impact. "Ultimately, it's about data quality and reliability," he said. "You can lose control in this virtual environment of big data."]]>
In a study of 145,460 Medicare patient records from 1,209 rehabilitation facilities across the US, researchers found that from 2006 to 2009, while functional status levels at discharge varied by 29.2 points across facilities, variation was only 3.57 points when outcomes were grouped by hospital referral region (HRR). Functional status was measured close to admission and discharge using the inpatient rehabilitation facility patient assessment instruction (IRF PAI), which includes 18 items from the functional independence measure (FIM) aimed at assessing cognitive and motor skills.
Researchers analyzed those functional outcomes by way of 3 models—outcomes of patients within individual facilities, outcomes of patients by HRR, and outcomes of patients within facilities by HRRs.
What they found was that variation differed according to—and was affected by—how the outcomes were grouped. When outcomes were analyzed according to facilities alone, the researchers found that once demographic and clinical covariates were accounted for, variation for cognitive and motor outcome ratings were 8.7% and 9.5%, respectively. When outcomes were analyzed only by HRR, overall variance was 3.7%.
When authors "nested" the 2 settings—facility within HRR—they found marked differences in the way the settings impacted each other. Researchers estimate that while the HRR did reduce facility variation by as much as 8%, factoring in individual facility data into HRRs reduced variation among HRRs by 82%.
"Our findings suggest that facility effects account for more variation in functional status following inpatient stroke rehabilitation than geographic region," authors write. "Each of our multilevel models supports this interpretation." The study was e-published ahead of print in the Archives of Physical Medicine and Rehabilitation (abstract only available for free).
Authors believe that their results are a counterpoint to an Institute of Medicine (IOM) study, whose findings "suggest that some regions are more efficient than others at delivering quality care." That study has been a factor in CMS consideration of more standardized measures for postacute care facilities--measures that will have payment implications for providers.
Authors of the new study call for more research into why, precisely, the facility variation exists, but suggest that "systematic selection of patients at facilities" might have something to do with the differences, as well as "patterns of care" affected by "differences in stroke guidelines and treatment approaches."
"As CSM moves forward with identifying and implementing functional status as a quality measure for rehabilitation, it is critical that facility administrators, policymakers, and researchers explore facility strategies that influence variation in outcomes of care," authors write. "The IOM report highlighted the need to focus efforts on improving the quality of rehabilitation among low performing regions. Our study of functional status at discharge suggests that improvements that minimize regional variation in post-acute care cannot focus solely on regional reimbursement adjustments."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
APTA has released 2 Storify collections that offer highlights from the national event. The first is packed with takeaways from the attendees themselves. The second collects APTA's various video dispatches and a new brief highlights video.
You can also browse and order photos from CSM. Visit http://davidbraun.photoreflect.com to check out what's available—just click on the appropriate CSM 2015 link under "Recent Photos" and enter password: distal. Select your photos and order through the shopping cart.
All of the above, plus daily news articles from CSM, are available at the CSM website.
Want to attend CSM next year? Save the date: February 17-20 in Anaheim, California. But don't wait until 2016 to attend an APTA national conference. This June 3-6 you can transform your career and your profession at NEXT and PT Day on Capitol Hill.]]>
A systematic review published in the February 22 issue of the Journal of Telemedicine and Telecare (abstract only available for free) analyzed the results of 12 randomized clinical trials that focused specifically on the use of telerehabilitation and the regain of motor function in 3 areas: neurological, cardiac, and TKA. A total of 1,047 individuals participated in the study, with 543 patients receiving telerehabilitation.
While not definitive, researchers did find that telerehabilitation had a "significant positive effect" on individuals who had received TKA surgery. Results of Timed Up and Go (TUG) tests showed that "a researcher would expect patients treated by telerehabilitation to improve 6.5 seconds more than patients treated routinely, on average," authors write. They caution that of the 3 TKA studies reviewed, 1 was at high risk of selection and attrition bias, which could have affected overall analysis.
The studies on individuals affected by neurological or cardiac conditions were less conclusive, but for different reasons. Authors found a "paucity" of eligible trials on telerehabilitation and cardiac conditions, and were only able to include 2 in their analysis. And although telerehabilitation trials related to neurological conditions represented 7 of the 12 trials included in the analysis, those numbers couldn't make up for small sample sizes and the difficulties of conducting these kinds of trials given the "broad range of disability experience by patients, the burden of care on caregivers and the long time needed to observe meaningful changes of clinical outcomes," authors write.
For purposes of their analysis, researchers only included studies involving rehabilitation delivered "by means of any technological device" allowing for online and offline provider/patient interaction, and involving remote supervision.
Authors write that while the analysis did not provide "final evidence" of the effectiveness of telerehabilitation on motor function, "the current data are encouraging and support continuity of rehabilitation care through [Internet and communication technologies]."
"The main potentiality of telerehabilitation is the possibility to increase the frequency and intensity of care provided to patients and consequently motivate clients in their own home environment," authors write. "But the quality of primary research has to be improved dramatically to have a clearer picture of benefits and risks associated with assisting patients at a distance, once discharged at home."
In 2014, APTA's House of Delegates approved a resolution that supports the adoption of telehealth technologies in physical therapy as "an appropriate model of service delivery" when provided in ways that are "consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations." The association offers resources on its telehealth webpage.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
As part of its "Spring Forward" launch program, Apple unveiled ResearchKit, an app that integrates with its HealthKit app to provide medical researchers with access to data from users who sign up and consent to participating in a particular study—also transformed by Apple into a simple online process.
The app is open-source, which will allow researchers to use ResearchKit in a wide variety of studies, and with non-Apple devices. According to an article in MobiHealth News, apps already created with ResearchKit focus on Parkinson disease, diabetes, cardiovascular disease, asthma, and breast cancer.
Participants in studies that employ ResearchKit will use their phones as a monitoring and data delivery system. The Parkinson app, for instance, can analyze the gait and balance of a participant by having the individual put the phone into a pants pocket, walk 20 steps, turn around, and return. Developers also report that the app can "detect symptoms in Parkinson patients just by having them say 'ahhhh' into the phone," according to the MobiHealth News article.
Apple claims it will never have access to the data shared between participants and researchers using the app. ResearchKit is set to launch in April.]]>
In its fifth annual study of medical identity theft (.pdf), Ponemon analyzed surveys from 1,005 respondents across the United States who had experienced theft. The survey asked not just about the costs and circumstances around instances of theft 2013–2104, but about respondents' attitudes toward their health care providers' security practices. Among the findings:
While Ponemon acknowledges that medical identify theft can't be prevented completely, the report does recommend that health care and insurance providers "help consumers gain more control over their medical records" by making electronic health records more accessible to consumers. Given the large percentage of respondents who knowingly shared their medical identity records with others, the firm also asserts that "providers … have a responsibility to inform individuals of the negative consequences of sharing medical credentials with others."]]>
A recent article published on the Fast Company website polled leaders from their list of the most innovative companies in fitness on what they think fitness programs will look like 5 years from now. Their predictions? You'll still have to work up a sweat, but technology may help you to get more benefit from your efforts—and will likely be able to track your every movement. Literally.
Besides the increasing use of personal data to shape workouts, the contributors also predicted an increase in smaller, more individualized training centers, widespread use of virtual classes at gyms, a stepped-up focus on early intervention and getting children more involved in fitness programs, and a more holistic approach to fitness that recognizes how behaviors outside the gym can impact health.
Because so many of these changes are fueled by access to personal data, the experts interviewed believe that wearable monitoring systems will evolve beyond the wristband, to include smart clothing.
Like, really smart clothing.
"Behavioral data will be collected on all aspects of our life—and without us being aware of it," said one leader interviewed for the story. "This will provide a noninvasive and holistic view of our health with opportunities to upgrade our behaviors."
Experts interviewed were not clear on whether the personal behavior upgrades would be compatible with older operating systems.
Want to hear what's in store for fitness in the very near-future? Check out a recent APTA Move Forward Radio podcast on fitness trends for 2015.]]>
According to a story recently published in CNET, University at Hertfordshire researchers have developed 2 of the gloves, which are capable of sensing and recording a wide range of finger, hand, wrist, and elbow movements. The movements can be programmed to operate elements in specially designed video games—bending the wrist to open and close a clam that earns points by eating fish, for example; or using a variety of hand, wrist, and elbow movements to control an alligator swimming down a river.
The device is designed for home use, but the difficulty levels and types of movements required to play the video games can be controlled by the individual's health care provider, who is also able to monitor use and progress. The project is part of the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) program.
Researchers reported that, on average, patients using the device and game chose to exercise by themselves for about 15 minutes a day for 6 weeks. "It has to be noted that this is without external motivation such as fixed appointments … for online remote supervision during exercise, which distinguishes the SCRIPT application from recent telerehabilitation approaches in stroke," authors write in an article on the glove (.pdf) published in the journal Robotica.
"The present research is the first exploration of independent arm/hand training at home using a physical hand/wrist orthosis combined with remote monitoring," authors write. Because the device is in its earliest stages of use, they add, more research is needed "to explore whether patients will actually use a telerehabilitation system provided to them and whether more use will actually result in larger clinical gains."
A video of the device and a closer look at the games developed for the glove are available at the SCRIPT YouTube channel.]]>
A new study from Australia conducted on a small group of men has found that the words used to describe activation of pelvic floor muscles (PFM) made a difference in the extent to which the striated urethral sphincter (SUS) muscle is activated with limited increase in intra-abdominal pressure (IAP)—the optimal combination to help men counter urinary incontinence, authors believe.
Researchers recruited 15 healthy men under the age of 50 (6 of whom were physical therapists) to respond to verbal instructions aimed at activation of pelvic floor muscles. Activation was monitored through ultrasound imaging, and 3 of the 15 individuals participated in a follow-up experiment that used invasive fine-wire electromyography (EMG) to measure the effectiveness of sonography as a way of tracking activation. Results were published in Neurourology and Urodynamics (abstract only available for free).
Authors write that they used 4 specific instructions: "tighten around the anus," "elevate the bladder," "stop the flow of urine," and "shorten the penis." Participants were instructed to follow the verbal cues to perform 3 repetitions, with each contraction sustained for 3 seconds and separated by an approximate 10-second rest. The verbal instructions were given in random order.
The most effective instruction in terms of midurethra (MU) displacement? "Shorten the penis," followed by "stop the flow of urine." The instructions that resulted in the best anorectal junction displacement were "tighten around the anus," followed by "stop the flow of urine."
A secondary finding: results from the 3 individuals who participated in EMG monitoring seemed to reveal that sonography captured displacement effectively enough to serve as a useful monitoring system—a result that researchers believe could help foster further noninvasive studies.
Authors note that results of clinical trials on the effectiveness of pelvic floor muscle exercises for men with incontinence have been "mixed"—but that inconsistency may be linked to the instructions men were given.
"It is plausible that the variability in results between seemingly similar clinical trials might be influenced by the strategies used to train muscular mechanisms for urinary continence," they write. "The optimal instructions to activate the pelvic floor muscles are likely those that induce the greatest amplitude of pelvic floor muscle shortening with minimal increase in abdominal muscle activity and IAP. From the current data, the best instruction to shorten the SUS is 'shorten the penis' or 'stop the flow of urine.'"
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The new workforce model now available online incorporates 2014 data on the number of licensed PTs, the number of PT graduates, and US population with health insurance into a workforce demand formula that projects demand for PTs under 3 different attrition scenarios—1.5%, 2.5%, and 3.5% yearly attrition rates. Those scenarios were developed to accommodate a still-uncertain picture of how many PTs retire or otherwise drop out of the workforce every year. The model is updated annually by the association's research department.
Most of APTA's projections continue to show physical therapy as a growing profession, with unmet demand ranging from 606 to 26,696 PT full-time equivalents (FTEs) over the next 5 years depending on how many PTs leave the workforce. Before the 2014 adjustments, APTA predicted a 1,530 FTE surplus at the lowest attrition rate. That surplus was changed to a shortage of 606 when the increased number of individuals with health insurance was factored in. A projected shortage was estimated downward by about 1,000 at the highest attrition rate, largely due to an anticipated growth in the number of PT program graduates.
The total number of licensed PTs is projected to rise from about 192,000 to between 203,000 and 234,000 by 2020. The supply and demand data are part of a suite of resources on the physical therapy workforce available on APTA's website.
The projections for shortages echo similar predictions made by The Conference Board and Forbe's magazine, which listed physical therapy as 1 of the "top 10 jobs in high demand."]]>
Levine was at the center of some of the most important developments in physical therapy practice and payment during the past 30 years. He was considered a leader in efforts to elevate the standards of physical therapist (PT) and physical therapist assistant (PTA) practice, including the elimination of unwarranted variation in clinical practice. A frequent advisor to the Medicare program, he was one of the nation's leading experts on the Resource Based Value Scale (RBRVS), at one point providing congressional testimony on the RBRVS.
Levine's involvement with APTA dated back to 1985, and included 11 years of service to the APTA Board of Directors, where he began as vice speaker of the House of Delegates before moving on to speaker. His position on the board led to involvement in many of the association's high-priority projects and initiatives, including the Guide to Physical Therapist Practice and the alternative payment system task force, which he chaired. Levine received a Lucy Blair Service award in 2011 and was named a Catherine Worthingham Fellow in 2014.
As executive vice president of compliance and consulting services for OpimisCorp and a founding partner of the Fearon & Levine consulting firm, Levine focused on practice management and payment policy in the outpatient rehabilitation setting. He received his degree in physical therapy from the University of Maryland at Baltimore, a master's degree in health administration from Virginia Commonwealth University, and his DPT degree from A.T. Still University of the Health Sciences.
In a statement issued yesterday, APTA President Paul A. Rockar Jr, PT, DPT, MS, wrote that Levine was "so much to so many: a tireless champion of the profession, a friend, a gentlemen, and a passionate leader." According to Rockar, Levine "not only contributed to, but also helped to shape the profession of physical therapy as we know it today."
Levine is survived by his husband, Bruce Anderson, PT; his father, Stanley Levine; his sister, Wendy Levine; and his nephews Andrew and Ryan Schiff. Details of funeral arrangements have not been announced, but will be shared on the APTA website when made available.
APTA has created a tribute page to allow visitors to share thoughts and remembrances of Levine.]]>
"The parents are so proud that their babies will pay attention to a screen for an hour," York said in the episode. And even though physical therapists (PTs) might be keenly aware that the American Academy of Pediatrics recommends no screen time for children under 2, she said, "Parents don't know these things."
But screen time is only part of the problem, and awareness is only part of the solution, according to York. Sometimes, even when families understand the need to avoid sedentary behaviors, they face some very real obstacles to being more active. "There are safety issues with [some] neighborhoods, or sometimes it's a busy work life," York said. "Some parents don't have things like bikes or safe parks to take their children to, the way we grew up."
In the interview, York provides several easy-to-implement ways to get children active—some of which can help adults avoid their own sedentary behaviors.
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to email@example.com.]]>
Authors Marie Hoeger Bement, PT, PhD, and Kathleen Sluka, PT, PhD, surveyed accredited PT programs on a range of issues around pain education, including how much time is spent on pain instruction, whether that instruction is delivered in a standalone course, what areas were covered, and whether the education reflected Institute of Medicine (IOM) and International Association for the Study of Pain (IASP) recommendations and guidelines for curriculum development. The survey was conducted between October 2012 and January 2013, and was sent to all PT programs listed in APTA's Physical Therapist Centralized Application Service.
In the end, 167 programs (76%) answered the first portion of the 10-part survey—the section that focused on time spent in pain education—while 137 (62%) completed the remaining sections, which focused on specific content covered and respondent perceptions about the adequacy of instruction.
Among the findings:
Authors describe a lack of data on how pain curriculum has evolved in PT programs, but they cite a 2001 survey that reported a modal of 4 hours. Although the current and earlier studies are not directly comparable, they write, the recent results "appear to be an improvement."
Still, despite increased hours and range of topics covered, only about 6 in 10 respondents felt that their programs offered sufficient instruction in pain management (63%), with 69% reporting that their programs provided inadequate education on pain across the lifespan. "These results suggest that not all PT programs adequately provide pain education in their curriculum, especially pain assessment and management in the young and old," authors write.
Authors also reported that less than half of the respondents were aware of IASP curriculum guidelines, or an IOM report calling for increased education on pain across health disciplines. Among the elements in the IASP guidelines is the recommendation that pain curriculum be taught as a freestanding course.
"Ensuring that PT students receive adequate instruction in pain mechanisms and management would likely result in improved patient outcomes and lower health care costs," authors write. "To stay current in pain education, PT programs should be aware of the latest educational advancements, including the IOM report, IASP guidelines, and pain competencies."
APTA has been a strong advocate for the ways in which physical therapy can be a transformative agent in the treatment of chronic pain. The APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT's role in chronic pain management was featured in the September 2014 issue of PT in Motion magazine.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
In the March issue of the magazine, associate editor Eric Ries explores how several innovative physical therapists (PTs) are establishing the profession as a key resource in a battle against obesity and overweight through a variety of approaches, from new research initiatives to real-world action.
Through a series of interviews, Ries traces the beginnings of PT involvement in treating obesity—at a time when some PTs themselves didn't understand how the profession could help—to the latest efforts to investigate new models of care in which PTs are an integral part of a medical home team for children who are overweight or obese, a project funded through an APTA Innovation 2.0 grant.
Along the way, the article touches on several emerging issues, including the development of an annual PT evaluation, the possibility of offering cash-based services, and the need for PTs to embrace their own power to transform society.
The PT in Motion article on physical therapist treatment of obesity and overweight appears in the March issue of the magazine. Hard copy versions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.]]>
The study, published in the British Medical Journal, tracked length-of-stay and later mortality of 116,111 patients 50 and older (mean age 82) who experienced a hip fracture and were admitted to hospitals in Sweden from 2006 to 2012. During that period, 30,052 individuals (25.9%) died within 1 year after admission for hip fracture; of those, 5,863 died during the initial hospital stay, and 6,377 died within 30 days of discharge. Researchers in this study focused on the individuals who died within that 30-day mark.
The most common cause of death within 30 days of discharge was listed as "expos[ure] to non-specified factor—home" (21.5%), followed by myocardial infarction (13.2%), cancer (10%), dementia (7.2%), falls 5.9%), and stroke (3.7%). Authors acknowledge the low frequency of autopsies conducted may affect the accuracy of these figures.
Researchers found that patients who were released 10 days or fewer after admission were not only significantly more likely to die within 30 days of release, but this risk increased in relation to the number of days of reduced stay, and seems have grown over time—from an 8% per-day increased likelihood in 2006, to the 16% increased likelihood recorded in 2012. Mean length of stay for hip fracture in Sweden over that time period decreased from 14.2 to 11.6 days.
When authors compared groups at either end of the study spectrum, they found that patients whose hospital stay was 5 days or fewer had twice the risk of death within 30 days of discharge than patients whose stay was 15 days or more.
Although researchers were able to identify a linear increase in risk as inpatient days were reduced, they weren't able to extend that trend in the other direction—stays longer than 11 days didn't seem to decrease the likelihood of death within 30 days of release at rates corresponding to length-of-stay.
Authors theorize that the connection to length-of-stay and mortality at the 10-day mark may have something to do with the time it takes to provide a full geriatric assessment of a patient. "Shorter length of stay … reduces the time available for comprehensive evaluation of medical conditions during hospitalization," authors write. "A growing body of evidence suggests that comprehensive geriatric assessment decreased the risks of complications after hip fracture and death after discharge in elderly patients."
According to the study's authors, future research should not only focus on how diagnoses in addition to hip fracture play into mortality rates, but also "evaluate whether early discharge to rehabilitation centers or nursing homes is associated with a worse outcome."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
In a February 26 announcement (.pdf) CMS reported that 81% of claims were accepted as part of its first "end-to-end" test of the new codes. The test involved 661 volunteer providers and all Medicare administrative contractors (MAC), as well as the durable medical equipment MAC common electronic interchange contractor, in a practice session to spot potential glitches in the submission of claims according to coding in the International Classification of Diseases, 10th Revision, or ICD-10. CMS is set to implement the new codes on October 1.
CMS reported that of 14,929 claims received between January 26 and February 3, 12,149 were accepted. Of the 19% of claims rejected, 3% were turned down because of invalid submission of ICD-9 codes, and another 3% for problems with ICD-10 codes. The rest were denied because of "non ICD-10 related errors, including setting up the test claims, health insurance claim number, submitter ID, dates of service outside the range of testing, invalid HCPCS codes, invalid place of service," according to CMS.
In other words: problems with the ICD-10 system had more to do with the submitters than the agency processing the submissions—at least for this round of testing.
"It's good that this testing is taking place well before the October 1 implementation date," said Matt Elrod, PT, DPT, MEd, NCS, senior specialist in APTA's Department of Clinical Practice. "Right now, it seems that the biggest challenge rests with the providers and those submitting the claims. It's crucial that they have a very clear understanding of how the system works. At this point, education is key." APTA offers multiple resources on the new system at its ICD-10 webpage.
Two more end-to-end testing windows are scheduled over the spring and summer—one April 27–May 1, and another July 20–24. Information on the tests is available in a Medicare Learning Network bulletin (.pdf).]]>
The prostheses are controlled through 2 "cognitively separate" electromyographic signals in the forearm—one from nerves and muscles already present in the patient's damaged forearm, and another surgically transferred into the affected arm from the leg. After the signal sites were established, the patients underwent cognitive training by, at first, controlling a graph on a computer screen via electrodes attached to the sites, and then through the operation of a "virtual hand" on the screen.
The final phase of the cognitive training involved a "hybrid hand" that was attached to the nonfunctional hand by way of a "splint-like" device. "As crude as it seems, the device provided direct proof for patients that better hand function could be achieved using the prosthesis than with their denervated hand," authors write.
After the patients completed cognitive training, they underwent amputation of the damaged hand, and were fitted with the bionic prosthesis. Patients completed 3 assessments of global arm function before and after the intervention—the Action Research Arm Test (ARAT), the Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire—and recorded significant improvement in all areas.
Results were published the Lancet (abstract only available for free), accompanied by free videos that show hand function in the patients before the intervention, during the "hybrid" stage, and after being fitted with the prosthesis. The videos show the patients using the prostheses to unscrew a jar lid, unfasten buttons, pick up coins, and pour water, among other activities. News of the research was also featured in major media outlets including the New York Times and CNET.
"Pre-interventional testing showed that all patients had dismal hand function," authors write. "The patients did not use the impaired hand in daily life, even when the bimanual tasks were specifically requested." After becoming accustomed to having 2 functional hands, the patients engaged in bimanual tasks, and were able to wear their prostheses 8-12 hours a day. Tests of overall psychological wellbeing also showed improvement—another positive sign for the researchers who had purposefully selected patients "who had had great psychological harm as the result of the injury."
"The loss of hand function after global brachial plexus injury with lower root avulsions poses a reconstructive challenge that is difficult to overcome," authors write. "Present surgical techniques for such injuries are crude and ineffective." However, they argue, the technique they pioneered presents "no technical or surgical limitations that would prevent this procedure from being done in centers with similar expertise and resources."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
This week, Sens Ben Cardin (MD) and Susan Collins (ME) introduced the Medicare Access to Rehabilitation Services Act (S. 539), which calls for an end to Medicare's payment ceiling for certain outpatient services including physical therapy. A companion version of the bill was introduced in the House in early February (H.R. 775).
The introduction of the legislation in the Senate comes during a busy week on Capitol Hill for APTA advocates and staff, who not only spoke with legislators and policymakers on the therapy cap, but participated in meetings at the White House, the Federal Trade Commission, and the National Institutes of Health to bring the profession's voice to the table on a variety of issues.
The therapy cap issue remains a policy priority for APTA, which sent out an action alert this week to encourage members to contact their representatives about the legislation now in Congress. Additionally, Mandy Frohlich, APTA vice president of government affairs, was featured in an episode of Comcast Newsmakers explaining why repeal of the therapy cap is a crucial to transforming health care for consumers and providers.
APTA will continue to monitor the progress of the legislation and provide members with updates.]]>
Both projects are focused on getting physical therapists (PTs) involved in patient care early-on, and both will be conducted as "pragmatic clinical studies"—research that analyzes a care option's effectiveness in real-life practice situations, such as typical hospital and outpatient care settings, with diverse patient populations. According to a PCORI news release, unlike standard clinical trials that "test whether a care approach works under optimized conditions with carefully selected patients in research centers," the findings from pragmatic studies "are more likely to be applicable to a wide variety of patients."
Duncan is professor of neurology at Wake Forest Baptist Medical Center. Delitto is associate dean of research at the University of Pittsburgh School of Health and Rehabilitation Sciences.
PCORI awarded $14 million for Duncan's project, which will involve stroke patients in 50 hospitals in North Carolina to find out if early discharge with ongoing support by PTs and other providers results in better daily function outcomes than longer hospital stays and standard transitional care. The study "will also consider caregiver strain, hospital readmission rates and mortality, use of health care, consistency of physician care, use of transitional care services, and death," Duncan writes in her summary of the project.
Delitto received $13.9 million in PCORI funding to look at the individual's transition from acute low back pain (LBP) to chronic LBP by focusing on 2 approaches in the outpatient primary care physician (PCP) setting—one "usual care" approach, and a second approach that would team up PCPs with PTs to provide cognitive behavioral therapy (CBT). Patients who have LBP and risk factors for moving from acute to a more persistent state of LBP will be the targeted population for the project, which will involve 12 PCP clinics in 5 different areas across the country. Delitto hopes to recruit 2,640 patients and acquire data on 2,400 over 6 months after enrollment.
"This study is designed to look at the value of a stronger partnership between primary care and physical therapy, particularly for painful musculoskeletal conditions," Delitto said. "A number of studies have come out detailing the success of the PCP plus PT-CBT approach, but they've all been conducted in Europe. Before we can recommend any approach, it should be thoroughly and rigorously tested in the US, with its unique health care system."
The program, with its focus on pragmatic trials, is intended to encourage exactly that kind of approach, according to PCORI Executive Director Joe Selby, MD, MPH.
"A critical feature of these studies is that they will involve all major stakeholder groups as partners, increasing the chances that the studies will be implemented in a useful way and analyzed with an eye toward implementation," said Selby in the news release. "And, if warranted, their results will be put to use in practice much more quickly than most research."
"We are extremely pleased that APTA member PT researchers are among those selected," said Paul A. Rockar Jr, PT, DPT, MS, APTA president in an association news release. "With improved patient outcomes based on evidence, we will be closer to achieving APTA's vision of transforming society by optimizing movement to improve the human experience."
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Besides the Duncan and Delitto projects PCORI will also be funding research on breast cancer screening, the intensity of CT surveillance needed to detect lung cancers, and how a standing-order entry system advising physicians when to prescribe a medication to prevent infections reduces over- and underuse of this medication among patients with breast, lung, or colorectal cancer.]]>
Called Friday Focus, the newsletter series will target 1 of 4 areas each week. The 4 areas that will be covered on a rotating basis are:
To get Friday Focus, members need only to select which topics they'd like to receive. They can do this by logging in to My Profile on www.apta.org and making their choices, as well as review all APTA communications and choose options that best suit their needs and interests.]]>
This week in Washington, DC, association representatives are bringing the profession's transformative vision for health care to multiple fronts by speaking with legislators and policymakers, and seeing to it that physical therapy has a place at the table for some of the most important discussions around the future of health care.
"The events happening this week are a fantastic opportunity for APTA to bring its message of the power of physical therapy to transform society," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "The association's vision is on point with many of the issues being discussed, and we're fortunate to have so many advocates who are passionate about sharing that vision. We're very excited about being able to contribute in these varied ways."
APTA is bringing its voice to:
In an APTA video dispatch recorded at the start of the week, Rockar described the current activities as part of a "really important week" that is allowing APTA to bring physical therapist issues to the fore. "If we're really going to transform society, we have to influence and educate people about policy that's going to help us provide care to our patients in this evolving health care environment," he said.
Terry Brown, PT, DPT, president of the PPS, stressed the importance of broad participation, both in-person and by way of participation through action alerts and other communications from PPS and APTA. "It's enormously important that other people get involved," Brown said. "We need each and every therapist at home to become involved."
There's more work to be done in Washington for the profession and the public it serves: make plans to join hundreds of other APTA members for PT Day on Capitol Hill, June 3–4. The event coincides with the 2015 NEXT Conference and Exposition being held in nearby National Harbor, but attendance at NEXT is not required for participation.]]>
The bioprosthetic heart, developed by the French company Carmat, is designed to replace the patient's original heart over the long term, mimicking nature using biological materials and sensors.
In December 2013, a patient with terminal heart failure was fitted with the artificial heart. Two months later, the Georges Pompidou European Hospital in Paris issued a statement that said, "The 76-year-old man is eating normally, no longer needs constant respiratory assistance, and is able to walk a little further every day thanks to physical therapy."
More recently, in January 2015, a 68-year-old recipient of the artificial heart was discharged from the hospital and "is living a completely normal life now," according to Alain Carpentier, the French surgeon who invented the device. Carpentier added that the man has been "pedaling like crazy" on a stationary bicycle.]]>
The special Open Door Forum sponsored by CMS provided information on the standardized data and assessment domains now required under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The new standardized submission requirements affect long-term care hospitals, skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities.
The requirements are part of the IMPACT Act's standardization measures that will allow the US Department of Health and Human Services to compare quality across PAC settings, improve hospital and PAC discharge planning, and use this standardized data to reform PAC payments in the future. APTA was a supporter of the legislation that created the act.
To access the recording and transcript, or sign up for email notifications of future forums, visit the Open Door Forum webpage. Visit the CMS webpage on postacute care quality improvements, including the IMPACT Act, for more details on the changes.]]>
The report describes the scenario as one in which hospitals "increasingly lose patients to medical care delivered in clinics and home settings." According to the article, hospital occupancy rates dropped to 60% in 2013, a 4-point drop from 2008 rates. In 1980, hospital occupancy rates were 77%.
Modern Healthcare reporter Melanie Evans writes that the new environment faced by hospitals is the result of "high deductibles, better technology, more case management, and shrinking reimbursement." Public policy changes fueled by the Affordable Care Act, coupled with slow wage growth in the wake of the Great Recession, have also significantly dampened the demand for hospital beds, according to the article.
"Numerous markets across the country now have more hospital beds than they need," Evans writes. "Given the intense pressure on hospitals to reduce costs, many healthcare organizations are driven to participate in narrow-network health plans as a way of outflanking the growing competition."
According to the article, many hospitals are replacing beds with outpatient services, while others are exploring new ways to generate revenue from their excess space, "including signing leases with hospice providers or even hotel operators."]]>
Researchers conducted a prospective double-blind study in 12 patients with moderate to severe PD and motor fluctuations who were randomized to a "cheap" or "expensive" subcutaneous "novel injectable dopamine agonist placebo"—which actually was ordinary saline solution. Patients were crossed over to the alternate arm approximately 4 hours later.
Blinded motor assessments in the "practically defined off" state before and after each intervention included the Unified Parkinson's Disease Rating Scale motor subscale, the Purdue Pegboard Test, and a tapping task. Brain activity measurements were performed using a feedback-based visual-motor associative learning functional MRI task. The results were e-published ahead of print in Neurology (abstract only available for free).
Although both placebos improved motor function, the benefit was greater when the patients were randomized first to the expensive placebo, with a magnitude halfway between that of the cheap placebo and levodopa.
The knowledge of cost also seemed to affect brain activity. "Our data showed that brain activation of visualmotor associative circuits is greatest when cheap placebo is given first and lowest when expensive placebo is given first, suggesting greater brain 'effort' (more activity) under placebo conditions of lowered expectations," authors write.
The researchers conclude: "Expensive placebo significantly improved motor function and decreased brain activation in a direction and magnitude comparable to, albeit less than, levodopa. Perceptions of cost are capable of altering the placebo response in clinical studies."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
In an article published recently in the British Journal of Sports Medicine (abstract only available for free), researchers describe their analysis of 17 randomized controlled trials that included taping (often referred to as "Kinesio taping" or KT) with minimal or placebo intervention, as well as with more active treatment approaches including exercise, stretching, traction, and manipulation.
Authors limited their analysis to trials that focused on individuals with chronic pain and disability, which they defined as a condition last for more than 4 weeks. Combined, the trials involved 416 patients in the experimental group and 406 in the control group.
While therapeutic taping was found to be "superior to minimal care"—approaches that included sham taping, no taping, and "usual care"—authors write that "KT is not more effective than other forms of intervention in reducing pain," and "is also not more effective than minimal or other forms of intervention in the reduction of disability."
They write that "the null effect of KT on disability signals the need for conventional therapy, for example, other active forms of intervention, over and above passive treatment, in the management of musculskeletal pain lasting [longer than] 4 weeks."
While taping alone didn't seem to produce significant reductions in pain and disability, authors did find evidence supporting its effectiveness as an adjunct to exercise-based treatments in some instances.
"Our review suggests that KT, when used in combination with conventional therapy, may be effective in reducing pain," authors write. "Our clinical impression is that many clinicians use KT in this way—as an adjunct to exercise."
The researchers cited limitations that include the small number of studies analyzed and "somewhat varying methodology and treatment 'dosage'" of taping application. That variance included not only how the tape was applied, but the number of treatment sessions (from 1 to 12), the frequency of sessions (from 1 to 5 times a week), the length of treatment (from 1 to 6 weeks) "There is a need for the use of standard application procedures (by body parts) to determine efficacy of [therapeutic taping] in future studies," authors write.
Partly because of the attention therapeutic taping has received through its use by professional and Olympic athletes, the research results were reported by media outlets including Reuters news service.
A systematic review on therapeutic taping for spinal pain and disability was recently e-published ahead of print in APTA's journal, Physical Therapy. Full text of that article is available for free to APTA members.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
It's time once again for members to help PT in Motion magazine decide the design to be used on the cover of the upcoming issue. For April, editorial staff is proposing 2 designs and asking members to vote on their favorite cover to illustrate a story about a relay race that includes astronauts. The design that receives the most votes will be the next cover.
Vote by February 25. Just pick the design you think is likely to get you to open up the magazine, and then check out the April issue to see which cover was most popular.]]>
Called the Supporting Athletes, Families, and Educators to Protect the Lives of Athletic Youth Act (SAFE PLAY Act), S. 436/H.R. 829 was introduced by Sen Robert Menendez (D-NJ) and Reps Bill Pascrell (D-NJ) and Lois Capps (D-CA). Supporters, including APTA, believe the legislation could lead to better management and awareness of some necessary aspects of sports safety, including concussions among student athletes, their families, and their coaches.
In addition to including PTs among the health care providers qualified to make return-to-play decisions, the bill provides for education, awareness, action plans, training, and further research related to health issues associated with sports—including cardiac conditions, concussions, and heat advisories—in which PTs play a role.
The bill was first introduced in August 2014 but not taken up before Congress adjourned that year.
The SAFE PLAY Act calls for school districts to have concussion management action plans that teach students, parents, and school personnel how to prevent, recognize, and respond to concussions, including assistance in the safe return of student athletes to academic and athletic performance. The legislation encourages the development of guidelines consistent with those to be developed by the US Centers for Disease Control and Prevention's (CDC) Pediatric Mild Traumatic Brain Injury Guideline Work Group, a group supported by APTA that includes 2 APTA members.
Concussion prevention and management has been a particular focus of APTA over recent years, with the association advocating for continued support of the CDC work group as well as for other legislation addressing these injuries. APTA continues to educate policymakers on how PTs are qualified to detect and manage concussions. Last year, the association attended an invitation-only White House summit on concussions; additionally, concussion management awareness was the focus of a student-led Flash Action Strategy in 2014, which resulted in the largest concussion-related grassroots effort in APTA history.
For information on federal and state legislation, and APTA's position on the role of physical therapists in concussion management, visit APTA's Concussions webpage. Find more resources on the Traumatic Brain Injury webpage, and direct patients and clients to the Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website.]]>
Called Friday Focus, the newsletter series will target 1 of 4 areas each week. The 4 areas that will be covered on a rotating basis are:
To get Friday Focus, members need only to select which topics they'd like to receive. They can do this by logging in to My Profile on www.apta.org and making their choices,as well as review all APTA communications and choose options that best suit their needs and interests.
To make room for the new offering, beginning next week, the popular weekly PT in Motion News email blast will move from Fridays to Wednesdays.]]>
There are some great stories out there, and now it's time to share them.
APTA is celebrating the transformative power of physical therapy by collecting powerful stories of patients to share at MoveForwardPT.com, APTA's official consumer information website, and via social media. If you have a current or former patient or client whose life has been transformed by physical therapy, please share it, or encourage the individual to do so. Submission instructions are available in the Patient Stories section of MoveForwardPT.com. Deadline for submissions is Monday, March 30, 2015.
Note: Do not use the comments section of this post to share stories. Also, remember to not include your patient' or client's name or any other identifiable information that would violate HIPAA's patient privacy protections if you submit a story on behalf of the individual.]]>
In recognition of February as American Heart Month, Move Forward Radio talks with Pamela Bartlo, PT, DPT, CCS, who outlines the signs of a heart attack and risk behaviors for heart disease. She also describes the role of a PT in cardiac rehabilitation, and discusses how cardiac rehabilitation works best as a part of a lifestyle change for people who have heart issues.
The main goal of cardiac rehab "is to change the person's lifestyle behaviors so that they don't ever have a heart problem again," Bartlo says in the podcast.
Other recent episodes of Move Forward Radio have included the topics of adaptive sports and fitness trends in 2015.
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to email@example.com.]]>
Applications are being sought for 1- or 2-year fulltime postdoctoral fellowship trainees committed to advancing health services and health policy research capacity in physical therapy. with the fellowship will provide didactic training, travel support, information resources, secretarial and technical support, and a proposed stipend of $55,000 annually. Health benefits, vacation time, and sick days are also included.
Fellowships may be based at participating CoHSTAR sites at Brown University, Boston University, or the University of Pittsburgh. Terms could begin as early as July 1, 2015.
Application instructions (.pdf) are available at the Foundation for Physical Therapy's (Foundation's) CoHSTAR webpage. Initial application requirements include a curriculum vitae, an essay, 3 current reference letters, and a copy of written work. Qualified candidates will be physical therapists with a PhD, ScD, or DrPH, or doctors of physical therapy (DPT) with formal research training and doctoral-level publication experience.
CoHSTAR (official name: the Center on Health Services Training and Research) was created through a $2.5 million grant awarded by the Foundation through its "Center of Excellence" initiative. In addition to the fellowships, CoHSTAR will host visiting scientists and provide special summer training sessions. The center will also fund several pilot studies each year from investigators inside and outside the program.
For more information about the CoHSTAR fellowship program, email Audrey Kidd or call 401/863-3631.]]>
In addition to the topics listed above, the recap covers the Cerasoli lecture as well as highlights from sessions focused on identifying predictors for injuries, identification of risk factors for wounds and ulcers, water-based exercise, bone health, and more.
The issue is the last in a series of daily publications that kept tabs on the activities at CSM. Highlights from the conference will also be featured in an upcoming issue of PT in Motion magazine.]]>
A new study (.pdf) from the US Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) looked at the use of complementary health techniques and found that in 2012, 34% of adults in the US reported using 1 or more of the approaches, with 17.7% reporting the use of nonvitamin/nonmineral dietary supplements.
The second most-reported complementary approach was deep breathing exercises (10.9%), followed closely by yoga, tai chi, or qi gong (10.1%). Of these, yoga, tai chi, and qi gong showed the biggest increase since a similar study in 2002, when only 5.8% of respondents reported engaging in these activities. Other approaches remained at similar levels in 2002 and 2012, with a slight uptick noted in a 2007 study.
Approaches defined as "complementary" for purposes of the most recent study included: acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy healing therapy, special diets (vegan, vegetarian, macrobiotic, Atkins, Pritkin, and Ornish), folk medicine/traditional healers, guided imagery, homeopathic treatment, hypnosis, naturopathy, nonvitamin/nonmineral dietary supplements, massage, meditation, progressive relaxation, qi gong/tai chi/yoga. The use of deep breathing was collected as a part of other approaches such as hypnosis and meditation.
Although many overall numbers didn't change dramatically, authors of the report noted some shifts within categories—most notably around the use of supplements.
According to the report, while still the most popular complementary approach, Americans have moved their use of nonvitamin/nonmineral supplements away from glucosamine and chondroitin (though still very popular), and are also not taking as much Echinacea, garlic, ginseng, ginko biloba, methylsulfonylmethane (MSM), and palmetto as they did in 2002.
The real favorite? Fish oil, which increased from 4.8% in 2007 to 7.8% in 2012. Another big gain was in the use of prebiotics and probiotics, which rose from .4% in 2007 to 1.6% in 2012, becoming the third most commonly used nonvitamin/nonmineral dietary supplement.
Although the study merged yoga, tai chi, and qi gong under the same category, authors report that yoga amounted to 80% of the reported use within that category. According to the report, use of yoga has risen across all age groups, with the most marked increase in adults aged 18–44, from 6.3% in 2002 to 11.2% in 2012.
How do complementary, alternative health approaches integrate with physical therapy? That's the subject of a feature story in the July 2014 issue of PT in Motion magazine, available to APTA members.]]>
In a 282-page document issued this week, an IOM panel reports on its efforts to evaluate current clinical diagnostic criteria and develop new criteria for CFS, consider possible changes to terminology, and suggest a strategy for dissemination of the report's conclusions. The 15-member panel that authored the report tackled that charge through extensive literature reviews, testimonies and reports in public hearings, and public comments.
"The primary message of this report is that [CFS] is a serious, chronic, complex, multisystem disease that frequently and dramatically limits the activities of the affected patients," write the report's authors. "It is 'real.' It is not appropriate to dismiss these patients by saying 'I am chronically fatigued, too.'"
The report establishes a new definition for the renamed SEID, noting symptoms that include:
Authors write that SEID is not a "diagnosis of exclusion," and can apply to patients with other conditions that produce fatigue.
News of the IOM report was covered widely in major media outlets including Time and NBC's Today show website. More professionally targeted outlets, such as Medscape, also reported on the IOM findings.
The report's authors acknowledge that disseminating information on a renamed disease with a new set of diagnostic criteria will take a significant amount of effort and strategic communication. Authors suggest broad-based actions that include establishing a new ICD-10 code for SEID, and leveraging the communication powers of the US Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS).
The report stresses the importance of direct contact with primary care providers, but adds that "many other health care providers often diagnose and/or care for patients with SEID" and should be an integral part of the communications efforts. That list of providers includes physical therapists.
The report's sponsors include the CDC, HHS Department of Women's Health, the National Institutes of Health, the US Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Social Security Administration.
The IOM report estimates that as many as 2.5 million Americans have CFS, with 84%-91% undiagnosed. APTA offers consumer-focused information on the disease at its CFS webpage at Move Forward PT, the association's website for public education on the value of physical therapy.]]>
In what its authors believe is the first-ever study to describe the incidence and natural history of lateral elbow tendinosis (LET), researchers closely examined medical records of 5,867 patients in a single Minnesota county for incidence and surgery rates between 2000 and 2012. Additionally, a random 10% sample of this patient population was reviewed more carefully to focus on "describing the natural history, recurrence rates, and utilization of nonsurgical and surgical treatments." The study was e-published ahead of print in the American Journal of Sports Medicine (abstract only available for free).
Researchers included all diagnoses consistent with lateral epicondylitis, medial epicondylitis, synovitis–upper arm, and synovitis–forearm.
Researchers found that during the 12-year study period, overall rates of new-onset LET decreased "significantly," from 4.5 per 1,000 in 2000 to 2.4 per 1,000 in 2012. During that same period the rates of surgical procedures for LET increased, from about 1% of all diagnosed cases between 2000 and 2008, to 3% of the cases from 2009 on. The rates were similar for men and women.
Authors write that the reasons for the drop in incidence are unknown "but could potentially include … a true change in incidence, changes in the diagnosing patterns among physicians, or fewer patients with mild disease seeking professional care after using alternative resources for self-diagnosis and treatment."
As for the rise in surgical procedure rates, authors speculate that surgical options have become more widely available "as techniques become more refined and outcomes more predictable." At the same time, they write, the rise could be linked in some ways to the decline of reported incidence, "as fewer patients with mild disease seek professional care."
Among other findings in the part of the study that focused on the 10% sample:
Of the 576 patients studied, 8.5% experienced recurrence of LET, with a median time to recurrence of 19.7 months.
Authors acknowledged limits to their research that included a lack of racial diversity among subjects, absence of data on self-diagnosed LET and individuals who do not seek medical attention, and a possible underestimation of recurrence rates due to the use of the 10% cohort for data. Still, they write, the "unique medical records linkage system" provided by the county hospital system "allows for near-complete ascertainment and validation of all clinically recognized cases of [LET] in a well-defined population."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
A recent article in Fast Coexist features "The Level," the latest addition to office furniture designed to encourage healthy physical habits in the workplace. Essentially a kind of skateboard deck with a curved bottom, the Level is an attempt to provide standing desk users with an unstable (though safe) platform that requires more muscles to maintain balance.
The device capitalizes on growing concern over the detrimental health effects of long periods of sitting, and a move toward desks that require that users stand, or self-adjust to allow standing work as an option.
The Coexist article describes the new device as a possible alternative for individuals who might up the ante even further by using a treadmill desk. According to the article, "the Level escalates user heart rate by 15% on average compared to a sitting environment, while their range of motion increases over 20 times, emulating the same range that you might see in the lower legs while walking (a natural stop built into the Level ensures that range of motion is steady). Most importantly, testers didn't make any more errors while typing than they did sitting down."
Pricetag for the new platform: $289.]]>
The review, published on January 28, examined 27 trials (2,485 participants) aimed at identifying whether exercise reduced neck pain and disability, improved function, and increased patient satisfaction and reported quality of life. The trials included studies that compared an exercise treatment with no treatment or a placebo, as well as those that combined exercise with another intervention such as manipulation, massage, education, heat, or medications. Reviewers excluded trials that included exercise as part of a multidisciplinary or multimodal treatment and those that "required application by a trained individual."
While none of the studies produced what reviewers classified as strong evidence, authors pointed to "moderate"-level evidence that "there appears to be a role for strengthening exercises" in treatment of not only chronic neck pain, but cervicogenic headache and cervical radiculopathy, "if these exercises are focused on the neck, shoulder, and shoulder blade region."
As for specific exercises and approaches, reviewers also found limited evidence that sustained natural apophyseal glides seemed to be among the more effective exercises for treatment of cervicogenic headaches, and "mindfulness exercises" such as Qigong possibly beneficial for mechanical neck pain, though the improvement may be slight.
Among other findings in the review:
The lack of strong evidence overall points not only to a need for more rigorously constructed research, but for more agreement on some fundamentals around neck pain and exercise interventions, according to the review authors.
"To date, there is no standardized definition of mechanical neck pain even if it has evolved over the last three decades," authors write. Given the variability of the group identified as experiencing neck pain, they write, "subgrouping based on diagnosis, treatment, or prognosis system classification would be useful to increase homogeneity for research and clinical applicability."
Another impediment to strong research in this area: exercise classification and dosage requirements. Authors of the review advocate for a classification system that describes "the physiological effect of exercise on the body rather than describing the types of activity used to produce that effect" and "allow[s] … researchers to classify exercises into a specific category by recognizing their mechanisms of actions." Additionally, authors of the review assert that "in general, there is also limited evidence on optimal dosage requirements … for exercise therapies and other modalities used to treat neck disorders."
Until more solid research is produced, providers should take a careful approach when considering evidence to date, authors state.
"The level of evidence of these studies varied from low to moderate," authors write. "Thus clinicians should not underestimate their clinical judgment in the choice of optimal treatment modality for client needs."
APTA members can access the full text via the Cochrane Database of Systematic Reviews in PTNow ArticleSearch; nonmembers can access the abstract only for free via PubMed.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The bottom line? For now, PTs can continue to use the 59 modifier under the Correct Coding Initiative.
The changes announced by CMS in August 2014 apply to the 59 modifier in payment claims—that's the code under the health care common procedural code system (HCPCS) used to represent a service that is separate and distinct from another service it's paired with. In an effort to tease out precisely why the service is distinct, CMS is requiring some providers to use different modifiers instead of the 59 modifier. The new modifiers —XE, XP, XS, and XU—are intended to bypass a CCI edit by denoting a distinct encounter, anatomical structure, practitioner, or unusual service.
"We're receiving questions from members about whether they have to use some new modifiers issued by CMS, and the answer at this time is no," said Gayle Lee, JD, APTA senior director of health finance and quality. "As of February, 2015, PTs are being instructed that these new modifiers are not required for physical therapist services. However, at some point in the future, PTs may need to use these new modifiers instead of the 59 modifier, so it's important that they stay abreast with this change as implementation continues."
In a recently issued Medicare Learning Network guidance document (.pdf), CMS stated that "providers may continue to use the 59 modifier after January 1, 2015, in any instance in which it was correctly used prior to January 1, 2015." The agency writes that "additional guidance and education as to the appropriate use of the new … modifiers will be forthcoming as CMS continues to introduce the modifiers in a gradual and controlled fashion."
APTA will continue to monitor this issue and share news of any changes.]]>
According to an NIH news release, 3 groups of researchers will receive funding from the Defense Advanced Research Projects Agency (DARPA) as part of DARPA's Hand Proprioception and Touch Interfaces program aimed at developing better neutrally linked prosthetics. Obama's BRAIN initiative opened the possibility of collaboration between the researchers, previously supported by NIH, and DARPA.
The 3 NIH-supported research projects now receiving the DARPA grants are focused on a wireless device that can be implanted directly into muscles to control prostheses rather than through electrodes placed on the skin; a tiny bundle of microelectrodes implanted in peripheral nerves to control muscle movement; and an electrode nerve cuff that allows the user of a prosthesis to experience pressure sensation. The nerve cuff technology was featured in a PT in Motion News story published in October 2014.
A complete list of all BRAIN initiative awards made to date, and notice of new funding opportunities, are available at the initiative website.]]>
As part of February 6 "National Wear Red Day" to raise awareness about women's heart health, APTA's PTNow blog features a quick case scenario about a 44-year-old woman who has a few questions for you, based on some recent results from her primary care physician.
Read the vignette, think about what you'd say to Ms LZ, then read on for comments on the case from Dan Malone, PT, PhD, CCS, president of the APTA Cardiovascular and Pulmonary Section. Finally, check out some additional resources that look at the PT's role in cardiopulmonary health.
National Wear Red Day is a special part of the American Heart Association's National Heart Month, which includes a special "Go Red for Women" campaign. Heart disease is the number 1 cause of death among women, responsible for one-third of all deaths among women every year.]]>
The center, to be called the Center on Health Services Training and Research (CoHSTAR), was the brainchild of the Foundation for Physical Therapy (Foundation), which responded to a need for stronger physical therapist (PT) leadership in health policy and health services research. This week, the Foundation announced that Brown University was awarded a $2.5 million grant to establish the center.
"Researchers who can develop an essential body of knowledge that shows the efficacy of physical therapy will help us achieve our vision of transforming society by optimizing movement to improve the human experience," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in a news release. "We fully expect the research to change the face of physical therapy and ultimately to improve patient outcomes."
CoHSTAR will offer postdoctoral fellowships, host visiting scientists, and provide special summer training sessions. The center will also fund several pilot studies each year from investigators inside and outside the program. Over 5 years, CoHSTAR will train up to 9 fellows and 5 visiting scientists, all focused on strengthening physical therapy-related health services research.
The center will be operational in June 2015 and begin accepting applications for fellows in July. Application materials will be posted on the Foundation's website.
In addition to APTA's contribution, funding for CoHSTAR, formerly known as the Center of Excellence, came from gifts from 50 APTA components, as well as foundations, corporations, and individual physical therapists.]]>
This week, about 9,000 physical therapists (PTs), physical therapist assistants (PTAs), and students from PT and PTA education programs have been attending the association's largest annual meeting, a 4-day event featuring educational sessions, platform events, poster presentations, and a bustling exhibit hall. For many, it's the same CSM they look forward to every year.
This time around, however, in addition to all the usual discussions, there has been increased attention on how the physical therapy profession will take a leadership role in a health care environment that's changing dramatically—a concept that APTA captures in its vision of "transforming society by optimizing movement to improve the human experience."
APTA CEO Michael Bowers is spending much of his time at CSM helping members and leaders think about how this transformational energy can be applied to the profession, to the association, and society in general.
"We are really focused on the vision that the [APTA House of Delegates] passed in 2013, and we're talking about the transformative power of physical therapy—we're looking at that in a lot of different ways," Bowers said in an APTA video dispatch. It's a vision that requires the profession to see to it that "we're operating not only in best practices, but in best-in-class, where we're really innovating and moving forward," he said.
The theme was echoed by Stephanie Yu, PT, MSPT, PCS, immediate past chair of the American Board of Physical Therapy Specialties (ABPTS). Speaking at a special ceremony marking the 30th anniversary of ABPTS, Yu told the audience that the qualities of PTs who pursue specialist certifications—passion, courage, determination, vision, and a recognition of their interconnectedness with others—are precisely the qualities that will help the profession lead in the future. "It's up to you to be the leaders and make a positive impact," she told the audience.
Conversations about transformation were also being had on the floor of the exhibit hall and elsewhere throughout the CSM meeting space, as APTA staff invited PTs, PTAs, and students to tell the world how they would transform society. Attendees were given a sign with the phrase "I will transform society by…" and then asked to complete that sentence. Photos of attendees showing off their own visions are being shared on social media, and will become part of an APTA educational campaign.
Bowers said that the transformative efforts should always be grounded in a recognition of why the profession is moving in these directions in the first place. "There's a lot of hard work to do," Bowers said. "We have to be consistent in applying the principles we believe in and not stop, but we never want to lose sight of what we're trying to do, which is to make a paradigm shift in the way health care is delivered in the US."
Want to let the world know how you will transform society as a PT or PTA? Complete the sentence "I will transform society by…" and tweet using the hashtag #PTTransforms.]]>
On February 4, the Foundation reported that Brown would receive the funding to establish the Center on Health Services Training and Research (CoHSTAR) over the next 5 years. While Brown will provide leadership and administration, Boston University (BU) and the University of Pittsburgh (Pitt) will also participate in the multi-institutional research and training program, working together to deliver "a 3-part focus on analysis of large data sets, rehabilitation outcomes measurement, and implementation science and quality assurance," according to a Foundation news release.
CoHSTAR will offer postdoctoral fellowships, host visiting scientists, and provide special summer training sessions. The center will also fund several pilot studies each year from investigators inside and outside the program. Over 5 years, CoHSTAR will train up to 9 fellows and 5 visiting scientists, all focused on strengthening physical therapy-related health services research.
"Health services research is like the basic science of the health care system," said Linda Resnik, PT, PhD, CoHSTAR's principal investigator and director, in an APTA video dispatch. "Health services is the kind of research that is relied upon by government agencies, by lawmakers, by payers, providers, consumers, and others for important decision-making. This is the kind of research that has never been more important than it is today in this era of health care reform."
Funding for CoHSTAR, formerly known as the Center of Excellence, came from a $1 million donation from APTA and gifts from 50 APTA components, as well as foundations, corporations, and individual physical therapists.
"The establishment of CoHSTAR is a tremendous step forward for the physical therapist profession, and we couldn't have come this far without our generous donors," said Foundation Board of Trustees President Barbara Connolly, PT, DPT, EdD, FAPTA.
Resnick said that CoHSTAR will be operational in June 2015 and begin accepting applications for fellows in July. Application materials will be posted on the Foundation's website.
'We need more physical therapy health services research to inform practice and policy," Resnik said. "Together we'll build a bigger community of physical therapy scientists who can provide evidence about the value of physical therapy, and who can address important issues that are facing the profession and the health care system."
The Foundation announcement was made at the 2015 APTA Combined Sections Meeting being held in Indianapolis, Indiana.
Visit the Foundation website to learn more about CoHSTAR and the impact the Foundation has made on physical therapy research.]]>
Stories in the New York Times, Reuters, and other media outlets report that Anthem became aware of the breach on January 29. The Federal Bureau of Investigation is now working with the company to track down the individuals behind the theft.
In an open letter to members on the Anthem website, CEO Joseph R. Swedish writes that while the breaches were sizable, "based on what we know now, there is no evidence that credit card or medical information, such as claims, test results, or diagnostic codes were targeted or compromised." Swedish is among the individuals whose records were accessed.
The letter also states that Anthem will notify all individuals whose records have been accessed, and will provide "credit monitoring and identify protection services free of charge so that those who have affected can have peace of mind."
While involving the most records to date, the Anthem breach is not the first large-scale theft of data related to health care. As of June, 2014, in the past 5 years there were a total of 1,026 breaches that affected 500 or more individuals, and another 116,000 that have affected fewer than 500. The larger-scale breaches are posted on a US Department of Health and Human Services (HHS) webpage. In June, HHS estimated that breaches affected 31.7 million people in the US, or 1 in 10 Americans.
Until the Anthem breach, the largest recorded cyber-attack on a health care operation affected 4.5 million patients associated with Community Health Systems, a company that owns, operates, and leases hospitals. That theft was discovered in August 2014.
Anthem operates under brands that include Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross and Blue Shield, Amerigroup, Caremore, Unicare, Healthlink, and DeCare.]]>
Hosted by Heather Smith, PT, MPH, director of quality in APTA's Health and Finance Department, the podcasts join a suite of offerings on the association's PQRS webpage that cover the system's history as well as ongoing updates. Transcripts for nearly all of the podcasts are also available online.
Interested in connecting with other providers to discuss PQRS? Check out APTA's online PQRS forum on the Hub—one of the most popular online communities offered by the association.]]>
The review process applies to outpatient physical therapy, occupational therapy, and speech language pathology claims that exceeded $3700 from March 1-December 31, 2014. The review of these claims had been temporarily halted due to delays in the transition to new RACs.
The new process, begun in mid-January of this year, doesn't alter the RAC cycle of 45 days between ADR letters, and prevents RACs from requesting review of a large percentage of a provider's claims at one time. Instead, it establishes a system that will enable RACs to review 100% of provider claims above the $3700 therapy cap within 5 cycles, depending on how many ADRs are sent to a provider during that period. The 100% review rate was mandated by Congress in 2014.
Essentially a 5-step process, the first ADR sent to a provider will focus on only 1 claim, but after that, RACs can request a gradually increasing percentage of claims for the second (up to 10% of total eligible claims), third (up to 25%), and fourth (up to 50%) ADR. The fifth ADR issued to a provider can cover 100% of the remaining claims.
The review process only applies to claims made by outpatient therapy facilities—for example, skilled nursing facilities, outpatient hospitals, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities—and for the time being, is limited to claims handled by existing RACs during the March – December, 2014 time period. CMS has not yet finalized the process for new RACs, and for claims made in 2015.
APTA developed a resource that helps explain the new process (.pdf) in more detail and provides examples of how the new system works.]]>
In an article published in the January 29 edition of The Lancet (abstract only available for free; full article available to members in 2 months in PTNow ArticleSearch), physicians from the Colorado Children's Hospital recount the development and treatment of 12 cases of acute flaccid paralysis and cranial nerve dysfunction among children (median age: 11.5 years). Ten of the 12 children experienced limb weakness, and 11 had extensive spinal cord lesions. Additionally, cranial nerve dysfunction—defective speech, facial droop, trouble swallowing, double vision—was observed in 10 of the children.
Testing revealed EV-D68 in 8 of the 12 children, findings that "suggest the possibility of an association between [EV-D68] and neurological disease in children," authors write. The Colorado illnesses coincided with an outbreak of EV-D68 across the country. The US Centers for Disease Control and Prevention (CDC) puts the number of EV-D68 cases at 1,153.
Physicians were unable to find a treatment that countered the illness, and to date, none of the children who experienced paralysis has made a full recovery. The only "mild improvements" the patients have seen have come "with the help of physical therapy," according to an article published by the University of Minnesota's Center for Infectious Disease Research and Policy.
According to the University of Minnesota, "very few similar cases" of the polio-like symptoms were observed before the 2014 EV-D68 outbreak, which could be attributable to more thorough testing—or the possibility of a new viral strain. If a solid connection is established between EV-D68 and paralysis, the virus would be added to a list of non-polioviruses capable of causing neurological damage.
"If [EV-D68] infections continue to happen in an endemic or epidemic pattern, development of effective antiviral or immunomodulatory therapies and vaccines should become scientific priorities," Lancet authors write.]]>
The cover story of PT in Motion's February issue, "The Future of Physical Therapist Education," examines how the changing health care landscape is altering not just curriculum, but the way that curriculum is delivered. The "educated predictions" included in the story are based on insights from PTs in both practice and education settings, and range from increased emphasis on interprofessional teams to more residency opportunities, all while continuing to stress the importance of critical thinking.
In the article, APTA Lead Academic Affairs Specialist Jody Frost, PT, DPT, PhD, FNAP, says that "the way we practice is going to affect physical therapist education."
PTs interviewed for the article add that education will need to focus more on communication skills, leadership, hybrid learning, research, and emerging technologies to reflect the changing profession. Education's response to these changes may also involve a shift in the location of residency programs, an increased emphasis on prevention and overall health, and a reduction in some of what is currently taught.
The PT in Motion article on physical therapist education appears in the February issue of the magazine. Hard copy versions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.]]>
As in previous years, Obama is proposing the elimination of loopholes in the Stark law that prohibit referral to most in-office ancillary services (IOAS) under Medicare. The current law contains exceptions that allow physicians to refer patients for certain services—including physical therapy—to a business that has a financial relationship with the referring provider.
Elimination of the IOAS exceptions remains one of APTA's public policy priorities, and was the focus of wider attention late last year when the American Association of Retired Persons voiced its official support for restricting the practice.
The Obama proposal around IOAS was applauded by the Alliance for Integrity in Medicare (AIM) a coalition of organizations, including APTA, that has been advocating for an end to the exceptions. Other professions impacted by the current exceptions include anatomic pathology, advanced diagnostic imaging, and radiation therapy.
The $3.9 trillion budget proposal is on its way to Capitol Hill, where it is likely to meet with opposition in both chambers of Congress. APTA will continue to analyze provisions in the spending plan and inform its members of additional proposals that could impact the profession.
Find out more about the IOAS exceptions on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.]]>
Known as the Prevent Interruptions in Physical Therapy Act (H.R. 556/S.313), the identical bills would allow a PT to bring in another licensed provider to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education.
While current law extends locum tenens to doctors of medicine, osteopathy, dental surgery, podiatric medicine, optometry, and chiropractic, PTs in private practice must avoid absences or risk gaps in patient and client care.
The efforts are led in Congress by Reps Gus Biliraikis (R-FL) and Ben Ray Lujan (D-NM) in the House, and by Sens Charles Grassley (R-IA) and Bob Casey (D-PA) in the Senate. APTA and its Private Practice Section (PPS) collaborated on pressing for the legislation.
"This small but important technical correction to Medicare law is long overdue," said Terence Brown, PT, APTA Private Practice Section (PPS) president. "Even short interruptions in a Medicare beneficiary's therapy can cause the patient to regress. For small or solo physical therapy practices across the country, this means Medicare beneficiaries can continue their treatment uninterrupted in pursuit of restoring their functional goals. PPS urges broad support for this change."
APTA has advocated for this issue as an easy technical fix bill that should be linked to larger Medicare reforms that are moving through congress. Achievement of locum tenens for PTs is one of the goals identified in the association's recently released list of public policy priorities.
Justin Moore, PT, DPT, APTA executive vice president of public affairs, characterized the bill as a good fit with the association's broad vision to transform patient access to care. "Work on this legislation upholds the association's commitment to eliminating unnecessary regulatory barriers," he said. "We will continue to identify ways for this and other policy priorities to gain traction in the 114th Congress."
APTA will monitor the progress of the bills and post updates to its locum tenens webpage. Resources on the website include a podcast on the importance of this legislation and information on how PTs can get involved in advocating for its passage.]]>
The webpage includes links to candidate statements and biographical information for each member running for APTA President, Vice President, Director (3 positions), and Nominating Committee (1 position). Elections will be held at the APTA House of Delegates session in June.
Candidates are:
More information on the elections process and links to related governance resources can be found on the Nominations and Elections webpage. Contact Amber Neil with any questions.]]>
In a paper e-published ahead of print in the January 12 Journal of Rehabilitative Medicine, authors share the results of a study of 851 patients—589 women and 262 men aged 18-65—who were referred to a pain rehabilitation clinic at a hospital in Sweden over a 3-year period. Once referred, patients were assessed by a multidisciplinary team consisting of a specialist physician in rehabilitative medicine, a physical therapist, an occupational therapist, a social worker, and a psychologist. The team then recommended 1 or more interventions. For their study, researchers only tracked patients who were referred by the team for an intervention from a single profession.
Researchers found that after adjusting for variables that included age, socio-demographic data, pain intensity, number of pain sites, and anxiety and depression, men were nearly twice as likely as women to be referred to a physical therapist. Likelihood of referral for radiological investigation was also significantly higher for men than women, they found.
"The finding that men more often than women were recommended physiotherapy by interdisciplinary teams was surprising," authors write, particularly in light of the fact that men and women reported similar levels of pain severity and interference with daily activities.
Additionally, authors write, the only notable difference between the symptoms reported by men and women—women tended to describe more pain sites than men—would seem to make women more likely to be referred to physical therapy, not less, "since several studies have shown that physical activity interventions are effective for patients with widespread pain."
In discussing possible reasons for the differences in referrals, authors speculate on the possibility that "men and women put different demands on health care," citing a study that found that "men with chronic pain more often requested medical tests, such as X-rays, while women more often asked for help or advice when visiting health care."
However, the explanation may not end there, they write: outcomes of the study open up the possibility that "gendered communication may have contributed to the difference," and should be the subject of further research. "Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended."
"The patients in the present study were assessed by several experienced professionals," authors write. "However, the gender differences in the team's recommendations suggest that their attitudes and preconceptions may have affected the results."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The findings are based on data collected in 2011 and 2012 on grip-strength tests of Americans 60 and older that divided participants into weak, intermediate, or normal groups based on sex-specific standards. The brief states that "these thresholds are related to the level of muscle weakness that is associated with slow gait speed, an important mobility impairment."
Among the findings:
In assessing results of the grip-test, weak strength was defined as less than 26 kg for men, and less than 16 kg for women; intermediate was defined as between 26 and 31.9 kg for men, and between 16 and 19.9 kg for women; strength at or above 32 kg for men and 20 kg for women was defined as normal.]]>
A newly released Cochrane review of studies on the effects of interventions aimed at reducing sitting time for office workers asserts that most evidence to date is of "low to very low quality." (APTA members can access the full text via the Cochrane Database of Systematic Reviews in PTNow ArticleSearch. Nonmembers can access the abstract only for free via PubMed.)
The good news? That low-to-very-low quality evidence seems to point toward a reduction in sitting time when study participants used a "sit-stand desk" that would allow them to work standing up at least part of the time.
Authors of the review found 8 trials that included 1125 participants in a range of initiatives designed to reduce sitting: 3 trials involving the use of sit-stand desks, 2 trials that looked at computer prompts to remind employees to stand and walk, and 1 trial each focused on walking strategies, mindfulness training, and information and counseling.
Though they deemed the quality of the evidence "very low," authors write that the use of a sit-stand desk with no accompanying information or counseling reduced sitting time by 113 minutes per workday. The other interventions reviewed either had no effect or were inconsistent.
Aside from the low-quality evidence about reduced sitting times, authors found low-quality evidence about effects of the sit-stand desks on musculoskeletal symptoms, workplace performance, reduction in sick days, or increase in any form of moderate-to-vigorous intensity physical activities.
Still, authors note, physical inactivity at the workplace does increase overall risk of obesity, heart disease, stroke, and diabetes, which does warrant further research into interventions aimed to reduce sitting. The problem, they write, is coming up with research models that are sufficiently robust.
"At workplaces it is difficult to randomize employees at an individual level," authors write. "Employees receiving an intervention might influence their colleagues belonging to a control group within the same workplace." To avoid contamination, they recommend "a cluster-randomized design with at least 2 intervention sites and 2 control sites, but preferably many more."
Authors also caution against limiting measurement to workplace only. "Reducing sitting at work is important," they write, "but compensatory mechanisms outside work, for example more sitting during leisure, might result in no net change in total sitting time."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Magdalen Goergeny, PT, and her husband Emil, made the donation as part of the settlement of their estate following their deaths in 2013. Magdalen Goergeny was 86 when she died in July of that year. She was followed in death by her husband, aged 96, 2 months later. The couple lived in Akron, Ohio.
The gift makes the Goergenys Foundation Legacy Partners, a designation reserved for members and friends who have included the Foundation in their estate plans.
"Bequests play a vital role in the Foundation's ability to carry out its mission to fund and publicize physical therapy research, and we are extremely thankful to the Goergenys and all our Legacy Partners who have thought of us when developing their plans," said Foundation Board of Trustees President Barbara Connolly, PT, DPT, EdD, FAPTA, in a Foundation news release. "With this generous bequest, the Foundation will be able to increase both the amount of research and the number of researchers it can fund at a time when the demand for physical therapy and physical therapy research also is dramatically increasing."
The Goergenys were born in Hungary, and lived there through World War II. Emil Goergeny lost sight in both eyes during a bombing raid in 1941, and endured more than 50 surgeries in Austria after the war. After being denied reentry into Hungary, the couple moved to Norway, where Magdalen graduated from the Oslo Physio-Therapeutical Institute in 1954.
Magdalen received her US physical therapy instruction at the New York University College of Medicine and the University of Oregon Medical School, among others, and opened her first practice in 1971. Her practice focus was orthopedics.
Contributions to the Foundation for Physical Therapy are tax-deductible and can be made online or sent to its headquarters at 1111 North Fairfax Street, Alexandria, VA 22314. For more information, visit www.Foundation4pt.org, email email@example.com, or call 800/875-1378.]]>
This week HHS officially announced that it will establish milestones in its efforts to create payment systems based on outcomes rather than services provided: by 2016, it plans to tie 30% of Medicare payments to alternative payment models, and increase that level to 50% by the end of 2018. At the same time, the department plans to link 85% of remaining fee-for-service payments to some outcome measures by the end of 2016 and bump that to 90% 2 years later.
While the HHS move toward outcome-based payment models has been well-known since the establishment of the Patient Protection and Affordable Care Act (ACA), this is the first time HHS has attached definitive timelines to what it believes are measurable goals.
"Although we have much to celebrate regarding increased access and quality, and reduced cost growth, much of the hard work of improving our health care system lies ahead of us," HHS Secretary Sylvia Burwell wrote in an article announcing the timelines published in the New England Journal of Medicine.
The alternative payment arrangements targeted in the shift will include accountable care organizations (ACOs), bundled payment arrangements, and patient-centered medical homes. Currently, about 20% of Medicare payments are made through alternative arrangements such as these.
The concepts being endorsed by HHS through the new timelines won't likely be news to APTA members, who have been learning about the new models—and investigating the ways physical therapists (PTs) and physical therapist assistants (PTAs) could work in these systems—since before the implementation of the ACA.
"Physical therapy stands to play a very important role in these new payment models," said Gayle Lee, JD, APTA senior director of health care finance and quality. "PTs are in a position to reduce readmissions, increase independence, and improve quality of life, all of which are central goals of the alternative systems. We are confident that PTs and PTAs are integral to bringing about an important transformation in health care delivery."
APTA has been helping its members position themselves for the future through its online resources on collaborative care and innovations in practice (including the latest information on the association's "Innovation 2.0" initiative). Additionally, members can access up-to-date information on the Physician Quality Reporting System (PQRS) generally, as well as specific resources on the value-based modifier system.
And as HHS prepares for a health care future with increased attention to outcomes, APTA is making that future a reality for physical therapy through the establishment of the Physical Therapy Outcomes Registry, a far-reaching project that seeks to build a database that will demonstrate how physical therapist services change lives.
The APTA initiatives resonate with several of the HHS plans. In her NEJM article, Burwell identified some of the targets for more immediate changes, including the testing of new payment models for specialty care, beginning with oncology, and "payments to providers for care coordination for patients with chronic conditions." These efforts will join current HHS programs to reduce hospital readmissions by encouraging hospitals to "improve transitional care and coordinate more effectively with ambulatory care providers," she wrote.
"Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people," Burwell said in an HHS press release. "We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement."
Other news sources and perspectives on the HHS announcement:
According to a new report issued by the Blue Cross Blue Shield (BCBS) Association (.pdf), differences in the prices of these surgeries can vary by as much as 313%--within the same metropolitan area.
BCBS looked at claims for the surgeries over 3 years in 64 markets and found dramatic variations in costs, from a low of $11,317 in Birmingham, Alabama, to a high of $69,654 in New York City for total knee replacement, and from $11,327—again in Birmingham—to $73,987 in Boston, Massachusetts, for hip replacement surgery.
But the differences weren't just regional. The BCBS study found wide variations within single metropolitan areas.
The Boston-Worcester area registered the highest level of variance for hip replacement surgery, from $17,910 to the $73k figure cited above. For knee replacement surgery, the Dallas, Texas metro area took the dubious top spot position with a range from $16,772 to $61,584, or a 267% difference.
The lack of wide cost differences in an area wasn't necessarily good news either: in Fort Collins, Colorado, for example, knee replacement costs varied by only .3%, but the average cost of $55,686 in that area was significantly higher than the nationwide average of $31,124.
The nationwide average for hip replacement surgery was $30,124—a figure that alone doesn't capture the $62,000 difference in prices across the country.
"The phenomenon of extreme price variation in health care can have obvious financial consequences for individuals and employers," the report's authors write. "And from a macroeconomic perspective, it can have serious implications for the sustainability of a US health care system that is exceeding its economic capacity."
The BCBS report was picked up by several media outlets, including the Washington Post (includes maps from BCBS report), the Los Angeles Times, and the Reuters news agency.]]>
According to a new study published in Arthritis Care & Research (.pdf), patient-reported knee pain while using stairs can often be linked to developing knee OA, even before its presence has been confirmed via imaging. Paying particular attention to pain reported during weight-bearing activities involving bending of the knee—the type of activity used in navigating stairs—"could help boost efficacy of interventions" by allowing them to begin earlier, authors write.
The study used pain-related data from the Osteoarthritis Initiative, a publicly available database of more than 4,700 individuals with confirmed radiographic OA, or who have been deemed at high risk of developing OA. Participants regularly complete the Western Ontario McMasters Universities Osteoarthritis Index (WOMAC), an evaluation instrument for patient-reported stiffness, pain, and function.
Researchers focused on 491 participants who scored 0 for pain on the WOMAC at baseline and went on to register a pain score. By applying a Rasch analysis to the question responses, they were able to reliably compare responses to the WOMAC questions with the development of pain symptoms over time.
Results showed that of 5 activities—using stairs, walking, standing, sitting, sitting/lying and "in bed"—pain when using stairs was most likely to be the first symptom reported. Next to be reported was walking, followed by standing. Pain while sitting/lying emerged later, with pain experienced while in bed consistently reported last.
While authors weren't particularly surprised by the results, they write that the Rasch analysis "helped us to formally identify the transition point between absence and presence of pain, which on a conceptual basis we have taken to be the point of pain onset."
Authors write that their study could help to inform future trials to help identify patients with OA sooner "if pain during such activities is used during screening, perhaps facilitating effective intervention to prevent further progression of the disease."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
According to a Harris poll sponsored by American Well, a privately held telehealth company, 64% of respondents answered that they would participate in a video visit with their physician, and 21% selected video technology as their first choice for "middle-of-the-night care," second only to a visit to an emergency department. The results were and reported recently in Mobihealth News and iHealthBeat.
Enthusiasm for telehealth options tended to be stronger among younger individuals, with 11% of respondents 18-34 answering that they would switch physicians if online visits were available. That rate dropped to 8% in the 35-44 year age group, and was recorded at 5% for the next 2 age groups. Only 3% of respondents over 65 said they'd make the switch.
While voicing support for the concept of online visits in a general sense, respondents were also very clear about a few particulars. Overall, 63% chose "HD video" as the preferred mode of delivery, 88% said that they would want to select their own doctors for the service, and 62% responded that they would expect online visits to be less expensive than in-person visits.
In 2014, APTA's House of Delegates approved a resolution that supports the adoption of telehealth technologies in physical therapy as "an appropriate model of service delivery" when provided in ways that are "consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations."
The survey did not address potential security concerns for patients and providers—a central concern for APTA as it continues to look at how physical therapists can use telehealth in their practice.
APTA offers resources on telehealth in physical therapy—including a link to Board of Directors definition and guidelines--on its telehealth webpage.]]>
Researchers analyzed results from the studies—5 controlled trials and 19 randomized controlled trials involving 1,769 women who were postmenopausal—to determine the effects of physical training on bone density, particularly in the spine and hip. Participants were limited to women who did not engage in regular exercise prior to study enrollment, and who were not receiving hormone replacement therapy or antiresorptive treatment. BMD outcomes were measured by way of X-ray or photon absorptiometry.
"Protocols that included only resistance training did not generate significant effects on BMD in older women," authors write. No studies were limited to high-impact or weight-bearing training alone—but significant improvements were found when these interventions were included as part of a "combined resistance training" approach.
"It was estimated that the beneficial effects induced by combined resistance training could contribute to almost 1.8% and 2.4% BMD gains for the hip and spine in postmenopausal women," authors write. "The training-related increase in BMD effectively prevented bone loss and greatly benefited postmenopausal women at risk for fracture."
Researchers included activities such as jumping, skipping, dancing, and hopping among the high-impact, weight-bearing activities that contributed to increases in BMD when combined with progressive resistance training.
Authors acknowledge questions about the safety of combined resistance training for older women, but write that the incidence of injury in the studies they reviewed was "very low," possibly due to the fact that most of the training was supervised. And while they write that "caution is advised when resistance training is performed at home," they conclude that data support the idea that resistance training is "a feasible nonpharmacological strategy for preventing postmenopausal bone loss." The study appears in the January 21 online edition of Osteoporosis International (abstract only available for free).
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The post offers highlights of the CPG+ reviews, which assigned a 5.0 out of possible 7 to the guideline on ankle stability and movement coordination impairments related to ankle ligament sprains, and a 5.25 rating to the CPG on shoulder treatment of pain and mobility deficits for individuals with adhesive capsulitis.
Links to both CPGs are available through the blog, as well as links to information on the AGREE II rating system used by the appraisers.
The CPG+ process is based on input from physical therapist experts. Interested in becoming an appraiser? Email email@example.com with "CPG+" in the subject line.]]>
APTA's public policy priorities for the next 2 years will bring new energy to some longstanding advocacy efforts, new focus on issues that are crucial to the profession, and new approaches to influencing decision-makers, all designed to advance the association's vision of "transforming society by optimizing movement to improve the human experience."
The association will focus on 4 major objectives: the positioning of physical therapists (PTs) as integral to collaborative care; the ongoing support of integrity in practice through reduction of fraud, abuse, and waste, and creation of strong state regulatory frameworks; the promotion of the value of physical therapy through support for research, outcome measures, and effective payment models; and the continued effort to increase patient access to care from a PT.
Within those objectives, APTA has identified "policy strategies"—goals it hopes to reach at the federal and state levels. The long list of strategies ranges from support for policies positioning PTs as key members of chronic care management teams to advocacy for rehabilitation research, and from the removal of restrictions in state and federal direct access policies to the promotion of PTs as an entry point to care. The priorities can be accessed through the APTA Federal Advocacy webpage.
"It's always energizing to share the association's policy priorities every 2 years," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "This year, it's even more exciting because of the ways they tie in to APTA's vision of transformation. There's a lot of energy in the profession around this vision, and we can draw from that energy to make some real-world changes that will help the profession and the public."
The association establishes new policy priorities every 2 years, to coincide with each new session of Congress. Priorities were determined through member input and review from the association's Public Policy and Advocacy Committee (PPAC). The priorities were considered and approved by the APTA Board of Directors during its November 2014 meeting.
"The new priorities are really an ideal mix that play well to our strengths as an association," Moore said. "Our work on these priorities will support our ongoing initiatives around quality of care, integrity of the profession, innovative models of practice, access to care, and payment reform."
The priorities aren't just about influencing policy on Capitol Hill and in federal agencies. Many of the strategies target changes at the state level, including reducing barriers to direct access, strengthening state term and title protection, modernizing practice acts, and improving appropriate coverage of physical therapy in state Medicaid plans.
Justin Elliott, APTA director of state government affairs, sees the priorities as a natural extension of ongoing work with state chapters and legislatures.
"The physical therapy profession enjoyed some hard-fought success last year when we reached the milestone of some form of direct access in all 50 states, DC, and the US Virgin Islands, but it's important to remember that for some states, more work needs to be done to eliminate unwarranted provisions tied to direct access laws," Elliott said. "We'll be working on that and several other issues that can make a difference in the profession's ability to better serve the public."
APTA members can get more involved with the association's policy work through the APTA Legislative Action Center, and by joining PTeam, the association's email group that provides regular updates on legislative and regulatory issues affecting PTs. Also available: a free "APTA Action App" for mobile devices that includes an action center, congressional directory, talking points, and more.]]>
According to a recent article in Modern Healthcare (free registration may be required to access story), predicted increases in health care hiring will be "uneven," with the growth in hospital-based hiring anticipated to be "modest at best."
The article describes US Bureau of Labor Statistics (BLS) data that project overall health care employment to grow by 29.4% over the next decade, but hospital employment growing at a 17% rate during the same period. BLS predicts that by 2022, hospital employment will represent 25.5% of health care jobs—down from its 28.2% share in 2012.
So where will the hiring happen? According to the Modern Healthcare article, "postacute care companies, which continue to expand, will pick up the slack in healthcare hiring," with home health leading the way, followed by skilled nursing and residential care facilities. The story includes data from the American Health Care Association, which predicts the number of individuals receiving long-term care, including home health services, will increase from 6 million today to 27 million by 2022.
Want to know where the jobs are? Check out APTA's Red Hot Jobs website for regularly updated opportunities.]]>
Researchers anticipated that if increases in falls prevalence were found, they would be largely due to "changes in age structure of the population"—that is, more and more people getting older and older. What they found surprised them: while prevalence did increase across the board for adults 65 and older from 1998 to 2010, from 28.2% to 36.3%, the largest jumps in prevalence occurred in the lower age brackets.
For adults age 65 to 69, falls prevalence increased by nearly 10 percentage points from 1998 to 2010, from 22.3% to 32%. The cohort of ages 70–74 experienced a similar increase, from 25.3% to 34.5%, as did the group aged 75–79, from 30.5% to 38.4%.
After that however, the rates of increase start dropping off. For adults 80–84 years old, prevalence increased from 37.6% to 44.3%, while the 2 highest age groupings reported less than a single percentage point increase in prevalence. Researchers based their analysis on data obtained from the Health and Retirement Study sponsored by the National Institute on Aging, which collects health information from more than 10,000 adults 65 and older every 2 years. The results were shared in a letter published online in the January 19 edition of JAMA Internal Medicine.
"Contrary to our hypothesis, we observed an increase in fall prevalence among older adults that exceeds what would be expected owing to the increasing age of the population," authors write.
One possible explanation for the increased prevalence: better reporting, according to the authors. However, they write, "if a true increase in falling is occurring, then further research is needed to identify possible reasons, such as an increase in fall risk factors (eg, cardiovascular and psychiatric medications) or an increase in fall risk behavior."
APTA provides education on exercise prescriptions for balance improvement and falls prevention, and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, and information on evidence-based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf).
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Take the quick and simple survey by January 26. Just pick the design you think is likely to get you to open up the magazine, and then check out the March issue to see which cover was most popular.]]>
The association delivered this message by way of comments to a draft managed care plan network adequacy model act (.pdf) developed by the National Association of Insurance Commissioners (NAIC). The model will be a template to help federal and state lawmakers and regulators develop changes to actual laws and regulations.
APTA's recommendations for the draft focus on real changes that counter some insurance company trends toward more narrow networks that make it difficult for consumers and patients to get the services they need. The APTA recommendations include:
The decision to revise the model—a document that hasn't changed since 1996—was driven by the Patient Protection and Affordable Care Act (ACA), which is built around care systems that are at odds with a growing number of narrow provider networks. The overhaul even extends to the name of the model, which will be released as the "Health Benefit Plan Network Access and Adequacy Model Act."
"The health care world is changing in ways that demand better patient access to a wide range of effective care, which clearly includes access to physical therapy," said Carmen Elliott, senior director of payment and practice management at APTA. "APTA's work with NAIC is aimed at helping to make this access not just possible, but a part of baseline standards for all consumers covered under insurance."
The association voiced the same network adequacy concerns to the US Centers for Medicare and Medicaid Services (CMS) in response to a proposed rule on payment parameters. That rule specifically stated that CMS was waiting to implement certain changes until after the final NAIC model was released.
The final NAIC model act is expected to be released later this year. APTA will continue to work with NAIC through the development process.
A true transformation of health care through reform can only occur if insurance networks provide adequate coverage—for more information on this issue, visit the webpage of APTA's Making Sense of Health Care Reform Series.]]>
Last week, News asked readers to choose the top 3 physical therapy-related stories from 2014 from a list of 8 contenders. Among the options, "all states achieve some form of direct access to PTs" was selected by nearly 85% of respondents.
The direct access story was the winner by a mile, in fact. Coming in a distant second was the news that legislation to end the therapy cap has now achieved majority support in the US House of Representatives (56.19%), followed closely by the increased attention on closing physician self-referral loopholes created when the American Association of Retired Persons (AARP) announced its support of making changes (53.33%).
The direct access landmark was met in July 2014, when Michigan became the 51st US jurisdiction to adopt legislation allowing some form of direct access. Despite this milestone, achieving unrestricted direct access nationwide remains one of APTA's policy priorities. This year, 4 APTA state chapters--Florida, Georgia, New Mexico and Virginia—will be pursuing this goal.
APTA releases a new public policies priorities agenda every 2 years. The revised agenda will be released in the coming weeks.]]>
In an article e-published ahead of print in the American Journal of Clinical Nutrition (.pdf), researchers compared individual BMI, waist circumference (WC), and self-reported physical activity (PA) levels with all-cause mortality data for 116,980 men and 217,181 women in Sweden, Denmark, The Netherlands, United Kingdom, France, Germany, Spain, Italy, and Greece. Individuals with baseline heart disease, cancer, or stroke history were excluded from the analysis, as were individuals who were in the top or bottom .5th percentile of the energy intake-to-estimated basal metabolic ratio rate. Researchers then created a 4-level activity designation based on daily kilojoule-per-kilogram rates: inactive (36 kJ/kg), moderately inactive (41 kJ/kg), moderately active (46 kJ/kg), and active (51 kJ/kg).
After adjusting for sex, educational level, and lifestyle (alcohol intake and smoking), researchers found that within all BMI groupings, mortality rates for moderately inactive individuals were 20%-30% lower than rates of inactive individuals. The reductions in mortality increased as activity levels increased, but only among normal and overweight individuals—rates for individuals with a BMI of 30 or higher did not drop when activity was recorded as more than "moderately inactive."
Researchers found a similar relationship between physical activity and WC, with decreased mortality rates in the moderately inactive individuals across adiposity groupings, and little additional effect for abdominally obese individuals who had PA levels beyond "moderately inactive."
According to the study's authors, the findings make a strong case for the effect of increased PA on mortality. "Physical inactivity may theoretically be responsible for twice as many deaths as high BMI … in this population, similar to the number of deaths averted if abdominal adiposity were eliminated," they write. "If all inactive individuals were at least moderately inactive, the number of deaths would theoretically be reduced by 7.5%." Authors estimate that in 2008, 676,000 deaths among Europeans may have been attributable to physical inactivity, compared with 337,000 deaths attributable to obesity.
Authors of the study believe that achieving a level of moderate inactivity among those who are currently inactive may be more easily reached than one might imagine. "This amount of energy expenditure can be achieved by a [physical activity energy expenditure] equivalent to 20 minutes of brisk walking per day, which is lower than the current PA recommendations for public health," they write.
"Our results suggest that the influence of physical inactivity on mortality appears to be greater than that of high BMI and similar to that of high [waist circumference] in European men and women," authors write. "From a public health perspective, it is therefore encouraging that our results suggest that small increases in PA in those who are currently categorized as inactive appear to be associated with significant reductions in all-case mortality at all levels of BMI and WC."
APTA is a strong and vocal advocate for the ability of physical activity to transform society through its effects on public health. The association offers a prevention and wellness webpage with resources on how physical therapists and physical therapist assistants can help individuals become more physically active. Additionally, the association's MoveForwardPT.com website stresses the importance of physical activity in ways designed to be easily understood by the general public. The association is also on the board of the National Physical Activity Plan alliance, a high-profile effort to create a comprehensive set of policies, programs, and initiatives to increase physical activity in all segments of the American population.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The episode features Ann Wendel, PT, DPT, CMTPT, who discusses the results of a recent worldwide survey released by the American College of Sports Medicine.
The top trend identified by the survey is body weight training, which Wendel says has the benefit of being a "self-limiting" activity that "allows for safe progression."
Wendel also had good things to say about the number 4 item on the list, strength training.
"I think strength training is one of the best things anyone can do," Wendel said. "When we look at the benefits of it—increasing bone density, increasing resting metabolic rate to burn fat and calories and things like that—it's very important, especially as we get older, to work on strength training and especially to make it functional so we can be fit for the activities we really want to do in our daily life."
Listen to more of Wendel's analysis of the ACSM's results here.
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to firstname.lastname@example.com.]]>
The call for volunteers to serve on APTA committees is open now through February 11. Members interested in serving on Ethics and Judicial, Finance and Audit, Leadership Development, and Public Policy and Advocacy committees or the Awards subcommittee are encouraged to let APTA know of their willingness to participate. We need your skills, passion, and perspectives to build a vibrant, inclusive, and multicultural corps of volunteer leaders who understand the transformative power of physical therapy.
The first step is to complete an interest profile on the Volunteer Interest Pool webpage. Once completed, click on the "Apply for Current Opportunities" button, and if an opportunity interests you select the committee and answer a question on why you are a good fit for the group. Complete details on all committees can be found on APTA's Volunteer Groups webpage.]]>
This week IOM released a report that supports efforts to increase access to data sets from clinical trials as a way to "enhance public well-being by accelerating the drug discovery and development process, reducing redundant research, and facilitating scientific innovation." The report, which was developed after a call for comment early last year, asserts that the rate of medical advances could increase dramatically, and new ideas for research could germinate at a much faster rate through more easily accessed data.
However, the IOM report—characterized by its authors as "a practical and ethical framework to help stakeholders navigate this complex terrain"—makes 1 thing clear: the devil is in the details.
"Before any of these benefits can be realized," the report's authors write, "stakeholders must confront significant risks and challenges." These include challenges to the privacy of participants, respect for the original researchers' need to keep data until sufficient analyses have been conducted, and protection of any sponsoring group's financial interests in the original research.
The IOM report suggests that data should remain the sole property of original investigators for no longer than 18 months, regardless of whether the original research is published (exceptions would exist for research submitted to a regulatory agency). Authors also stress the importance of clear policies that control "which parties can access data and under what conditions," and rely on the use of "independent panels" to make decisions about whether and how data will be shared.
While the benefits are clear, authors write, "significant barriers remain" to implementation of a widespread data-sharing environment. The report cites deficiencies in infrastructure, interoperability, funding, and workforce as "key challenge areas."
"Because data sharing benefits multiple stakeholders—including the public, insurers, health care providers, and researchers—all of these stakeholders should also bear some of the costs of the data-sharing enterprise," authors write.]]>
Called the Maestro Rechargeable System, the new device uses a rechargeable electronic pulse generator that sends intermittent pulses to the trunks of the nerves responsible for signaling whether the stomach feels empty or full. According to an FDA news release, although it's clear that the impulses block nerve activity, "the specific mechanisms for weight loss due to use of the device are unknown."
The system was evaluated in a clinical trial of 233 patients with a BMI of 35 or more that recorded weight loss of 8.5% more than a control group after 12 months. According to the FDA, just over half of the participants in the experimental group lost at least 20% of their excess weight.
The Maestro system is approved to treat patients 18 and older who have not been able to lose weight through a weight-loss program, and who have a BMI of 35 to 45 with at least 1 other obesity-related condition. It is the first obesity treatment device approved by the FDA since 2007.
EnteroMedics, the manufacturer of the Maestro system, agreed to conduct a 5-year study on the device as a condition of FDA approval.]]>
New to the board are Stuart Binder-Macleod, PT, PhD, FAPTA, Aimee Klein, PT DPT, DSc, OCS, Sheila Schindler-Ivens, PT, Phd, and Fran Welk, PT, DPT, MEd.
In addition to welcoming its newest members, the board also elected officers for 2015. Elected were Barbara Connolly, PT, DPT, EdD, FAPTA, president; Michael J. Mueller, PT, PhD, FAPTA, vice president; Charles L. Martin Jr, CAE, CIA, treasurer; and Randy A. Roesch, DPT, PT, MBA, secretary.
Connolly assumes the position previously held by William Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, for the past 5 years. Boissonnault is completing a 9-year span of service on the Foundation board.
Biographical information on the new trustees and officers is provided in a Foundation news release.]]>
In addition to a discussion of barriers to changing practice to reflect current evidence, the hangout also provides some tips on how to get the message across that go beyond the "here's a handout" approach.
The hangout features Patty Scheets, PT, DPT, MHS, NCS, director of quality and clinical outcomes at Infinity Rehab and vice president of the APTA Neurology Section, and Ken Miller, PT, DPT, CEEAA, clinical educator for Catholic Home Care and chair of the APTA Home Health Section's Practice Committee. Mary Tischio Blackinton, PT, EdD, CEEAA, GCS, PTNow associate editor for social media, hosted the session.
Check out the blog, check out the hangout, and then join the conversation.]]>
The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 million Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel's work were published earlier this week (.pdf), and featured in the online edition of Time magazine.
Much of the report is focused on the use—and possible overuse—of opioids as the "go-to" approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.
"Together, the prevalence of chronic pain and the increasing use of opioids have created a 'silent epidemic' of distress, disability, and danger to a large percentage of Americans," authors write. "The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm."
The answer to that question, the panel found, is no. Patients with chronic pain are typically "'lumped' into a single category, and treatment approaches have been generalized with little evidence to support this practice," they write.
Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These nonpharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that "lack of knowledge or limited availability of these nonpharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids."
An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that "clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches." The solution, he believes, is to ensure that "every patient's individual needs are met by a patient-centered health care system."
The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans' resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which "large numbers of Americans are receiving suboptimal care."
The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, a new film starring Jennifer Aniston as a women with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a "blended approach" to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled "8 ways to deal with chronic pain." The article's first recommendation: "embrace physical therapy."
"The more you move, the better you feel," reporter Rachel Noble Benner writes in the article. "Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain."
APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist's guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT's role in chronic pain management was featured in the September issue of PT in Motion magazine.]]>
A recent article in Modern Healthcare (accessible through free 1-time registration) cites a Bureau of Labor Statistics (BLS) report estimating that the health care industry added 311,000 jobs in 2014, marking a 2.1% increase. According to the Modern Healthcare report, this growth rate is similar to the average prerecession rate of 2.4%. From 2009 to 2013, health care job growth averaged 1.7% per year.
An article in the online edition of Forbes attributes the growth to 3 main elements: the overall rebound of the US economy, an infusion of expenditures under the Affordable Care Act, and a surge in hospital hiring in particular.
Meanwhile, US News and World Report released its annual "Best Jobs" review for 2015, ranking physical therapist (PT) as the sixth "best job" among all professions, not just health care.
The rankings are based on BLS predictions for job growth from 2012 to 2022. The article describes physical therapy as "a versatile profession" that BLS expects to grow by 36% over the next 8 years, and attributes the growth to the theory that "more qualified PTs are needed to work with the vast, aging baby boomer population."
In a more detailed section on the physical therapy profession, the US News and World Report story quotes Eric Robertson, DPT, OCS, FAAOMPT, who describes physical therapy as a "safe, happy approach" that "offers a meaningful and positive alternative to pharmaceuticals or surgery."
The entire US News and World Report list, in order: dentist, nurse practitioner, software developer, physician, dental hygienist, PT, computer systems analyst, information security analyst, registered nurse, physician assistant.
Want to go where the jobs are? Check out APTA's Red Hot Jobs website for regularly updated opportunities.]]>
The article, e-published ahead of print in the Journal of Athletic Training, looked at 17 studies that examined the relationship between specific sports participation (almost all at the elite level) and rates of knee OA. The 17 articles that were included in the final review were identified from 69 studies, and did not include research in which the study population had an underlying condition.
Authors found that among the 3,759 sports participants studied in the articles, knee OA prevalence was 7.7%, compared with a 7.3% rate among control groups.
When rates for individual sports were examined, authors concluded that participants in elite long-distance running, soccer, weight lifting, and wrestling had a knee OA prevalence rate 3 to 7 times higher than the control "nonexposed" population. Elite-level throwing, handball, cross-country skiing, ice hockey, and orienteering were classified as "possibly associated" with increased knee OA prevalence, but sample sizes were small. Elite basketball, boxing, shooting, and track and field were designated as unlikely to be associated with knee OA.
American football at the high school level (defined as nonelite for this study) was also included in the review and appeared to show a connection between participation and knee OA, but authors write that the range was "large," and study size small.
Authors acknowledged "significant gaps" in the literature, particularly around links between nonelite sports participation and knee OA, and even more significantly between women (elite and nonelite) sports participants and knee OA. The latter gap, authors write, "is a considerable deficiency in the literature because more than 40% of college and high school athletes in the United States are female, and women have higher rates of OA."
The study also refers to the prevalence of sports as a way of helping individuals meet public health goals of sufficient physical activity, and calls for more evidence that could "help people choose the sports that may reduce their risk of OA."
Further affecting any definitive conclusions, authors write, are level-of-play and joint injury history.
"Until we have more information to make clearer, data-based decisions regarding sports participation and OA risk, athletes who choose to participate in contact or collision sports, such as soccer and football, at elite levels for many years should know they have an increased likelihood of OA and should pay attention to mitigating factors (eg, preventing obesity and severe joint injuries) associated with the development of OA," they write.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Recently the Centers for Medicare and Medicaid Services (CMS) announced that it is extending the deadline for an April "end-to-end" testing program (.pdf, see page 5). The program will allow approximately 850 health care providers to see a claim through from submission to remittance advice. APTA is encouraging members to sign up for the program before the new January 21 deadline to gauge their own practice's readiness for the change.
The testing program will run the week of April 26 through May 1, 2015, and will allow a sample group of providers to work with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.
CMS is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by January 21. The MACs and CEDI will notify the volunteers who have been selected and provide them with information by February 13.
More information on the testing process is available online (.pdf). The ICD-10 codes are scheduled to be implemented on October 1, 2015.
Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.]]>
"Caseload to Workload and the role of Specialized Instructional Support Personnel" will focus on approaches to staff allocation that move away from a medical "caseload" model that divvies up staff based on the number of students in need of services, and moves toward a "workload" model that assesses the range of demands on an individual student as well as the range and intensity of services required to meet those demands.
The free 90-minute presentation will begin at 1:00 pm, and will feature speakers from APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association. Presenters will share success stories and offer downloadable practice resources.
The presentation is sponsored by the Idea Partnership, a consortium of national associations, technical assistance providers, and state and local organizations focused on cross-disciplinary collaboration in education. APTA is a member of the partnership.
Joining the webinar is easy:
The Idea Partnership recommends that participants who have never used Adobe Connect test their connection before the webinar. Contact Sandy Schefkind for more information.]]>
Take this quick survey and let us know what 3 developments (or lack thereof) had the biggest impact during what APTA CEO Michael Bowers called a "transformative year" for the association and the profession.
And then … stay tuned. We'll publish the results in next week's PT in Motion News blast.]]>
According to a CMS announcement, the hold will not affect claims for services provided in 2014, and should have "minimal impact on provider cash flow," as current law prevents payment on clean electronic claims no sooner than 14 days after receipt.
Want to learn more about payment? Sign up for the APTA webinar "Navigating the Payment Maze: Reducing Denials and Minimizing Risks," coming February 28.]]>
In addition to a basic description of the process, APTA's peer review webpage also provides a list of terminology, and information on how to conduct a self-assessment—a key element that needs to take place before a peer review system begins.
Also available: a .50 CEU online course on peer review. Both the online course and web resources were developed in response to a motion from the APTA House of Delegates.
APTA's position is that PTs are the preferred peer reviewers of physical therapist services. The association is opposed to any activities related to peer review that may adversely impact a PT's plan of care or intervention without the involvement of a PT reviewer.]]>
A recent article in Fast Company features a new kind of robotic appendage, named Versaball, able to grip and manipulate delicate objects through the use of a "squishy, expandable balloon that can easily stretch around different shapes and sizes."
To demonstrate the new approach at the last Consumer Electronics Show, which demands catchy displays, robot designer Empire Robotics arranged for beer pong matches between the Versaball arm and professional beer pong players. In at least 1 contest, the robot won. Video provided with the Fast Company story shows the balloon-like appendage picking up a ping pong ball and then projecting it through the air and into a cup.
The robot's designers say that the beer pong demonstration is an attention-getting way to point to possible uses in industry, and more important, in the creation of a new breed of prosthetics. Empire expects a final version of Versaball to be released in the coming months.]]>
The Joseph case, scheduled to be heard by the high court on February 19, is an appeal of a decision made by the state circuit court last year that ruled in favor of the South Carolina Board of Physical Therapy Examiners (SCBPTE) and the South Carolina Chapter of APTA (SCAPTA). The case was brought against SCBPTE by 2 medical doctors and a physical therapist (PT) who sought to extend the state's ban on PTs working for physician-owned groups to PTs working in PT-owned group practices.
In its summary judgment (.pdf) issued last year, the state circuit court upheld the ability of PTs in physical therapist-owned group practices to receive payment for treatment of patients referred by another PT in the practice, and kept in place the prohibition on POPTS in the state. The state's high court has agreed to hear an appeal of this case, and its decision could overturn the POPTS prohibition or impact the ability of PTs to operate in group practices in South Carolina.
APTA provided significant legal, financial, and staff resources both to SCAPTA and the individuals who intervened in the case on behalf of SCBPTE after its motion to dismiss the case was denied in December 2012. The chapter also received support from individual members and some APTA components.
The upcoming case arrives on the scene at a time when the issue of physician self-referral is receiving increased attention thanks in large part to the efforts of APTA, the Private Practice Section (PPS), and a coalition of other professional groups organized as the Alliance for Integrity in Medicare (AIM).
Most recently, these efforts were boosted by the American Association of Retired Persons (AARP), which voiced its official agreement (.pdf) with the elimination of loopholes in the Stark law originally designed to tighten up restrictions on self-referrals under Medicare. Currently, physical therapy is among 4 services that are considered "exceptions" to the restrictions.
Earlier in 2014, President Obama established the administration's support for closing the loopholes through a proposed federal budget that would eliminate exceptions that now apply to physical therapy, radiation therapy, anatomic pathology, and advanced imaging. The Office of Management and Budget estimates that eliminating the exceptions would provide a savings of just over $6 billion over 10 years.
APTA is awaiting the President's next budget submission, scheduled for winter release. The association recently met with administration officials to advocate for the President's continued support on this issue.
Find out more about self-referral on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information. Members wishing to provide support to SCAPTA may do so online.]]>
Tuesday, January 6, marked the opening day for the 114th Congress in the wake of a midterm election that shifted Senate power to the Republicans and solidified the party's hold on the House of Representatives.
APTA staff members were on Capitol Hill on opening day to meet with new and returning legislators and their staff, and to let lawmakers know that the association is committed as ever to working with congress on its bipartisan policy priorities.
"There is no better way to transform health care than by continuing to show the value that physical therapist services deliver, and the association plans to carry that message to the Hill every day," said Justin Moore, PT, DPT, chief public affairs officer for APTA. "We're excited about engaging with the new Congress to move our priority issues forward."
APTA has refined its 2015 policy priorities and will release its list soon.
APTA staff members were on hand to meet with new and returning legislators on opening day of the 114th Congress. Newcomers include Sen Mike Rounds (R-SD), at left, whose son John Rounds, PT, DPT, right, is an APTA member.
With changed dynamics in Congress, it is more important than ever for members to stay informed by joining APTA's PTeam email list to receive updates and Action Alerts when members should contact their legislators on issues. In addition, PT-PAC has initiated a $20 campaign for APTA members, citing if every APTA member donated $20 each year, the physical therapy profession would have the largest health care provider PAC in the country. Learn more about this campaign here.]]>
In a paper e-published ahead of print on January 5 (.pdf), researchers report on findings from a study of 88 patients, aged 11 to 22, who reported to a Wisconsin emergency department (ED) and were diagnosed as having experienced concussion. Of that number, 43 were prescribed "usual care" of 1–2 days of rest followed by a gradual return to activity, while the remaining 45 participants were prescribed strict rest for 5 days (no school, work, or physical activity).
Assessments were performed in the ED and at 3 and 10 days after injury. Participants also completed activity diaries that included a 19-symptom Post Concussive Symptoms Scale (PCSS).What researchers found was that while neurocognitive and balance tests showed no significant differences in the groups as they recovered, 50% of the participants assigned to strict rest took an average of 3 days longer to report symptom resolution. Additionally, the strict rest group reported higher PCSS scores than the usual-care group.
"Recommending strict rest from the ED did not improve symptom, neurocognitive, and balance outcomes in youth diagnosed with concussion," authors write. "Surprisingly, adolescents who were recommended strict rest after injury reported more symptoms over the course of this study."
Authors forwarded several possible explanations for the difference in symptom reporting, including the possibility that the more restrictive treatment influenced the patients' perceptions. "The deleterious effects of strict rest may have more to do with emotional distress caused by school and activity restriction," they write. "Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms."
The research was featured in stories in the New York Times, Time, and CBS News, among other media outlets, in part because it confirms care standards that were questioned in previous studies.
Physical therapists (PTs) play an important role in the treatment of individuals who have suffered concussions. Get the latest information on these injuries and what's being done to reduce them at the APTA traumatic brain injury webpage (look under the "Concussion or mTBI" header). Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
So what does it all mean for physical therapists and physical therapist assistants?
APTA members can get the latest insights on the legislative scene during a free 90-minute webinar on Thursday, January 15, 2015, beginning at 2:00 pm. APTA staff experts will fill in listeners on legislative initiatives such as the Medicare therapy cap, self-referral, the sustainable growth rate, and congressional payment reform. Key state legislative initiatives such as fair copays, scope of practice, and direct access will also be discussed.
Members can register for free at the APTA Learning Center.
Coming soon: find out how APTA will approach advocacy for the profession when the association releases its 2015 policy priorities.]]>
The 18 specialty sections of APTA are seeking proposal submissions for the Combined Sections Meeting (CSM) scheduled for February 17–20, 2016, in Anaheim, California. Proposals for 2-hour education sessions and 1- or 2-day preconference courses are now being accepted.
Visit the 2016 CSM submission page for detailed information and a link to the online submission site. Proposal submission deadline is March 4, 2015.]]>
According to a Foundation news release, the donation marks DJO's renewal as a platinum-level partner in support of the project, which seeks to create a COE for health services and health policy research that will significantly expand the number of physical therapist investigators specializing in research in the delivery, organization, and financing of care, as well as analyses of outcomes.
The Foundation has raised more than $3.1 million to fund the COE and support research grants and scholarships through the COE's internal funding mechanism. The Foundation plans to announce the recipient of the $2.5 million COE grant during APTA's Combined Sections Meeting (CSM) in February.
"DJO has been a longstanding supporter of the Foundation," said Sharon Wolfington, DJO's president of recovery sciences. "We both agree that we need to measure the quality of our patient treatments and devices to bring the greatest value in a cost-effective manner."
Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, thanked DJO for its support. "Backing from our corporate partners like DJO is vital to continue funding emerging physical therapy scientists and advancing the profession," he said.]]>
Authors of the review gathered 804 studies that in some way addressed the effect of physical therapy on healing and quality of life (QOL) outcomes among patients with VLUs. After excluding articles that were poorly constructed, considered to be expert opinion only, focused on the effects of motivation and behavioral changes on adherence to physical therapy, or used qualitative approaches, only 10 articles remained for review.
The bottom line, according to authors is that articles that directly assessed the relationship between physical therapy, healing, and QOL for individuals with VLUs are "extremely limited" and mostly comprise "studies with small sample sizes and exercise programs rather than physical therapy sessions."
Authors wrote that among the articles they reviewed, most of the studies were designed by a physical therapist (PT), but few studies involved supervision. In studies that did, supervision was usually conducted by a nurse or physical therapist assistant (PTA). Instead, patients were often provided with home exercise instructions and encouraged to keep a journal of their activities, which they rarely did.
"Despite the increasing number of studies suggesting the implication of exercises to strengthen the calf pump on improving QOL of patients with VLU, evidence of the clinical effect is scarce," authors write. "Moreover, there is limited evidence addressing its influence on ulcer healing."
The new study echoes earlier findings from the Agency for Healthcare Research and Quality (AHRQ) reported in PT in Motion News. That report found "a paucity of well-designed and well-controlled studies" on VLU treatment.
"As health care provision continues to move away from the hospital-based models and toward more home care and independent patient care models, comparative effectiveness research with supervised physical therapy needs to be explored," authors write. "We hope that this review will highlight the lack of evidence-based research in this area and potential for physical therapy to be an integral component of VLU management and therapy during and after healing of a VLU."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
That's APTA's vision statement. It's big, it's bold, it's ambitious—and apparently it's a perfect fit for members, who spent 2014 engaging in transformative efforts across society, the profession, and the association.
According to a recently published statement from APTA CEO Michael Bowers, 2014 was a year in which members' response to the vision was "quick and passionate," and supported by association activities aimed at keeping that momentum going.
Find out how APTA and its members are making changes for the better: check out the year-end message and accompanying infographics, and take a moment to appreciate the transformative power of physical therapy.
And happy new year from APTA!]]>
"Once again my attempt to complete a solo circumnavigation has come to an end," Paris wrote in his blog. The tear in the sail, coupled with gale force winds he expected to encounter off the tip of South Africa, made it "not advisable to continue," he wrote.
The 77-year-old adventurer was embarking on his second attempt at circumnavigation as a way of bringing attention to physical therapy research and the Foundation for Physical Therapy (Foundation), where he serves as a member of the Board of Trustees.
"This of course is a big disappointment to me and to many who have wished me well," Paris wrote. "But that is life. I have never let difficulties get in my way of trying something worthwhile. I am always aware that failure can occur but I have never let the fear of failure deter or prevent me from trying. To do so would be to accept mediocrity and that I will never do."
Paris documented his journey on his Facebook page, www.facebook.com/uofstaugsolo and via a blog on his website. Visit the Foundation's website to find out how to contribute to physical therapy research.]]>
Researchers evaluated outcomes of 254 women aged 55 and older who reported UI. Half of the participants were assigned to "standard care" with general practitioners (GPs) who did not ask about their condition and did not provide treatment unless the woman requested consultation for incontinence. The other half was assigned to GPs who administered UI evaluations to all participants and worked with urologists and physiotherapists to create treatment plans that included pelvic floor muscle training.
Authors write in the journal Maturitas (.pdf) that even though all of the control group experienced UI, only 3 women sought treatment (2 received treatment from a pelvic floor physiotherapist; 1 woman was prescribed an anticholinigeric drug). Meanwhile, of the women in the intervention group, all of whom received diagnosis and treatment, 34% reported a lessening of symptom severity after 1 year.
"This … trial showed that if older community-dwelling women with [UI] are invited to be diagnosed and treated, the probability of improvement of the severity of symptoms after 1 year is 2 times higher than if they had received standard care," authors write. When data from women who reported only mild incontinence were excluded from the study, symptom reduction rates among the intervention group increased to nearly 3 times those of the control.
In a report on the study published by Reuters news service, lead researcher Els Visser, MD, describes the study's findings as pointing to a "very sad" mindset about UI wherein "most women don't ask for help because they think there is no help for them."
"The present study adds support to the effectiveness of diagnosing and treating older women with [UI] that do not visit a caregiver" specifically for the condition, authors write. "GPs should be convinced that 'therapeutic nihilism' is not justified in this group of patients."
APTA has been a strong advocate for the role that physical therapy can play in transforming the lives of women experiencing UI, and has provided guidance to the federal Agency for Healthcare Research and Quality (.pdf) in its research efforts around the condition. The association offers several relevant resources to members and the public, including the APTA Section on Women's Health and the PT's Guide to Incontinence. Physical therapists looking for evidence-based research on UI treatment can find information at PTNow.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
PT in Motion News reviewed several year-end lists of top stories and issues in health care, and provides the following recap—sort of a list of lists.
Medscape's year in medicine
This list, delivered in slideshow form, includes the Centers for Medicare and Medicaid Services' (CMS) release of billing data—and the gaps in these data—among its list of top developments in 2014. Also included: delays in providing a permanent fix to the flawed sustainable growth rate (SGR) formula, and the postponement of implementation of ICD-10 codes. The 35-item rundown also lists research linking excessive exercise with increased cardiovascular (CV) disease risk, and another study that asserts that regular intake of naproxen presents more CV risk than ibuprofen.
Medscape's primary care "lessons" from 2014
Medscape also produced a 10-item list of the biggest lessons learned in 2014 in primary care (visitors must set up a free account for access). This list includes among its top issues a call for more nutrition training for physicians, and the debate around testosterone use and increased CV risk.
CBS Newsf
The CBS list of "top health stories for 2014" includes information on "text neck," the cervical condition resulting from extensive time spent by individuals with their heads down—the typical posture for viewing smart phone texts.
Forbes lists for 2014
Forbes online offers several health care-related lists, but its widest-ranging collection puts the year's various health care data breaches at the top of the pack, above Ebola. Also offered by Forbes: an entertaining list of the "Top Healthcare Tweets for 2014."
Healthcare Dive
The business and tech-oriented site offers a list of the "12 Most Important Healthcare Stories of 2014" that, like the Forbes list, includes health care data breaches but adds problems with attrition in the CMS "Pioneer" accountable care organization (ACO) program. Also worth reading: Healthcare Dive's list of "4 Healthcare Buzzwords That Have Lost All Meaning."
Almetric's list of 100 papers that received the most online attention
A fascinating list of scientific research articles that sparked wide interest across media outlets. Topics include social science, paleontology, and at least 2 papers that relate to physical therapy—one on the effectiveness of surgery for meniscal tears, and another on obesity rates in 2011-2012. Both the surgery and obesity reports (including a subsequent report on the accuracy of the obesity findings) were covered in PT in Motion News when they were released.
CDC year in review
The US Centers for Disease Control and Prevention offers up a list that focuses mostly on infectious disease but also mentions the importance of reducing CV disease.
Medical News Today's most popular articles of 2014
A list of linked articles that includes stories covered in PT in Motion News: a man whose severed spinal cord was repaired using cells from his nose, and the emergence of a "polio-like" disease among children in California. The list also features an article on the use of yoga to treat scoliosis.
Other "best of" lists worth checking out: Details magazine's list of "Top 10 Health Myths of 2014," Modern Healthcare's "Best Places to Work in Healthcare in 2014," and the Healthcare IT News list of the biggest health-related technology stories of the year.]]>
Gordon stated in his lecture that physical therapist education programs have a tripartite mission: education, research and scholarship, and clinical practice. These education programs form the core of academic physical therapy, which Gordon placed at the center of the profession's knowledge creation infrastructure. However, Gordon contended that too many education programs do not have research and scholarship as a core part of their mission, which threatens future knowledge creation and jeopardizes the profession's future. Questions to ponder: Can programs have a greater focus on education or clinical practice, or must there be a balance among all 3 parts of the mission? Is there evidence that faculty members engaged in research are better educators? Listen in to find out what these academic leaders think.]]>
In a review published in the December 12 issue of the Journal of Physiotherapy (.pdf), researchers share the results of a meta-analysis that involved 11 randomized controlled trials that involved 1,530 individuals, mostly women (78%), all of whom were receiving treatment for cancer. The trials involved supervised physical activity interventions with a mean duration of 17 weeks at an average rate of 3 45-minute sessions per week. The activities included aerobic exercise in all trials, resistance training in 6 trials, and flexibility exercises in 4 trials.
Researchers analyzed results from several assessments including the Functional Assessment of Cancer Therapy (FACT) – fatigue scale and found that supervised physical activity overall resulted in a moderate reduction in fatigue in individuals undergoing treatment. The most effective approach? A combination of aerobic and resistance training. In terms of aerobic exercise alone compared with resistance exercise alone, only resistance exercise was found to reduce fatigue.
Authors call for more research to determine the best exercise program for this population, but they write that supervision by a physical therapist is key to ensuring that appropriate pre-screening and prescription decisions are made.]]>
The $1 million system, called the Computer-Assisted Rehabilitation Environment (CAREN), uses a split-belt treadmill, 6 degree platform and a large screen that wraps itself nearly 180 degrees around the user while motion sensor cameras monitor movements and feed data into computers. The virtual reality scenarios can be programmed to simulate movement through real-world environments—a trail walk through a forest, for instance—or more gamelike settings, such as piloting a boat through a slalom course by leaning in different directions.
Michael Jason Highsmith, PT, DPT, CP, an associate professor with the USF School of Physical Therapy who has been working with the CAREN system, is quoted in the story saying that "we now have some ways to actually start thinking about, okay, get this person from the clinic setting and actually start making some transitional therapies to help them integrate back into their home life."
Highsmith continued, "The ability to change the environment is very helpful because we can now take one instrument … and we can package pre-test, post-test measurements, as well as a therapy all in one system. There's not a lot of systems out there that allow that flexibility."]]>
LAT reporter Noam Levey writes that by managing employee insurance health care providers as they would any other supplier, these companies are now bringing some of their own quality assurance approaches to health care. According to Levey, "the results include better health, higher patient satisfaction, and in some cases lower costs, making the community a model as employers and governments nationwide look for ways to improve care."
The report follows one patient, a Boeing employee, as he moves through the Virginia Mason process during an appointment for treatment of back pain. The 9:50 am appointment begins on time and is completed by 11 am. During that time, records information is obtained, he is assessed by a PT, receives consultation with the PT and a rehabilitation physician "in an unusual team system developed by the clinic," and is trained by the PT on exercises to increase abdominal strength.
The LAT story characterizes the "carefully structured system" as being "designed to maximize use of physicians' time and better respond to what patients want: quick care that gets them well quickly."
In the new system, "a patient spends most of an exam with a therapist, who can do basic diagnostic testing and is often better at communicating with patients than a doctor," Levey writes. "Fewer unnecessary tests and more use of therapists—which the medical center calculated cost about $1 a minute, compared with $4 a minute for a doctor—led to lower costs."
Back pain patients at Virginia Mason now recover faster than the national average (4-5 visits, compared with 10 nationally), and miss fewer days of work, according to the LAT.
Levey writes that Virginia Mason worked with Boeing and other companies to redesign care, particularly around treatment of back pain, a condition that keeps employees from working.]]>
In a new "All Evidence Considered" podcast, Sandra Billinger, PT, PhD, FAHA, talks with PTNow Associate Editor Mary Blackinton, PT, EdD, GCS, about the AHA/ASA Physical Activity and Exercise Recommendations for Stroke Survivors.
Billinger, assistant professor and director of the R.E.A.C.H. Lab at University of Kansas, chaired the interdisciplinary committee that updated the scientific statement earlier this year. In the podcast, she says that exercise "should be treated like walking and balance" in stroke rehabilitation.
Some of the topics discussed in the podcast include:
The podcast is free to APTA members.
Want to learn more? Billinger will be at CSM 2015 in Indianapolis, where she will join Pierce Boyne, PT, DPT, NCS, Kari Dunning, PT, PhD, and Marilyn MacKay-Lyons, PT, PhD, to present "Getting to the Heart of Stroke Rehab and Mobility: Considering Cardio" on Friday, February 5.]]>
The study tested 1,387 individuals from 49 to 75 years old (average age 67) for postural instability and compared the results with brain MRI scans. The results were e-published ahead of print in the American Heart Association's journal Stroke (abstract only available for free).
Researchers used 2 tests to measure postural stability: a 1-leg standing time (OLST) assessment, and a posturograph test of center of gravity. For the OLST, subjects were allowed to choose the leg on which they stood and were measured on 2 attempts to balance on 1 foot with eyes open for 1 minute. The posturograph test used a footplate that measured fluctuations in pressure while subjects stood on both feet and viewed a "circular achromatic target" placed 200 centimeters (78.7 inches) away. After sitting for 1 minute, subjects were reassessed while standing with their eyes closed.
What researchers found was that while a significant correlation existed between OLST results and the posturographic test, only the OLST showed a strong relationship to the presence of cSVD. The correlation was strongest among individuals who were unable to stand on 1 foot longer than 20 seconds. Among these subjects, 2 or more lacunar infarctions occurred at the rate of 34.5%, and 2 or more microbleed lesions were found in 30% of the subjects.
Researchers also administered tests for dementia, and found a strong correlation between mild cognitive decline and an inability to maintain balance for more than 20 seconds in the OLST. Authors write that this relationship shows that "postural instability might also be a factor involved in the elevated incidence of falls in subjects with dementia."
"Our data from community-dwelling residents identifies postural instability as a factor in early pathological changes in the brain and functional decline, even in apparently healthy subjects," the authors write. "Our findings incorporate postural instability as an important measure of comprehensive geriatric assessment, and individuals showing postural instability should subsequently receive increased attention because this instability may signal potential brain abnormalities and cognitive decline."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Galloway was included in the list for his GoBabyGo project, a nonprofit initiative that seeks to rethink pediatric assistive technologies by adapting toys that children actually enjoy playing with—battery powered ride-on cars, for instance—into pathways for greater independence. The project is based on creative repurposing of existing, inexpensive, and easily-acquired materials.
Speaking at APTA's 2014 Combined Sections Meeting (CSM), Galloway told attendees "I'm not advocating for high tech—I'm advocating for go-tech."
Galloway joins some impressive company on the list, including Otis Brawley, chief medical officer of the American Cancer Society, columnist Ellen Goodman, and Sam Foote, the internist who brought allegations of scheduling and care problems at a Phoenix, Arizona VA hospital, triggering federal-level investigations of the entire VA hospital system.
Galloway was featured in a March 2014 PT in Motion article that focused on PTs who are putting the APTA vision of transforming society into action.]]>
"True or false: lack of awareness of government bulletins and transmittals regarding billing and coverage for physical therapist services would be a good defense by a provider if the government alleges violations of fraud and abuse laws, such as the False Claims Act."
Think you know the answer? Click here to find out.]]>
Connectivity ranked @ATPAtweets at number 38 in its list of the top 100 associations. The association's 30,000+ followers put the APTA handle in the company of associations such as the American Nurses Association, the National Association of Homebuilders, and the American Dental Association.
The association's main Twitter account, established in 2009, is part of an extensive social media effort that includes Move Forward, APTA's branding program aimed at consumers. Physical therapists (PTs) and physical therapist assistants (PTAs) are encouraged to follow and share that branded information and resources with their patients, clients, and communities.
Move Forward's Twitter handle is @MoveForwardPT. Additionally, both APTA and Move Forward have Facebook pages (APTA, Move Forward) as well as YouTube channels (APTA, Move Forward). APTA also posts images to Instagram, and Move Forward has a Pinterest page.
Additional APTA-sponsored social media offerings include:
Two new programs—"Experts in Arthritis" and "Fit to a T"—are designed to help health care professionals get the word out on how to manage arthritis, understand bone health, and prevent or make an early detection of osteoporosis.
The experts in arthritis program is an all-ages resource aimed at osteoarthritis, rheumatoid arthritis, and juvenile arthritis. The service provides people with information on how to manage their arthritis presented by health care professionals, and allows participants an opportunity to interact directly with an expert.
Similar to the arthritis program, USBJI's Fit to a T program allows participants to learn from and talk with a health care professional on issues around bone health and osteoporosis. Topics in the program include advice to prevent or slow down bone disease, as well as prevention, early detection, diagnosis, and treatment of osteoporosis.
Both programs are free. USBJI works with local PTs and PTAs to promote the program and supplies materials needed for the sessions. Each session includes a PowerPoint presentation, question and answer period, and handout materials. Visit the USBJI website to learn how to schedule a session, or contact USBJI by email for more information.
APTA is founding member of USBJI.]]>
The awards honor individuals, selected by the WCPT Executive Committee, who have made a significant contribution to physical therapy internationally or within their region. International service recognitions are made in education and research.
Neumann is the recipient of 4 Fullbright scholarships, and has made lasting international contributions to physical therapy education through teaching and a kinesiology video on spinal cord injury. In addition, he is the author the landmark Kinesiology of the Musculoskeletal System, which has been translated into 6 languages.
Neumann's work has helped transform teaching and practice in Japan, Hungary, and Lithuania, where he received an honorary PhD. His international teaching and service has extended to El Salvador, Haiti, Korea, Nepal, Mexico, and Puerto Rico.
The award will be announced at the WCPT General Meeting April 29 - May 1 in Singapore and will be presented at the awards gala dinner on April 30.
APTA is a member of WCPT.]]>
The December 16 article reports on an analysis conducted by Sageworks, described by Forbes as "a financial information company." According to that company, 2014 sales among privately held physical, occupational, and speech therapy firms are still up by 6% over 2013, but the rise marks a slowdown from the previous 5 years "during which sales grew by double-digit percentages in all but 1 year, including a 13% gain in the 12 months ended Dec. 8, 2013."
The company speculates that the declining sales could be due to "declining reimbursement rates or perhaps uncertainty among patients about whether services are covered" under the Affordable Care Act.
The article offers the same explanation for a decrease in average profit margins in 2014, pegged at 10% rather than the 11%-12% rates experienced every year since 2008.
Quoted in the article, Sageworks analyst James Noe describes physical therapy and other rehabilitation services as "a healthy industry" that "has the potential to catch back up to its normal levels of growth based on the demand projections by multiple sources."]]>
Ready to move on? So is Stanley Paris.
Paris recently used the famous Winston Churchill quote to describe his progress in his attempt to beat the speed and age records for circumnavigation of the globe in a cruise yacht. According to the 77-year-old adventurer, he has now passed the one-quarter mark in the journey in terms of days spent on the water—the end of the beginning.
And so far, things are looking pretty good.
As of December 17, Paris was off the coast of Brazil in his attempt to capture the age record currently held by Dodge Morgan, who completed a journey in 150 days at age 56. Paris is making his second attempt at the record as a way to bring attention to the need for physical therapy research in general and to the Foundation for Physical Therapy (Foundation) in particular. Paris serves on the Foundation's board of trustees.
Oh, and while he's at it, Paris also hopes to beat the fastest overall record of 137 days, held by a Chinese sailor.
Though differing routes make direct comparisons tricky at this point, Paris believes he is keeping pace or maybe even bettering the progress of Morgan.
"Dodge did well and in a virtually straight line, whereas I have covered more miles and with a frontal passage expected tomorrow maybe have to head further south and even a little west for a period," Paris wrote in his December 17 blog post. "But by about day 40 (it's now day 31 since Bermuda) our paths will meet on the 40th parallel south and then we shall see exactly where we are. Stay tuned."
Paris documents his journey, posts videos, and provides other information on his Facebook page, www.facebook.com/uofstaugsolo and via a blog on his website, which also allows visitors to track his progress in real time. Visit the Foundation's website to find out how to contribute to physical therapy research.]]>
WCPT recently announced its lineup of 21 courses—10 to be held on Friday, May 1, and an additional 9 on Tuesday, May 5. Topics include airway clearance, women's health, work injury, sports and therapeutic taping, chronic pain, postural stability, research methods, and more. The preconference offerings also include half-day workshops on balance training and creating online courses.
Full course descriptions, schedules, presenter biographies, and registration information can be found at the WCPT website. APTA is a member of WCPT.]]>
Before joining APTA in 2009, White spent 30 years in direct clinical practice and management. She served in volunteer leadership positions in the Virginia Chapter, the Orthopaedic Section, and the Foundation for Physical Therapy. White earned an MPT from the University of Alabama Birmingham and a DPT from Marymount University in Virginia.
As chief professional affairs officer, White will oversee APTA's work in the areas of practice, research, and education as well as provide information, knowledge, and resources that will strengthen the profession and empower physical therapists and physical therapist assistants to transform society by optimizing movement to improve the human experience.
The Professional Affairs Unit is one of 4 major operational units at APTA headquarters that includes the Member Affairs Unit, Public Affairs Unit, and Business Affairs Unit.]]>
Last week, AARP Senior Vice President for Government Affairs Joyce Rogers voiced the organization's agreement with efforts to eliminate 4 services from the in-office ancillary services (IOAS) exception in the Stark law originally passed to tighten up restrictions on self-referrals. The support came in a letter to Rep Jackie Speier (.pdf), who is sponsoring the Protecting Integrity in Medicare Act (PIMA) (H.R. 2914). The legislation seeks to close up loopholes that allow physicians to refer patients for certain services—including physical therapy—to a business that has a financial relationship with the referring provider.
"AARP agrees that restrictions on physician self-referral and provider-kickback schemes must be strengthened," Rogers wrote. "Closing the [IOAS] exception for certain services will save taxpayers and Medicare beneficiaries money and reduce unnecessary care."
In separate news releases, both APTA and the Alliance for Integrity in Medicare (AIM) congratulated AARP on its decision to speak out on the IOAS exception.
"AIM applauds AARP for defending patients who are at risk of receiving unnecessary care caused by the abusive, profit-motivated practices exploiting the [IOAS] exception," AIM stated in its release. "Patients should not have to question whether financial incentives are driving their physician's treatment recommendations."
APTA is a founding member of AIM, which also includes medical specialty, laboratory, radiation oncology, and medical imaging groups.
In a joint statement APTA and PPS characterized the AARP letter as a "bold move" that supports an effort to "save the country billions in unnecessary treatments and protect patients from being used as pawns for profit."
"APTA continues to urge Congress to take action to close this loophole, which threatens the integrity of the Medicare program," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in the release. "It is time for Congress to pass [PIMA]."
PPS, which has been partnering with APTA in its advocacy efforts, sees the AARP announcement as a "huge win for health care," according to PPS President Terry Brown, PT, DPT. With support such as AARP's, changes could be made to the IOAS exception that "would shift the focus in health care from profit and put it back on the patient," he said.
Find out more about this issue on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.]]>
The deadline for advance registration discounts is Wednesday, December 17, at 11:59 pm, ET. It's your last chance to save before full registration fees take effect.
In the unlikely event that you're on the fence about whether to attend, check out the educational sessions, preconference courses, and sponsored events on tap.
Need more convincing? CSM attendee special rates are available for travel, housing, and rental cars.]]>
This holiday season, APTA is spreading a little holiday cheer by releasing a series of videos that provides a behind-the-scenes look into the goings-on at "North Pole Physical Therapy." Take a few minutes to follow the work of NPPT's intrepid staff, who find themselves dealing with mobility problems that until now have only been discussed in the elf-reviewed journal Frivolity and Function.
All 5 videos are being posted throughout the day on APTA's Facebook page and will be included in an e-mail blast to all members. Can't wait? Make yourself a mug of hot cocoa and binge-watch at the association's YouTube channel.
Happy holidays from APTA!]]>
The study used data from private insurer Optum Insight Inc to evaluate prevalence of lymphedema in cancer survivors, and the ways in which the use of a PCD affected health care usage. Researchers tracked data from 2008 to 2012 and found that the incidence of lymphedema has increased over the years, from a prevalence of .95% of cancer patients in the Optum database in 2007 to 1.243% in 2013. The study appears in the December 3 issue of PLoS One.
Authors describe the prevalence figures as "almost certainly an underestimate, as not all cases are coded and evaluable in an administrative dataset."
"Nonetheless the estimates reflect a prevalence comparable to, or exceeding, many other disease states that have been more thoroughly investigated and supported by the medical community," they write.
In addition to prevalence, the study also examines the use of PCDs in lymphedema treatment, and finds that among the 1,065 patients in the PCD study sample, clinical outcomes improved and health care costs dropped.
Authors write that hospitalization rates for patients using PCDs dropped from 45% to 32%. Similarly, rates of outpatient hospital visits declined from 95% to 90%, and clinic visits decreased from 47% to 32%. Also reduced: rates of cellulitis (from 28% to 22%), and usage of physical therapy, from 50% to 41%. Reductions in physical therapy-related costs were estimated to have dropped from $276 to $135.
Overall, authors write, "use of a PCD was associated with a remarkable decrease in total costs of 18% ($62,190 to $50,857) in the 12 months after device prescription."
Researchers in the study estimate that in a US cancer population of about 10 million, more than 121,000 experience lymphedema. They believe that the use of PCDs is most effective at reducing health care costs for patients with mild-to-moderate condition severity.
APTA strongly supports increased research on and reimbursement for lymphedema treatment, and recently participated in a Lymphedema Lobby Day in Washington, DC.
"The prior lack of health outcomes data [such as the data provided in this study] has contributed to the under-recognition of lymphedema, and may have limited patient access to lymphedema treatment resources," authors write. "This is particularly relevant in the cancer-survivor population, where the advent of lymphedema has a particularly profound impact on quality-of-life and general health."
Two of the authors in the study disclosed relationships with Tactile Medical, "a company which manufactures a product used to treat lymphedema." According to PLoS One, the authors adhered to the journal's policies on sharing data and materials.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
In a December 11 letter to Rep Jackie Speier, AARP Senior Vice President for Government Affairs Joyce Rogers wrote that the organization is throwing its support behind Rep Speier's efforts to eliminate the in-office ancillary services (IOAS) exception to the Stark law designed to tighten up restrictions on self-referrals. Speier is sponsoring the Protecting Integrity in Medicare Act (PIMA) (H.R. 2914) to close up loopholes that allow physicians to refer patients for certain services—including physical therapy—to a business that has a financial relationship with the referring provider.
"AARP agrees that restrictions on physician self-referral and provider-kickback schemes must be strengthened," Rogers wrote. "Closing the [IOAS] exception for certain services will save taxpayers and Medicare beneficiaries money and reduce unnecessary care."
The AARP decision was applauded by APTA President Paul A. Rockar, Jr., PT, DPT, MS.
"We'd like to see patients put back in the driver's seat, receiving treatment because they need it to be healthy, not because of the profit it will generate," said Rockar. "We are pleased to see AARP join the fight, and we stand behind them 100%."
APTA Private Practice Section President Terry Brown, PT, DPT, called the AARP letter a "huge win for health care."
"We've been working hard for years to make these changes, and it is exciting to see a major influencer like AARP join the effort," Brown said.
The AARP letter is being released as President Obama assembles his 2016 budget. The Obama budgets for 2014 and 2015 included the elimination of the IOAS exception for these services in the Stark law, and supporters of ending the loophole are hoping the next spending proposal from the White House will continue the pattern.
APTA's years-long work to end the exception included participating in the creation of the Alliance for Integrity in Medicare, a coalition of organizations that includes professional associations affiliated with the health care services affected by the IOAS exception. In addition to physical therapy, those services include advanced diagnostic imaging, anatomic pathology, and radiation therapy.
Find out more about this issue on APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.]]>
The measure allocates $30.1 billion for NIH, a $150 million increase over the current budget. Provisions in the spending authorization require the NIH Rehabilitation Coordinating Committee to host a "state of the science" conference on medical rehabilitation research, develop a plan for medical rehabilitation science, and coordinate grants in ways that follow the definitions of rehabilitation research established by the Blue Ribbon Panel on Medical Rehabilitation Research. Craik was a co-chair of the panel.
APTA was a strong supporter of the panel's work, from its formation in 2011 to the release of its final recommendations in January 2013. The association continues to advocate for rehabilitation research, and offers several resources on the topic at its Rehabilitation Research and Appropriations webpage.
"This language moves the ball forward on APTA's advocacy efforts to achieve better recognition of the value of rehabilitation research," said Justin Moore, PT, DPT, chief public affairs officer for APTA. "It also complements the core provisions in Senator Mark Kirk's rehabilitation research legislation which seeks better coordination of these activities. We look forward to continuing to advance this important issue in Congress and at NIH."
After House passage on December 11, the spending bill moved on for Senate approval. The Senate could vote on the bill as early as December 12, or possibly December 15.]]>
In "Doctors Dole Out Prescriptions for Exercise," WSJ reporter Laura Landro describes how the Exercise is Medicine initiative from the American College of Sports Medicine (ACSM) is educating physicians on how to assess physical activity levels, prescribe exercise, "and in some cases refer patients to certified trainers or physical therapists who can design regimens for different medical conditions."
The article touches on the idea that counseling patients on physical activity has not always been a strong suit for physicians—an issue brought to light earlier this year by the Alliance for a Healthier Generation, a group that includes ACSM.
Landro's piece also highlights a Kaiser Permanente effort to include physical activity data in patient records "along with other traditional vital signs including blood pressure, pulse, breathing, and temperature," an initiative that echoes a recent recommendation from the Institute of Medicine that physical activity levels be included as standard data points in patient electronic health records.
Visit APTA's prevention and wellness webpage for resources on how physical therapists and physical therapist assistants can help individuals become more physically active.]]>
The 30-minute program will be led by Daniel K. White, PT, ScD, MSc, an assistant professor in the Department of Physical Therapy at the University of Delaware who has focused his research on the determinants and benefits of physical activity in people with arthritis and after joint replacement.
The session will begin at 12:00 pm ET, and online registration is now open. OAAA archives its webinars for viewing at a later time.
APTA is a member of OAAA.]]>
The Federal Health IT Strategic Plan, 2015 – 2020 is now available for review and comment through February 6, 2015. According to an HHS news release, the strategic plan "represents a coordinated and focused effort to appropriately collect, share, and use interoperable health information to improve health care, individual, community, and public health, and advance research across the federal government and in collaboration with private industry."
"The 2015 strategic plan provides the federal government a strategy to…use health IT beyond EHRs, and use policy and incentive levers beyond the [current] incentive program," said Karen DeSalvo, MD, national coordinator for health IT and acting assistant secretary for health. The plan also aims to create a marketplace that HHS hopes will "bring new tools to health IT consumers" to improve safety, quality, and prevention while reducing disparities.
APTA provided comments to the last strategic plan, and will submit comments for the new version. The association offers several resources on IT and EHRs, including a webpage devoted to the use of EHRs.]]>
According to an announcement from the commission, the aim of the program is to "provide a pathway for hospitals and ambulatory care settings to demonstrate that they can come together to deliver clinically coordinated care, treatment and services." The commission believes that the most likely candidates for certification are accredited organizations in the early stages of establishing or seeking to strengthen their ambulatory-hospital relationships.
Feedback on the integrated care certification proposed requirements will be accepted through January 16, 2015.
APTA representatives serve on the Joint Commission's Professional and Technical advisory committees.]]>
According to the UnitedHealth Foundation (UHF) "America's Health Rankings" report (.pdf), increasing rates of obesity and inactivity are among the "national challenges" faced by the country since publication of its 2013 report. UHF estimates that obesity rates climbed 7% in 2014, to 29.4% of all Americans. Physical inactivity also rose by 3%, with 23.5% of Americans reporting that they did not participate in physical activity for the past 30 days.
The report estimates that in the 25-year history of its analyses, obesity rates have increased by 153%, from 11.6% to nearly 30%, while physical inactivity rates have remained relatively stable.
In its state-by-state breakdown of health factors, the UHF report cites Colorado (21.3%), Hawaii (21.8%) and Massachusetts (23.6%) as the 3 least-obese states. At the bottom of the list for obesity rates are Arkansas (34.6%), Mississippi (35.1%), and West Virginia (35.1%).
Colorado also ranked first in rates of physical activity, with 16.2% of adults reporting inactivity. Oregon (16.6%) was second, followed by California (18.6%). The 3 states with the highest rates of inactivity are Arkansas (31.5%), Tennessee (33.6%), and Mississippi (35.2%).
Other findings in the report:
Besides obesity and physical inactivity, other "challenges" include a 154% increase in pertussis from 6.1 to 15.5 cases per 100,000 population, and a 7% increase in drug deaths of any intent, from 12.2 to 13 deaths per 100,000 population.
APTA strongly supports the promotion of physical activity and the value of physical fitness to prevent obesity, and has representatives on the board of the National Physical Activity Plan Alliance. The association offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.]]>
According to the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR), this was a lesson recently learned by Anchorage Community Mental Health Services (ACMHS), which was fined $150,000 for not preventing malware from infecting its computers. The malicious programming breached the protected electronic health information of 2,743 individuals in violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
According to an OCR news release, ACMHS adopted HHS security rule policies in 2005 but never followed them. The introduction of the malware into the ACMHS system was "the direct result of ACMHS failing to identify and address basic risks, such as not regularly updating their IT resources with available patches and running outdated, unsupported software," according to an HHS/OCR bulletin (.pdf).
In addition to the $150,000 settlement amount, the resolution agreement (.pdf) between ACMHS and OCR includes a corrective action plan and requires ACMHS to report on the state of its compliance to OCR for a 2-year period.
OCR and the Office of the National Coordinator for Health Information Technology offer a Security Rule Risk Assessment Tool to help organizations conduct regular security reviews.
HIPAA rules can be complex, but the consequences of not understanding them can be serious. APTA provides resources on compliance on APTA's HIPAA webpage. Also, read about securing information specifically on mobile devices in the December/January issue of PT in Motion magazine (member login required).]]>
CMS is leveraging authority granted to it through the Affordable Care Act in a new rule that uses "common-sense safeguards to preserve Medicare for generations to come, while making the rules more consistent for all providers that work with us," said CMS Administrator Mary Tavenner in a news release.
According to a CMS fact sheet, the changes the organization announced on December 3 will:
In addition, CMS is continuing its moratoria on enrollment of new home health and ambulance providers in 7 "fraud hot spots" across the country.
According to CMS Deputy Administrator and Director of the Center for Program Integrity Shantanu Agrawai, the new rule is a natural follow-up to the agency's removal of almost 25,000 providers from Medicare. "For years, Medicare providers tried to game the system and dodge rules to get Medicare dollars," he said in the news release. "This final rule makes it much harder for bad actors who were removed from the program to get back in."
APTA is actively engaged in helping members guard against fraud, abuse, and waste. The APTA Center for Integrity in Practice website offers resources that include information on the Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;" a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.]]>
The article, part of the journal's "recent regulatory insights" section, examines the use of NFL players to promote SC therapies for orthopedic injuries, therapies that authors believe are largely lacking in solid scientific data and peer-reviewed, evidence-based research.
Authors reviewed SC therapy clinic advertising, online reviews, news articles, and blogs, and identified 12 NFL players who "publicly acknowledged seeking unproven stem cell interventions for injuries," including high-profile players such as Peyton Manning, Ray Lewis, and Terrell Owens. "In turn, clinics have been using these players to advertise their procedures by citing this as a common practice of the NFL," they write.
The article cites the lack of US Food and Drug Administration (FDA) approval of SC therapies, most of which fall within an exemption clause because they are "same-day procedures involving minimal manipulation of autologous cells." More complex treatments performed by companies including CellTex and Regenexx were shut down by the FDA because they involved "significant manipulation" of the cells. These kinds of therapies continue in other countries, according to the article.
Authors write that in addition to the lack of regulatory oversight, the SC therapies used by the NFL players lack good clinical data. "The few peer-reviewed articles [on the treatments] only describe the safety of these procedures, the majority from authors linked to the clinics," authors write. They argue that without regulation and data, "potential patients do not have adequate information to understand the risks associated with the treatments and thus make uninformed decisions."
This information gap is made worse by the influence wielded by big-name athletes, according to the authors, who write that "further research should be conducted on the use of athletes in the promotion of these ... therapies to determine … if they should be regulated by the government similarly to direct-to-consumer ads for pharmaceuticals."
In the meantime, the authors recommend that the NFL approach this issue in a way similar to its approach to traumatic brain injury (TBI) over the past few years—by convening expert panels, funding research, and establishing other standards, including whether SC treatments should be labelled "performance-enhancing."
"By staying abreast of the development of these therapies, the NFL will protect itself and its players by enabling new and beneficial treatments while curbing illegitimate and unsafe usage," they write.
Want more on the role of stem cell treatments in physical therapy, as well as other advances in technologies that regenerate tissues? Check out APTA's webpage on Regenerative Rehabilitation. Resources include a podcast on "stem cell basics."]]>
The 1-hour session, which will begin at 4:00 pm EST, will focus on how the US Department of Health and Human Services (HHS) and others are addressing the challenges of multiple chronic conditions among individuals who are aging, and how its strategic framework on multiple chronic conditions (.pdf) has informed its approach.
Webinar participants will be able to submit questions to featured speakers Nora Super, executive director of the 2015 White House Council on Aging; Anand Parekh, MD, MPH, deputy assistant secretary for health at HHS; Cynthia Boyd, MD, associate professor, Johns Hopkins University; and Robert Schreiber, MD, medical director of evidence-based programs at the Hebrew SeniorLife Department of Medicine.
Registration is free but must be completed by December 10. The presentation is part of an HHS initiative on multiple chronic conditions.]]>
The symposium is sponsored by the Alliance for Home Health Quality and Innovation, which was joined by APTA representatives and speakers from other organizations in an Institute on Medicine (IOM) and National Research Council (NRC) home health workshop in October. According to the Institute, the January symposium "seeks to build upon the … themes" raised at that meeting.
Speakers for the event confirmed to date include presenters from Empire BlueCross BlueShield, Kindred, naviHealth, and the United Hospital Fund, with more to be announced soon. Registration for the day-long event includes breakfast, lunch, and a cocktail reception the evening before in Washington, DC, as well as access to speaker presentations.
Provision of home health physical therapy is the topic of a new publication from APTA and the Home Health Section, Providing Physical Therapy in the Home. The 128-page book covers the expanding roles of PTs and PTAs in the home health setting, changes in reassessment requirements, and increased public accountability for best practices and positive patient experiences.]]>
"The change will mean that in a world where clinical and professional knowledge advances so fast, physical therapists around with world have a better chance of keeping abreast of the latest developments," wrote WCPT President Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS, in an e-mail notice. "It will also mean that twice as many WCPT member organizations will have the opportunity to host a congress and create visibility and opportunity for the profession in their country and region."
Moffat wrote that congress locations may alternate between "locations which attract good numbers and those where large numbers cannot be guaranteed but there is a clear case for hosting the congress on professional grounds."
The next WCPT congress is set for May 1–4, 2015, in Singapore. Registrations for the event are now being accepted. APTA is a member organization of WCPT.]]>
The study, e-published ahead of print in the journal Spine (abstract only available for free), examined 107 patients with onset of LBP within the past 12 months and no radicular features. The patients were divided into 3 groups: 1 group received "usual medical care" of 3 visits with a physician who prescribed over the counter analgesics and NSAID medications as well as advice to stay physically active; 1 group received 8 mechanical-assisted manipulation sessions in the prone position; and 1 group received 8 sessions of high-velocity, low-amplitude thrust manipulation in the side posture position.
Using the Oswestry OBP Disability Index and a self-reported 1–10 pain intensity scale, researchers assessed improvement among the groups at 4 weeks, 3 months, and 6 months.
According to the study, at the 4-week mark, 76% of the MTM group achieved at least a 30% reduction in disability, compared with 50% of the MAM group, and about the same number in the UMC group. Half of the MTM group achieved a 50% or greater reduction in disability, compared with 16% of the MAM group and 39% of the UMC group.
The MTM group also fared better in pain ratings, with 94% of that group reporting reductions in pain of 30% or more, compared with 69% of the MAM group and 56% of the UMC group. Among the MTM participants, 76% reported a 50% or greater reduction in pain, compared with 47% of the MAM group and 41% of the UMC group.
Differences fell off after 4 weeks, however, with authors writing that "none of these tests at the 3- or 6-month time points were statistically significant."
Authors describe the differences between the groups as "relatively modest but still relevant" to patients with LBP. What they were most surprised by, however, was what they describe as the "significant advantage of MTM over MAM on reductions of both disability and pain scores." They had expected the scores to be more similar compared with UMC; instead, MAM and UMC tended to be more similar in pain and disability outcomes.
According to the authors, the study was limited in terms of its "modest" sample size. Additionally, the lack of a natural history control made it impossible to determine what was "attributable to natural history, direct treatment effect, and/or non-specific factors," they write.
Still, they assert, the findings support the use of manipulation as a short-term approach, depending on the patient.
"Manipulation should be offered as an effective therapeutic option to patients within the context of preference-sensitive care, allowing the patient to make an informed choice which reflects their individual values and preferences," authors write. "It has been found that treatment options which align with patient preferences lead to enhanced patient satisfaction."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
To rent through Avis: Go to Reserve online, or call 800/331-1212 and mention AWD Number T031200.
To rent through Budget: visit the APTA member discount site, or call 800/455-2848 and mention BCD Number X570900. Also, enjoy $25 back with Budget Bucks Payback by renting with Budget twice through December 31, 2014, to receive a $25 gift certificate toward your next rental. To start earning Budget Bucks, register your Fastbreak RapidRez number at www.budget.com/bucks, or enroll for free.
In the article, reporter Matthew Braga focuses on 2 projects that are aiming to advance the use of 3-D printers to produce prosthetic devices: a University of Toronto-based effort that will work with a Ugandan hospital to facilitate the production of prosthetics for children there, and a crowdsourced initiative that brings together over 3,000 individuals to collaborate on 3-D-printed hand and finger prostheses.
According to the Fast Company article, the technology and materials are largely in place for the fabrication of the prostheses—though there is still some work to be done on load-bearing devices. The problem, Braga writes, is in making the technology widely available in sustainable ways.
While systems could be put in place that would, for example, allow the Ugandan hospital to take scans and upload data to a remote creation system, "the problem with that approach is it denies African hospitals the knowledge and expertise to develop these prosthetics themselves," Braga writes. "It doesn't build up new infrastructure, but leverages existing networks."
Despite these issues, projects are moving forward, according to the article: this December, Boy Scouts and Girl Scouts will volunteer time to assemble prostheses parts for the hand project, and the Ugandan initiative aims to supply at least 65 working prosthetics to children during 2015.]]>
The NIH funds are part of the agency's participation in the Interagency National Robotics Initiative to create devices that employ robotics technology to work cooperatively with people, called co-robots. Other participants in the initiative include the National Science Foundation, NASA, and the Department of Agriculture.
Recently announced projects include a project designed for individuals poststroke to "extend therapy into the home by providing patients with a lightweight robotic exoskeleton that can be placed on an affected arm and provide the kind of therapeutic guidance found at a rehabilitation center," according to an NIH news release.
A second major project will focus on a co-robot wheelchair that will help individuals with limited hand function achieve greater mobility by tracking head movements via a camera placed on special glasses. According to the news release, the new technology will "adapt to individual users by gaining information as the patient responds to various situations in natural ways (such as turning their head as their attention shifts)."
The initiative will also fund research on co-robotic technology to develop "a music-based system that will help children with [autism spectrum disorder] interact with a robotic companion in a safe and natural manner."
NIH will provide approximately $2.3 million in funding over the next 5 years.
Check out APTA's resources on technology and patient care as well as an audio course on robotics and physical therapy.]]>
The National Physical Activity Plan (NPAP) Alliance has announced that registrations are now open to attend the 2015 NPAP Congress, February 23 – 24 in Washington DC. The focus of the event will be on strategizing on the upcoming release of a revised NPAP, a high-profile effort to create a comprehensive set of policies, programs, and initiatives to increase physical activity in all segments of the American population.
Registration is available online. APTA is a member of the NPAP Alliance board of directors.]]>
Elections for national office will be held at the 2015 House of Delegates on June 1. Please contact Amber Neil in APTA's Governance and Leadership Department for additional information.]]>
The report, covered widely in media outlets including the New York Times, US News and World Report, Kaiser Health News, and others, pegged 2013 growth in health care spending at 3.6%--that's the lowest annual increase since 1960.
Spending in 6 out of 9 categories studied—such as hospital care, durable medical equipment, home health care, and "other professional services"—dropped in 2012–2103, compared with 2011–2012. The only areas of increase were in prescription drugs, nursing care, and nondurable medical products.
In a blog post for the Washington Post, health care policy reporter Jason Millman writes that the CMS actuaries were "not surprised by the recent slowdown … since it usually tracks with GDP [gross domestic product] coming out of a recession."
However, Millman writes, other data point to factors that "don't seem to apply to the experience of previous recoveries," including increases in high-deductible health plans that could discourage individuals from using health care, cuts to Medicare spending, and "greater Medicare drug rebates and limits on insurer profits." If these policies have made a difference in spending, the rate of future increase could be slower than what experts would expect if the pattern were tied solely to GDP.
Regardless of the contributing factors, health care spending is predicted to rise to $5.2 trillion by 2023, a figure almost double the 2013 numbers, making up 19.3% of the US economy.
"The key question is whether health spending growth will accelerate once economic conditions improve significantly; historical evidence suggests that it will," write the CMS report's authors. "However, in the near term, the health sector will undergo major changes that will have a substantial impact on the consumers, providers, insurers, and sponsors of health care."
"The balance of these and many other factors over the next few years will determine how the historically low health spending growth from 2009 to 2013 is viewed: as the temporary aftermath of the great recession or the beginning of a new era," they conclude.]]>
The Center of Excellence for Health Services and Health Policy Research and Training will be dedicated to expanding the number of physical therapist (PT) scientists specializing in health services and health policy research. The groundbreaking initiative will provide PTs accepted into the program with training and skills necessary to examine the most effective ways to deliver, organize, and finance health care delivery.
Applications for the COE grant are currently under review by a special ad hoc Scientific Review Committee. The Foundation plans to formally announce the institution or network of institutions awarded the COE grant at APTA's Combined Sections Meeting in February 2015. Additional funds raised for this campaign will be used to offer grants and scholarships through the Foundation's scientific program to complement the COE.
The coming announcement caps off the most aggressive fundraising campaign in the Foundation's history, which took in more than $3 million.
"This an exciting time for the Foundation," said Foundation President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT. "As we review grant applications, we find creativity and innovation presented to be truly overwhelming. Thank you to APTA, its sections and chapters, PTs and PTAs, corporations, and foundations for turning this idea into reality."
Visit the Foundation website to learn more about the COE and the impact the Foundation has made on physical therapy research.]]>
On December 3, the House overwhelmingly approved the Achieving a Better Life Experience Act (ABLE), a bill that allows people with disabilities to establish tax-exempt savings accounts that would not disqualify them from receiving Medicaid and Social Security benefits. Currently, disability benefits are not provided to individuals with more than $2,000 in assets earning more than $680 a month.
According to a story in USA Today, the strong House vote in favor of the legislation (404-17) will likely be answered with equally enthusiastic support in the Senate, given that about 85% of all members of Congress are listed as cosponsors.
APTA Chief Public Affairs Officer Justin Moore, PT, DPT, thinks that physical therapists and physical therapist assistants should applaud the bill's passage.
"The ABLE act is at the core of who we are as a profession," Moore said. "At the heart of APTA's vision for transforming society is a belief that individuals should be given every opportunity to participate fully in that society. This legislation, which will allow people with disabilities to achieve greater financial independence, is a significant step in the right direction."
The ABLE Act could come up for a vote in the Senate as early as next week.]]>
According to an RSNA press release, the study examined magnetic resonance imaging of 355 knees that developed osteoarthritis in the past 5 years—31 knees that had meniscal surgery a year prior to the arthritis diagnosis, and 281 knees that had meniscal damage but no surgery. The study group was compared with a control group with no meniscal damage, matched for age, gender, BMI, and arthritic severity. Patients in the study were mostly overweight with an average age of 60.2. Two-thirds of the subjects were women.
RSNA reports that "'all 31 of the knees that underwent meniscal surgery during the prior year developed osteoarthritis, compared with 165 (59%) of the knees with meniscal damage that didn't have surgery."
Cartilage damage rates were even more dramatic. According to the announcement, cartilage loss was found in 80.8% of the knees with surgery, but was present in only 39.5% of the knees that did not undergo the procedure.
"Increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint," said lead researcher Frank W. Roemer, MD, in the press release. "The indications for meniscal surgery might need to be discussed more carefully in order to avoid accelerated knee joint degeneration."
The study was discussed at the RSNA conference but has not undergone peer review.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The outage is expected to last from approximately 9:30 am ET to 12:30 pm ET.
Sites affected by the outage include:
Also affected will be websites that depend upon APTA.org for login, including: the APTA Learning Center (LearningCenter.apta.org), The Hub (communities.apta.org), PTNow (ptnow.org) and various component websites. The "Find a PT" feature at MoveForwardPT.com also will be unavailable during this time.
We regret any inconvenience and thank you for your patience and understanding.]]>
Bernadette Gillick, PT, MSPT, PhD, is this year's recipient of the $80,000 Magistro Family Foundation Research Grant. Gillick, an assistant professor at the University of Minnesota, is conducting a 2-year project to study the effectiveness of transcranial direct stimulation combined with constraint-induced movement therapy to improve hand function in children with weakness after stroke. She was a former recipient of Foundation Promotion of Doctoral Studies II (PODS II) scholarships in 2009 and 2010. The Magistro grant is funded by the Magistro Family Foundation Endowment Fund.
In addition to the Magistro grant, 3 physical therapists (PTs) have each received $40,000 in support of research that Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT, said will "contribute to our profession's scientific advancement." The grants, recipients, and research areas are:
The Foundation also announced the recipients of this year's Florence P. Kendall Doctoral Scholarships awarded to outstanding PTs in their first year of study toward a doctoral degree. Winners for the 2014–2015 academic year are Jason Falvey, PT, DPT, GCS, CEEA, University of Colorado – Denver; Allison Kosir, PT, DPT, University of Colorado – Denver; and Matthew Ithurburn PT, DPT, OCS, The Ohio State University. Each recipient was awarded $5,000.
The awards were made possible through donations to the Foundation, which has provided over $14 million in research grants, fellowships, and postprofessional doctoral scholarships to more than 500 emerging scientists. A news release announcing the latest grant and scholarship recipients (.pdf) is available at the Foundation website.]]>
Well now's your chance to release that inner visionary—but you don't have long to act.
December 15 is the deadline to submit your entry for the World Confederation for Physical Therapy's (WCPT) art and health competition. The work of the finalists will be displayed in an exhibition at the WCPT Congress 2015, May 1-4 in Singapore, the largest international gathering of physical therapists in the world.
The theme of the competition is "fulfilling potential," and the original artwork must be a photograph, painting, drawing, or sculpture. The competition is open to all, with a maximum of 3 entries submitted by any individual. Find out more at: www.wcpt.org/congress/art-and-health.
Want some inspiration? Check out previous competition winners.]]>
The 2015 multiple procedure payment reduction (MPPR) calculator is now live on APTA's Medicare webpage. PTs must follow an MPPR policy that implements a 50% payment reduction to the practice expense value of approximately 44 codes, with payment calculated based on code combinations. The 2015 APTA calculator is designed to help PTs identify those payments from January 1-March 31, 2015.If Congress does not take action by March 31, 2015, a 21.2% payment cut will go into effect.
APTA is actively involved in the SGR reform process and will be asking PTs, physical therapist assistants, educators, patients, and supporters to contact their legislators when Congress is poised to take action on this issue. Members interested in joining APTA's advocacy efforts to reform the SGR and repeal the therapy cap can sign up for PTeam.]]>
The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to APTA's federal government affairs efforts and shown exemplary leadership in furthering the association's objectives in the federal arena.
The Public Service Award is presented annually to an individual who has demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination: members of Congress, congressional staff members, federal agency officials, health and legislative association staff, and celebrities or other public figures.
Recipients will be selected in February by the APTA Board of Directors, and the awards will be presented during APTA's Capitol Hill Day to be held on either June 3 or June 4, 2015, in National Harbor, Maryland.
Nominations must be submitted by Tuesday, January 13, to Stephanie Sadowski at firstname.lastname@example.com or by fax to 703/706-8536. If you have questions, call Stephanie Sadowski at 800/999-2782, ext. 3127.]]>
Preventing Fraud, Abuse, and Waste: A Primer for Physical Therapists (.pdf) is a free guide that examines not only the laws around these issues but the ways in which a PT's relationships with payers, referral sources, and patients can set the stage for potential problems. The 20-page booklet is written in an easy-to-read style and includes many real world examples of the ways in which PTs can intentionally or unintentionally cross the line, as well as information on how to comply with the relevant laws and regulations and avoid risk.
In addition to the primer, APTA offers .2 free CEUs to PTs who successfully complete Navigating the Regulatory Environment: Ensuring Compliance While Promoting Professional Integrity, an audio roundtable that covers topics related to health care fraud and abuse and provides interactive case vignettes to illustrate types of Medicare fraud or abuse involving physical therapist services.
The primer and the course are part of APTA's Integrity in Practice campaign, an initiative that supports physical therapy's high practice standards. The campaign helps PTs understand regulations and payment systems, and puts them in touch with tools and resources that promote evidence-based practice; ethics; professionalism; prevention of fraud, abuse, and waste; and more.]]>
Of particular interest to physical therapists (PTs) and physical therapist assistants (PTAs) in the 324-page proposal (.pdf) are provisions around essential health benefits (EHBs) and network adequacy standards for plans offered through the marketplace. According to a fact sheet on the proposal (.pdf), the new rules would guard against discrimination within health plan benefit design and provide greater transparency for consumers.
Specifically, the proposed changes to EHB provisions are based on 2012 health plans that must cover 10 EHBs, including the habilitative and rehabilitative services category. Benchmark plans will continue through 2016 in the proposed rule, and new base benchmark plans for 2017 may be chosen by states. These new plans will be based on 2014 plans and will be adjusted to ensure that they meet all EHB requirements, including prohibitions on discrimination based on an individual's age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions.
According to the proposal, network adequacy requirements will not see any significant change until after the National Association of Insurance Commissioners (NAIC) issues its model act. The proposed rule states that available out-of-network providers cannot be counted in determining network adequacy and suggests that new enrollees be allowed to use their current providers for up to 30 days after joining a plan if under an ongoing course of treatment.
The proposed provider adequacy requirements also require up-to-date directories of providers accepting new patients, available to consumers "through a clearly identifiable link or tab and without creating or accessing an account or entering a policy number," according to the fact sheet.
Among other features of the proposed rule:
Would adopt a uniform definition of "habilitative services" to ensure adequate coverage and clarify the distinction between habilitative and rehabilitative services. Currently, each state can define habilitative services as long as the definition is nondiscriminatory.
Automatic hardship exemptions would be available for individuals under 65 who live in states that have failed to expand Medicaid, have household incomes below 138% of the federal poverty level, and do not qualify for traditional Medicaid or Medicare.
Cost-sharing limits for noncalendar year plans would not be allowed to be reset at the end of the calendar year.
APTA is reviewing the proposed rule and will provide comments to CMS.]]>
The article is a sequel to an earlier piece that looked at in-demand professions that did not require a college degree. The new list was created by CareerBuilder and Economic Modeling Specialists Intl, and targets professions in which the number of available jobs posted each month is larger than the number of workers available.
According to the research, physical therapy is in 8th position, with an average of 24,425 unique job postings per month, during which an average of 10,880 PTs are available for hire. The study estimates total PT employment at 211,296, and median hourly earnings at $38.63.
The entire Forbes list, in order: marketing executive, software developer, registered nurse, industrial engineer, network and system administrator, web developer, medical and health services manager, PT, speech-language pathologist, and sales manager.
Want to go where the jobs are? Check out APTA's Red Hot Jobs website for regularly-updated opportunities.]]>
The proposed rule (.pdf) issued on December 1 is mostly carrot—and a little stick—designed to ease concerns that many ACOs don't have the infrastructure and experience in place to meet current CMS rules, adopted in 2011, that impose financial penalties if the organizations don't meet savings targets after 3 years, according to a recent article in Modern Healthcare (free access available via registration).
The proposed rule would give ACOs the option of foregoing the 3-year penalties if they meet certain criteria, including slowed spending over the first 2 years. The tradeoff: ACOs that go with the less-risky option would still face penalties after 6 years, and the cap on potential bonuses after year 3 would be reduced to 40% of savings.
ACOs that opt for the more stringent 3-year requirements could access bonuses of up to 50% of savings.
The CMS proposal also establishes a third option for ACOs that "would use new methods to identify which patients are included in the ACO," according to the Modern Healthcare article. This "third track" would identify patients "whose care and costs [the ACO] must manage," and would allow the organization to earn up to 75% of what they save—though they would risk responsibility of up to 75% of their losses as well.
APTA will post a summary of the proposed rule in the coming weeks, and will provide comments to CMS on behalf of its membership.
APTA members can learn more about a physical therapist's role in an ACO by visiting APTA's webpage, FAQ: Accountable Care Organizations (ACOs): Medicare Shared Savings Program and Pioneer Models.]]>
And we just happen to have a suggestion for a great place to give.
The Foundation for Physical Therapy is participating in giving Tuesday, a great day to kick-off the Foundation's celebration of a phenomenal year by raising $5,000 of its $75,000 2014 holiday season fundraising goal in a single day.
You can support online here, make a pledge from your cell phone by texting 41444 with the message: "F4PT [your donation amount] [your name]," or simply call 800/875-1378 to make your donation with a credit card.
Help the Foundation raise $5,000 on December 2. To follow the progress, check out the fundraising thermometer at www.app.mobilecause.com/campaign.]]>
Take the quick and simple survey by December 5. Just pick the design you think is likely to get you to open up the magazine, and then check out the February issue to see which cover was most popular.]]>
PT in Motion News wishes you a safe and happy Thanksgiving!]]>
Researchers write that the older adults who ran for at least 30 minutes 3 times a week demonstrated 7% to 10% better walking economy than study participants who walked at the same durations and rates. The results, they write, support the idea that "higher intensity aerobic activities may mitigate the typical age-related decrease in walking economy, and consequently, preserve mobility into older age."
The study, published in the November 20 issue of PLoS One, involved 30 adults (14 males and 16 females) who ranged in age from 66 to 72 (average age of 69). Half of the participants were runners who self-reported engaging in that activity 30 minutes or more at least 3 times per week, and for at least 6 months prior to the study. The 15 "walkers" reported the same levels of participation in their activity.
After evaluation by a physician and a treadmill familiarization session, participants were evaluated after walking on a dual-belt force-instrumented treadmill at 3 speeds—.75, 1.25, and 1.75 m/s—for at least 7 minutes at each speed. Areas evaluated by the researchers included oxygen consumption and carbon dioxide production, as well as ground reaction forces that were in turn used to determine gait cycle events and stride variables.
Researchers found the runners' 7%-10% reduction in metabolic energy consumption occurred at all speeds tested. At the fastest walking speed, walkers increased gross metabolic power by 95%, while runners required an 86% increase in power.
The "most striking" finding in the study, according to authors, occurred when researchers compared these data with younger and older sedentary adults who underwent the treadmill testing.
"The results of this analysis showed that across the range of speeds, older walkers consume metabolic energy at a similar rate as sedentary older adults," authors write. "However, our most striking finding was that older runners consumed energy at a similar rate as young sedentary adults across the range or walking speeds."
Authors of the study were somewhat surprised to find that the differences in metabolic cost could not be attributed to the actual mechanics of walking, which did not vary substantially between the walkers and runners.
"Among spatio-temporal gait characteristics, we found no significant differences between older walkers and older runners in regards to stride time, stride frequency (p = .879), single leg stance time (p = .126) or duty factor (p = .126)," they write. The same was true with ground reaction forces relative to first and second peak vertical force, as well as anterior-posterior braking and propulsive reaction forces.
Researchers are uncertain about the precise reason for the metabolic differences, but cite decreased muscle co-activation and increased muscle efficiency as possible contributors.
Authors acknowledge the study's limitations, particularly around its small numbers and uneven distribution of males and females in the walker/runner groups (11 females and 4 males in the walking group; 5 females and 10 males in the running group). Still, they write, "while it would have been preferable to have a larger sample size with more similar sex and anthropometric matched cohorts, it would not have changed our overall conclusions."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
In recognition of November as COPD Awareness Month, the recent post gathers information on COPD from PTNow and offers it up in 1 convenient set of links. The partial listing includes a clinical summary, clinical practice guidelines, tests and measures, and clinical cases.
Also included: patient education resources from APTA and the National Heart, Lung, and Blood Institute.]]>
In the November 24 article, Post reporter Amy Ellis Nutt describes early efforts at Ohio State Wexner Medical Center to use Nexstim, a technology that painlessly suppresses activity in the healthy parts of a patient's motor cortex. Researchers believe that after stroke, undamaged parts of the brain "[go] into overdrive in order to compensate," which "may actually slow recovery of the injured side," according to the article.
The Post reports that the process involves using "a technology similar to a GPS" to pinpoint the areas of the motor cortex that have been injured. Researchers then apply low-frequency magnetic pulses to the corresponding healthy area to decrease activity. "This allows the injured side to make use of more energy during physical therapy, which immediately follows the [TMS]," Nutt writes.
Nexstim is planning on conducting an 8-month double-blind randomized clinical trial with 200 individuals who have suffered a stroke in the past 3-12 months and have weakness in the arm and hand on only one side. According to the Post report, the trial will involve up to 29 visits for each participant.]]>
November 30 is the last day APTA members can enjoy a prerecorded webinar or audio conference, courtesy of APTA. The limited-time offer is the association's way of saying thank you for your membership.
Choose from programs on audits and appeals, how to overturn denials and get visits approved, the role of the PT in hospice and palliative care, and more.
To redeem your complimentary recorded webinar or audio conference course:
Once you receive your order confirmation number, go to "My Courses" to launch the course. This offer is nontransferable and expires November 30, 2014.
Questions? Contact Member Services or call 800/999-2782, ext 3395, M-F, 8:30 am to 6:00 pm, ET.]]>
"We are pleased to welcome RockTape to APTA's Strategic Business Partners family," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in an association news release. "It is important to APTA to enhance our business relationships and develop meaningful partnerships with for-profit companies. We are pleased that our services and marketing opportunities provide mutual benefits to our partners and APTA."
"We knew that to best leverage all of our great relationships in the physical therapy profession, we needed to partner with and support the profession through the APTA Strategic Business Partners Program," said Alyson Evans, director of US sales.
In 2015 RockTape will exhibit at APTA's Combined Sections Meeting, the NEXT Conference, and National Student Conclave.
The APTA Strategic Business Partners program seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA. For further information on the program, visit the Strategic Business Partners webpage.]]>
The 300-plus page report, "Capturing Social and Behavioral Domains and Measures in Electronic Health Records," makes the case for the Centers for Medicare and Medicaid Services (CMS) to include the measures as part of the EHR certification and meaningful use regulations.
Data on 4 of the domains—alcohol use, tobacco use and exposure, race/ethnicity, and residential address—are already being widely collected, the report states. But additional domains should be included, each with its own measures—education, financial resource strain, stress, depression, physical activity, social connections/isolation, exposure to violence/intimate partner violence, and neighborhood compositional characteristics.
The IOM report describes "a large body of empirical evidence" around the dose-response relationship between physical activity and improved physical and mental health throughout the lifespan, with "little evidence that an upper threshold exists." Authors write that not only is the relationship strong enough to be worth collecting data, the very act of obtaining this information from patients at outpatient visits is associated with "significant, yet small, changes in patient weight loss and [plasma glucose concentration] levels compared [with] those who were not asked about their physical activity levels."
Authors of the report recommend that 2 "Exercise Vital Signs" questions from the US Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System be used as the standard measures for physical activity in EHRs. The 2 questions are:
Authors also reviewed the International Physical Activity Questionnaire, a 9-question form, finding it "acceptable" but "more time consuming" than the 2-question measure.
The report noted that the additional domains would likely add to costs, and that these costs would largely fall to providers. However, the report asserts, the long-term benefits would be significant.
"The US health system has achieved technological advances but lags behind other countries in population health outcomes," write the report's authors. "Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research."
APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs. Additionally, APTA has long supported the promotion of physical activity and the value of physical fitness, and is involved with the National Physical Activity Plan (NPAP), where the association has a seat on the NPAP Alliance board. The association also offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.]]>
A recent story in the Washington Post describes the upcoming publication of a study that analyzed the burden placed on the cervical spine through the typical posture of people looking at their smartphones—head tilted down at angles as severe as 60 degrees. At that angle, researchers determined that weight on the cervical spine increases to about 60 pounds.
According to the Post report, the "text neck" posture seen just about everywhere is like "carrying an 8-year-old around your neck several hours per day," at the rate of between 700 to 1,400 hours a year. For adolescents, that number could be 5,000 hours higher. The poor posture can lead to degeneration of the spine.
The Post reports that the problems associated with text neck have been known for some time, and borrows quotes from a 2013 CNN interview with APTA Private Practice Section President Tom DiAngelis PT, DPT, in which he describes the dangers of the posture over time.
The article offers suggestions from Kenneth Hansraj, lead author of the upcoming study, on how to counteract text neck. His biggest piece of advice: look down with your eyes—no need to bend your head. Second, he suggests specific exercises to improve mobility and posture.]]>
The United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada announced that they are now accepting applications for the Young Investigator Initiative, a career development and grant mentoring program. Investigators chosen to participate in the program will attend 2 workshops 12-18 months apart and work with faculty between workshops to develop grant applications.
This grant mentoring workshop series is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed and have a commitment to protected time for research. Basic and clinical investigators, with or without training awards (including K awards), are invited to apply.
Application requirements and more details can be found at the USBJI website. Deadline is January 15, 2015, to participate in the next workshop, April 24-26.
According to an announcement from USJBI, 140 program participants have obtained more than $130 million in research grants. APTA is a founding member of USBJI.]]>
The American Academy of Nursing (AAN) became the most recent nonphysician profession to add to the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely® campaign aimed at educating consumers and health care professionals on health care-related tests, procedures, and practices that may not be necessary or appropriate under certain circumstances. In September, APTA became the first nonphysician group to join the campaign when it unveiled its list of "5 Things Physical Therapists and Patients Should Question."
Of particular interest to PTs and PTAs in the AAN list of "5 Things Nurses and Patients Should Question" (.pdf) are recommendations that nurses should not let older adults lie in bed or only get up to a chair during their hospital stay, that physical restraints should not be used with patients who are older and in the hospital, and that urinary catheters should not be placed or maintained in a patient "unless there is a specific indication to do so."
"PTs know that an important contributor to hospital-associated disability is immobility during hospitalization, which leads to decreased function, increased fall risk, and increased length of stay—especially in older adults," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "The AAN Choosing Wisely list is an excellent addition to the support for greater mobility in hospitalized patients."
Bemis-Dougherty noted that the AAN recommendations around restraints are consistent with The Joint Commission (TJC) restraint standards. In addition, she said, the AAN list correlates strongly with APTA's Choosing Wisely recommendations against using continuous passive motion machines after uncomplicated total knee replacement, and against bed rest following diagnosis of acute deep vein thrombosis after anti-coagulation therapy, unless significant medical concerns are present.
"Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls," noted Bemis-Dougherty. "If the patient is restrained, the immobility could lead to poor outcomes."
APTA Senior Director of Practice and Research Nancy White, PT, DPT, OCS, was involved in the development of the APTA Choosing Wisely list, and thinks that the AAN recommendations add to the reach of a campaign that's making a difference.
"Choosing Wisely is recognized as a great way to improve outcomes of care and reduce the use of treatment approaches that are either not effective or that may even be harmful," White said. "AAN has identified several practices that are common in many hospital settings that result in prolonged and unnecessary bed rest—something that PTs know leads to poorer outcomes and prolonged hospital stays."
Bemis-Dougherty believes that the AAN list can help APTA in its efforts "to change the culture of immobility in the hospital to one of mobility."
"Creating that kind of change is a daunting task and can't be accomplished by PTs alone," Bemis-Dougherty said. "To have nursing recognize the problem caused by immobility is huge and hopefully can contribute to a more widespread culture of mobility that involves all health care professionals within hospital settings."
APTA's Choosing Wisely list is offered in several forms, including consumer-focused versions in English and Spanish, and an expanded version containing citations on the association's Center for Integrity in Practice website. Resources on that site also include a ProfessionWatch paper from Physical Therapy that details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation.]]>
On October 29 Humana reinstated the MPPR policy on the initial claims adjudication for non-facility providers. The policy will be applied to facility settings in late January.
The 50% reduction applies to the practice expense (PE) portion of the relative value unit (RVU). Humana will pay 100% of the first code with the highest PE RVU, and all codes billed after that will be reduced by multiplying the PE portion of the code by 50%. For Medicare advantage plans, Humana will apply the reduction regardless of whether the therapy services were provided in 1 therapy discipline or multiple therapy disciplines.
Humana originally implemented this policy in the fall of 2013 and applied the program retroactively, requiring physical therapists (PTs) to pay back portions of reimbursement that Humana claimed exceeded MPPR standards. APTA raised questions about the accuracy of the overpayment calculations and concerns about the administrative burden of the overpayment recovery process on PT practices, among other issues. As a result of those efforts, Humana temporarily ceased application of the MPPR policy in January 2014 to focus on correcting its payment logic and refunding inappropriate overpayment recoveries.
Members who have questions about the reimbursement policy and suspect a calculation error should contact APTA at firstname.lastname@example.com.
Need more information on MPPR? Visit APTA's MPPR webpage. Resources include FAQs, strategies for managing contracts, approaches to verify payment accuracy, and more.]]>
APTA posted a summary (.pdf) of the interim rule (under the "summaries" header) from VA. Many of the changes focus on definitions in Veterans Choice and clarifications around the non-VA providers who can provide hospital and medical services through the program. The APTA summary provides highlights of provisions that may impact PTs, including copayment regulations, program scope, key terms, eligibility requirements, payment rates, and other issues.
The interim final rule took effect on November 5.]]>
Now's your chance to help.
APTA is calling for volunteers to serve on the Recruitment and Retention of Early-Career Members Task Force, the group charged with analyzing and evaluating existing membership trends and current outreach practices for early career PTs and PTAs, and identifying innovative strategies to increase membership value. Deadline for application is December 1. Complete details on the task force can be found on APTA's Volunteer Groups webpage.
APTA relies heavily on its volunteers, who gain valuable leadership and growth opportunities while working with some of the most outstanding physical therapists in the country.
Interested? Complete a volunteer interest profile, then click on the "Apply for Current Vacancies" button and select the task force you're interested in joining.]]>
APTA was among the organizations advocating for the legislation as part of the association's broad push to bring attention to TBI and rehabilitation in general.
If signed by the president, the finalized, bipartisan legislation will:
The Senate version of the bill was sponsored by Sen Orrin Hatch (R-UT) and cosponsored by Sen Bob Casey (D-PA).
Besides its efforts in support of TBI reauthorization legislation, APTA has participated in the Joining Forces initiative, promoted the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf), and participated in a congressional Brain Injury Awareness Day in March. Concussion management awareness was also the focus of this year's student-led Flash Action Strategy, which resulted in the largest concussion-related grassroots effort in APTA history.
APTA provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.]]>
APTA's American Board of Physical Therapy Residency and Fellowship Education's accredited Education Leadership Institute (ELI) Fellowship, a collaborative with the American Council of Academic Physical Therapy, Education Section, Physical Therapist Assistant Educators Special Interest Group, and APTA, now is accepting applications for 2015. Submission deadline is December 1, 2014, 5:00 pm ET.
This yearlong, invitational, blended learning (online and onsite components) fellowship program includes experienced mentorship, and is designed to develop emerging and novice (0-7 years) physical therapist and physical therapist assistant education academic program and residency and fellowship directors with leadership skills to facilitate change, think strategically, and engage in public discourse to advance the physical therapy profession.
Applicants are selected based on the strength of their application and meeting all eligibility criteria. To learn more about the Education Leadership Institute Fellowship, go to the ELI webpage.
Considering the fellowship experience? Check out the video testimonials of ELI graduates.]]>
As reported in Bloomberg.com, the Washington Post, and elsewhere, the average premium for a "silver" plan will rise by 2% in 2015, while the average "bronze" plan increase will be closer to 4%.
At a more granular level, different parts of the country are seeing more significant increases—and a few reductions. For example, Alaska residents will experience a 28% increase to marketplace premium rates that are already among the highest in the country, while Mississippi residents well see a 19% drop in premium rates for a bronze plan.
The approved rates released by CMS also contain information on deductibles and cost-sharing increases or decreases, depending on the plan. While there are variations, in general, physical therapists (PTs) can expect to see a continued trend toward higher cost-sharing and more limited participation in narrow networks, said Gillian Leene, senior regulatory affairs specialist at APTA.
"In 2014, we saw high deductibles and high cost sharing, such as copays and coinsurance, for patients with coverage through the health insurance exchange plans, which in many cases limited access to physical therapist services," she said. "Additionally, many plans sold on the health insurance exchanges are narrowing their provider networks to contain costs and have very limited out-of-network coverage."
Leene suggested that the startup of the open enrollment period is a good time for PTs to reacquaint themselves with the ACA through APTA's Health Care Reform page, and in particular via the association's series of resource documents titled Making Sense of Health Reform. Topics covered in the series include narrowed networks, cost-sharing, and the grace period. "It's a great way for PTs to understand practical implications and get a few tips on how to mitigate some of these issues," she said.
Sharing information and experiences is another way to stay on top of health care reform. Members are urged to contact APTA with any issues they're experiencing through the association's feedback form.]]>
Care4life allows participants to set reminders for appointments, medications, and glucose testing; as well as set and track weight and exercise goals. The features are available through text message, on the app, and by logging on to www.care4life.com.
ADA continues to offer "Where Do I Begin," a hardcopy guide for patients with a recent type 2 diabetes diagnosis. The 16-page guide helps patients understand the fundamentals of type 2 diabetes and the steps that can be taken to live with the disease, including exercise and proper diet. Multiple copies of the booklets are available at no charge to PTs and PTAs to give to their patients.]]>
In an analysis of 4,157 hospital-based health care providers in 35 hospitals, researchers monitored compliance with 13.7 million hand-washing opportunities, and found that over the course of a single 12-hour shift, hand-washing compliance rates dropped by just over 20%, from rates that weren't all that high to begin with. Authors of the study, published in the November issue of the Journal of Applied Psychology (abstract only available for free), believe that this is the first research to show that the negative effects of job demands on workplace compliance accumulate much more quickly than previously believed.
Researchers looked at data from hospitals that use radio frequency identification technology in the form of badges worn by providers that track behavior. The badges are capable of registering when and where providers use hospital room sanitizer dispensers. Authors of the study correlated hand-washing opportunities to specific shifts, and examined compliance through the course of a shift as well as the ways compliance changed after the provider took a break or had more than 3 days off.
The study sample comprised nurses (65%), patient care technicians (12%), physicians (4%), and unspecified "therapists" (7%), with behaviors reviewed over a 3-year period.
First, the bad news: compliance with hand-washing standards (washing upon entering and leaving a patient's room) started at 42%, and dropped by more than 8 percentage points over the course of a single 12-hour shift, to 34.8%. Authors write that "for every additional hour worked, the fitted odds of compliance are estimated to decrease by … 4%." Making matters worse, compliance drops even more dramatically "when caregivers have had more frequent interactions with patients during a shift and when caregivers have spent a larger proportion of their time in patient rooms," they write.
Not only were the compliance effects cumulative over the course of a single shift, the problem was compounded as a caregiver worked through consecutive shifts. "The more total hours a caregiver had worked in the past week, the faster his or her compliance decreased during a given shift," authors write.
The relatively good news is that researchers discovered a strong relationship between time off and subsequent compliance. Specifically, authors found that taking as little as an additional half-day off was associated with a 1.3% increase in the probability that a caregiver will comply with hand-washing on his or her next shift.
While authors acknowledge that the improvement rate may seem small, they maintain that the real-world effects could be significant, citing a Swiss study that correlated a 1% improvement in hand hygiene with a reduction in hospital-acquired infections of 3.9 per 1,000 patients. When evaluated against another study that estimated a per-patient cost of $20,549 for every hospital-acquired infection, authors concluded that across the US, the rates of noncompliance they observed could produce an additional 600,000 infections per year at an estimated annual cost of $12.5 billion.
"The findings reported here suggest that demanding work environments can produce negative consequences far more rapidly than prior [research] … has recognized," authors write. "In other words, a day in the saddle can indeed take its toll."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
APTA members can now access summaries of final rules for the following areas:
To access each document, scroll down to the "APTA Summaries" headline and select the link for 2015 rules.
The association will also hold a webinar on November 20 for PTs who bill Medicare for outpatient physical therapy services in private practice settings (using the 1500 claim form or 837-P) and face new requirements under PQRS. The 90-minute session, which will begin at 2:00 pm ET, will help PTs understand how to comply with the new rules in 2015 in order to avoid a 2% pay cut in 2017. APTA Director of Quality Heather Smith, PT, MPH, will lead the discussion. Registration includes on-demand access to a recording of the webinar for later listening.
APTA also offers an overview of the PQRS changes through a podcast, free to members.]]>
Charles M. Magistro, PT, DPT (Hon), FAPTA, DrSci (Hon), former President of APTA, first chairman of the Foundation for Physical Therapy (Foundation), and emeritus member of the Foundation's board, will celebrate his 90th birthday on Tuesday, November 18. In response to requests, the Foundation has created a way for you to add to the celebration by making a donation in Magistro's name. A card will be sent to Magistro notifying him of your gift.
Magistro has been a steadfast donor to the Foundation and created the Magistro Family Endowment Fund in 2005 to support the investigation of innovative therapeutic interventions in rehabilitation.
"Charles Magistro was one of the visionary leaders instrumental in helping to establish the Foundation in 1979," said Foundation President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT. "His impact on the Foundation is reflected in the leadership and guidance he continues to provide. We at the Foundation wish Charles a very happy birthday."]]>
Crane represented the 8th district of Illinois from 1969 to 2005. During that time, he became known as a champion of smaller government who was also willing to reach out to lawmakers regardless of their political perspectives.
In 2002, Crane received APTA's Public Service Award for his efforts on behalf of direct access to PTs, efforts that he led from 2001 until he lost his reelection bid in 2004.
Crane's life and political career were reported in the Washington Post, Chicago Tribune, Reuters, and many other media outlets earlier this week.]]>
The November 11 edition of WSJ includes a story of how Parker Hannifin Corporation developed a prototype set of robotic leg braces designed to allow individuals with paraplegia to walk. The new device, named Indego, is now undergoing trials with 40 people at 5 rehabilitation centers.
According to the WSJ story, Indego is an exoskeleton device that weighs in at 26 pounds. Users control walking speed by leaning forward and backward, while "tiny gyro-chips commonly used to rotate images on cellphones" help users keep from veering off-course, and serve as part of a vibration-based alert system for changes to speed and position.
Parker Hannifin is seeking FDA approval for the device, which the company says could come as soon as 2015. The WSJ reports that if successful, Indego would be only the second device to receive FDA approval for a robotic orthosis for home use by people with lower-body paralysis. The company estimates a $69,500-$100,000 pricetag for the device.]]>
The new approach, developed by Martha Murray, physician with the Boston Children's Hospital Division of Sports Medicine, was the subject of a recent Q and A article in the Boston Globe. In the article, Murray outlines how the procedure works and its possible benefits over traditional ACL surgery.
Murray describes how her team focused on the ways fluid in the knee joint prevents the torn ACL ends from properly reconnecting through clotting. "Once we figured that out, we developed a scaffold, basically like a sponge, that you can use to hold the blood between the 2 torn ends of the ACL long enough for the cells around and the tissue around to grow into it and reunite," she says in the article. "When we do the repair of the ACL and we sew it back together, we sew it with the sponge between the 2 ends."
Besides being much less invasive than traditional ACL surgery, the procedure has shown promise in animal trials in reducing the development of later arthritis. Murray told the Globe that the FDA has approved a 10-patient safety study that she hopes to begin in January, 2015.
In the article, Murray also describes the rehabilitation process that will be used with the new procedure. "What we've done is gotten advice from multiple physical therapists who have a lot of experience with ACL rehabilitation," she told the Globe. She characterized the rehab protocol as "very similar" to what is done after traditional graft surgery, but added that the protocol would be adjusted as the study continues.
"Our relatively simple solution of a sponge and putting the blood there where it belongs may not be the final solution," Murray says in the article. "If we can just get some really smart scientists to think this could work, then maybe they'll design an even better scaffold or figure out an even better growth factor to put in there."]]>
NSC-related resources include Storify highlights that feature pictures, videos, tweets from attendees, and other submissions.
Interested in even more detail? Check out the collected video dispatches from NSC.
And if you need any more reason to put NSC on your calendar for next year, watch the archived livestream of 6 dynamic NSC sessions that were broadcast live, including a powerful story from Joanna Rolek on the importance of interprofessional communication, and a closing keynote address from Scott Chesney that left attendees inspired and energized.]]>
The November 11 edition of WSJ includes a story of how Parker Hannifin Corporation developed a prototype set of robotic leg braces designed to allow individuals with paraplegia to walk. The new device, named Indego, is now undergoing trials with 40 people at 5 rehabilitation centers.
According to the WSJ story, Indego is an exoskeleton device that weighs in at 26 pounds. Users control walking speed by leaning forward and backward, while "tiny gyro-chips commonly used to rotate images on cellphones" help users keep from veering off-course, and serve as part of a vibration-based alert system for changes to speed and position.
Parker Hannifin is seeking FDA approval for the device, which the company says could come as soon as 2015. The WSJ reports that if successful, Indego would be only the second device to receive FDA approval for a robotic orthosis for home use by people with lower-body paralysis. The company estimates a $69,500-$100,000 pricetag for the device.]]>
The approach involves the use of a pneumatic surgical tourniquet to reduce blood flow to the injured limb while the patient participates in strength training. Johnny Owens, PT, a physical therapist and chief of human performance optimization at the Center for the Intrepid, introduced the technique at the Brooke Army Medical Center.
Owens claims tourniquet training allows patients to train at low loads "to improve their function without compromising vulnerable joints or soft tissue." According to an article that accompanied the ESPN video, the technique has resulted in 50%-80% strength gains.
In the ESPN segment, APTA spokesperson Stephania Bell, PT, OCS, ESPN.com's injury analyst and senior writer, was interviewed about the possibility that the technique might the useful for rehabilitation of elite athletes. Bell thinks the likelihood is strong. "Our service members are truly highly trained, gifted athletes, and if we can return these ultimate athletes to their field … how can we not consider these results and expand them out to the general athlete population?" she said.
Owens is a scheduled presenter at APTA's 2015 Combined Sections Meeting, February 4-7 in Indianapolis, where he will join Jason Wilken, PT, MPT, PhD, to provide an overview of the rehabilitation strategies being used at the Center for the Intrepid.]]>
The list was developed by the Physiotherapy Evidence Database (PEDro), an Australia-based project and collaborative partner with PTNow, in celebration of its 15th anniversary. The final top 15 trials are from 7 countries: 4 each from the United Kingdom and Australia, 2 each from the United States and Norway, and 1 each from Sweden, the Netherlands, and Brazil.
The US-based studies that made it into the list were "Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial," published in JAMA in 2006, and "Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial," published in 2009 in The Lancet (abstract here; APTA members have full access to the article via ProQuest in PTNow ArticleSearch).
The EXCITE study, co-authored by Steven Wolf, PT, PhD, FAHA, FAPTA, Carolee Winstein, PT, PhD, FAPTA, Philip Miller, AB, Edward Taub, PhD, Gitendra Uswatte, PhD, David Morris, PT, PhD, Carol Giulani, PT, Kathye Light, PT, PhD, and Deborah Nichols-Larsen, PT, PhD, focused on the effectiveness of rehabilitation constraining the "good" arm of individuals poststroke whose upper limb or limbs had been affected. Acccording to primary author Wolf, "this trial was the first large multi-center, randomized controlled trial in stroke rehabilitation that lay the groundwork for many other trials to follow." The trial was funded by the National Institutes of Health.
The other US trial to make the PEDro list focused the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. Authored by William D. Schweickert, Mark C. Pohlman, Anne S. Pohlman, Celerina Nigos, Amy Pawlik, PT, DPT, CCS, Cheryl L. Esbrook, Linda Spears, PT, Megan Miller, Mietka Franczyk, PT, PhD, Deanna Deprizio, Gregory A. Schmidt, Rhonda Barr, PT, MA, CCS, Kathryn McCallister, Jesse B. Hall, and John P. Kress, the trial found that "therapy in the earliest days of critical illness was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care."
"These are ground-breaking trials that changed the way people are treated for a variety of conditions seen by physiotherapists and other healthcare professionals," states PEDro on its webpage announcing the winners. "Some of these trials set the stage for breakthroughs, some represent a paradigm shift, and all of them mark important milestones in the evolution of physiotherapy treatment."]]>
And they have some impressive—and interesting—ways of showing it.
First the impressive: during the PPS 2014 Annual Conference November 5–8 in Colorado Springs, Colorado, PPS members helped to raise more than $160,000 for PT-PAC, the profession's political action committee. Nearly 2 out of every 3 PPS members made a donation to PT-PAC.
But a couple of lucky attendees found other ways to show their support.
Demonstrating that a picture can sometimes be worth more than just words, former APTA Board of Directors member Steve Levine, PT, DPT, MSHA, FAPTA, is now the proud owner of a portrait of basketball superstar LeBron James, painted onsite during the PPS conference keynote from Erik Wahl. Levine donated $2,650 to PT-PAC to walk away with the winning bid for the artwork.
Steve Levine, PT, DPT, MSHA, FAPTA, with his newly acquired (and newly-created) LeBron James portrait.
And in a successful effort to snag another kind of superstar, Ronald Dean Hasse, PT, spared no expense by donating $1,000 to earn the winning bid for the opportunity to bowl with physical therapy legend Marilyn Moffat, PT, PhD, FAPTA, at the PT-PAC party that took place in conjunction with the PPS conference. No word on who won the match.
Michael Matlack, director of grassroots and political affairs for APTA, says that the generosity shown by PPS conference attendees benefits the entire profession. "Donating to the PAC is important because it provides the opportunities for APTA staff and members to talk about physical therapy issues that impact their patients and practices and build champions on Capitol Hill," he said.]]>
The study, published in the November issue of Anesthesiology, compared the results from the 6-Minute Walk Test (6MWT) administered to 2 groups of patients with colorectal cancer: 1 group of 38 patients who received a "trimodal" exercise/nutrition/relaxation program 4 weeks prior to resection surgery and for 8 weeks afterwards, and another group of 39 patients who received only the postoperative 8-week program.
Researchers found that the gains made before surgery raised 6MWT scores throughout rehabilitation relative to the control group, and that functional losses didn't dip far past baseline standards. Patients who received only the postoperative program, on the other hand, began functional declines leading up to surgery and were generally unable to return to baseline function 8 weeks afterwards.
The trimodal program combined aerobic exercise (walking, jogging, swimming, or bicycling) and resistance training with dietary consultation and protein supplementation. Stress reduction techniques provided by a psychologist made up the third element of the program.
Though both groups began with similar baseline mean 6MWT scores—421 meters (m) in the prehabilitation group, and 425 m in the rehabilitation group—differences began to occur very soon after the prehabilitation program began. By the end of the 4-week program, the prehabilitation group had improved mean scores by 25.2 m, while the rehabilitation group continued to decline, creating a 41.7 m gap between the groups. And while almost 50% of participants in both groups recorded 6MWT scores that were 20 m below their baselines 4 weeks after surgery, by 8 weeks, the prehabilitation group had regained above-baseline scores.
"In the present trial, the average 25.2 m increase in preoperative walking capacity achieved with trimodal prehabilitation offsets the average 21.8-m decline observed with rehabilitation in the first 4 weeks after surgery, thus providing a buffer and facilitating a faster return to baseline walking capacity," the authors write.
Researchers noted that, while physical activity was an important component in the gains, "the additional roles of nutritional optimization and psychological motivation cannot be ruled out as essential contributors to the observed improvement."
"Efforts to improve recovery have traditionally focused on the postoperative period," write the study's authors. "However, this may not be an opportune time to commence lifestyle changes as cancer patients may be fatigued, concerned about disturbing the healing process, or anxious as they await treatments for the underlying condition. The preoperative period may in fact be a more salient time to intervene, as patients are generally in a better physical condition."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Rockar's November 6 letter was written in response to "Steps to Avoid an Accident," an article that accompanied a 2-part series that looked at how care facilities are responding to a growing number of falls among an aging population and how one woman struggled to recover from her fall-related injuries.
The article, Rockar writes, "raises an important point—loss of balance and falls could be prevented if adults take measures to protect themselves." But what the article fails to mention, he adds, is that "assessment and treatment by a licensed physical therapist is the best way to obtain this protection."
"A [PT] plan of care will include exercises to improve strength, aerobic capability, flexibility, proper gait, and the function of the vestibular (balance) system," Rockar writes. "Although an individual's age is a risk factor for falling, falls are not an inevitable part of aging."]]>
That's the focus of the latest Move Forward Radio, which examines the psychological toll of sports injuries and its potential effect on an athlete's return to play. The podcast was recorded in light of studies indicating that fear of reinjury is common among athletes with anterior cruciate ligament (ACL) tears who don't return to their sport.
"With something like ACL injury, there's strength gains to be had, but then there's that neurological control and that confidence in the limb," said Carol Ferkovic Mack, PT, DPT, SCS, CSCS, of the Cleveland Clinic's Sports Health Center, one of the podcast's featured guests. "If those aren't there, then that's the percentage that's not going to return to sport."
Ferkovic Mack was joined on the podcast by Jack Lesyk, PhD, CC-AASP, director of the Ohio Sports Psychology Center. Both Ferkovic Mack and Lesyk stressed the value of gaining an athlete's confidence in the treatment process in order to achieve recovery.
"From the psychological point of view, we know that athletes as a group are very goal-directed people," Lesyk, said, "but they're also high-information people—they're used to that from their regular sports training. … Giving them very realistic, honest, complete information about the natural course of recovery and physical therapy is just so important."
Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.
APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to firstname.lastname@example.com.]]>
"Men were approximately one-third as likely as women to be evaluated for osteoporosis and to initiate calcium and vitamin D supplementation" after a distal radial fracture, authors write. "Moreover, whereas nearly all osteoporotic women received pharmacologic antiresorptive therapy, only one-third of the osteoporotic men received pharmacologic treatment." Researchers described being male as "the strongest predictor of failure to obtain a [bone mineral density (BMD)] test after fracture."
The study was based on a single-institution retrospective review of medical records from 95 men and 344 women aged 50 and older who experienced a distal radial fracture, and whether they received a dual x-ray absorptiometry (DXA) scan and osteoporosis treatment within 6 months after the injury. Researchers also looked at how the absence of a DXA scan affected the FRAX algorithm used to place men in risk categories for future osteoporetic fractures. Results were published in the November 5 issue of The Journal of Bone and Joint Surgery (abstract only available for free).
In addition to confirming that men were far less likely than women to undergo a DXA scan, researchers found that when it was used, the procedure dramatically changed how men were classified in terms of risk for future osteoporosis-linked fractures using the FRAX algorithm. When no DXA scan was performed, 63% of the men were placed in high or intermediate risk categories; when the DXA scan was used, those combined categories jumped to 82%. Even more significant, according to authors, is that the percentage of men classified as high risk increased from 8% without the scan to 53% when the scan was used.
"Numerous expert panels agree that women over the age of 65 years and those over the age of 50 years who have sustained a fragility fracture should undergo BMD evaluation with [DXA]," authors write, adding that similar studies have called for the same steps with men.
And though the need for BMD evaluation after a distal radial breaks can sometimes be obscured by age and cause of fracture, the gaps in evaluation are there even in cases of potentially telling hip fractures. "Many studies still show unacceptably low rates of BMD testing … in the female population," authors write. "Rates of BMD testing in men who sustain a hip fracture are even lower, highlighting a critical gap in care."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The translated consumer-friendly summary is available at MoveForwardPT.com and joins multiple resources that provide education on APTA's participation in the Choosing Wisely campaign developed by American Board of Internal Medicine (ABIM) Foundation. The initiative aims to help consumers make informed health care choices by providing lists of procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. Consumer Reports partners with the ABIM Foundation and APTA to share the lists with the public.
APTA was the first nonphysician group to release a list, joining more than 50 medical specialty societies.
APTA released its list in September and offers an expanded version containing citations on the association's Center for Integrity in Practice website. Resources on that site also include a ProfessionWatch paper from Physical Therapy that details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation.
APTA's Choosing Wisely list is part of a larger APTA Integrity in Practice campaign, an effort to support the profession of physical therapy as a leader in the elimination of fraud, abuse, and waste in health care. The Center for Integrity in Practice website will offer resources throughout the course of the campaign, but already provides a primer on preventing fraud, abuse, and waste, and a free online course on compliance and professional integrity.]]>
PTNow continues its discussion of journal clubs with a post that shares some creative ways to meet the logistical meeting challenges through online and hybrid learning platforms. The blog post covers options for real-time get-togethers that range from the good ol' fashioned conference call to video and file sharing programs such as Google+ Hangouts, and touches on ways to set up a club when it's impossible or inconvenient for members to meet at the same time. All options are easy to set up, and most are free.
The blog post includes plenty of links to the tech tools, as well as examples of some of the technologies in action. Check it out, and get clubbing.
Have you ever participated in an online journal club? Post comments, suggestions, and questions to the PTNow blog.]]>
PT winners include:
Unfortunately, tight races prevented PT candidates from being elected in 2 states: in Wisconsin, State Assembly member Penny Bernard Schaber, PT, lost her race for a seat in the state Senate; and State Representative Elizabeth Thomson, PT, was not reelected in New Mexico.]]>
Largely through the efforts of the PT-PAC, its political action committee funded by voluntary member contributions, APTA was able to inform and influence several candidates on issues central to physical therapy. From the $1.3 million in campaign contributions given by the PT-PAC this election cycle, candidates had a 92% success rate in their elections. Now the association's efforts will turn to encouraging APTA members to contact their newly elected representatives as early as possible to keep the momentum going.
In the US Senate, Republicans will gain at least 7 senators, giving them the majority with 52 seats, with the possibility of adding 1 or 2 additional seats with 3 remaining races to be determined. Republicans also solidified their control of the House of Representatives and will begin 2015 with at least 247 seats (and as many as 250)—the largest House majority the party has held since 1928.
At the important congressional committee level, where details of legislation are often hammered out, there will be changes to account for vacated seats in leadership and membership positions.
"With the Senate changing hands, Republicans will now chair all congressional committees," said Michael Matlack, director of grassroots and political affairs for APTA. "Republicans will have a different legislative focus, but APTA is well positioned to continue its advocacy efforts, since many of our legislative priorities are bipartisan in nature."
Matlack added that when the 114th Congress begins in January, APTA will need to educate new legislators on physical therapy issues and reintroduce important legislation including the repeal of the Medicare therapy cap, whose exceptions process is set to expire March 31, 2015. "In the House, there will be more than 50 new members, and they'll need to be informed of the importance of physical therapy and how health care legislation impacts their constituents." Matlack said.
With dynamics in Congress expected to change, it is more important than ever for members to stay informed by joining APTA's PTeam e-mail list to receive updates and Action Alerts when members should contact their legislators on issues. In addition, the PT-PAC has initiated a $20 campaign for APTA members, citing if every APTA member donated $20 each year, the physical therapy profession would have the largest health care provider PAC in the country. Learn more about this campaign here.]]>
Eligibility and application information for the postprofessional 2015 Promotion of Doctoral Studies (PODS) Scholarship and the New Investigator Fellowship Training Initiative (NIFTI) is now posted on the Foundation website. The deadline to apply is January 21, 2015, by 12:00 pm, ET.
Contact Rachael Crockett for more information, or call 800/875-1378, ext 3385.
Sign up for the F4PT Alert and be first to know about Foundation funding opportunities.]]>
What is news is that for a limited time, you can do it for free.
During the month of November, APTA is inviting members to enjoy a complimentary prerecorded webinar or audio conference as a thank-you for membership. Choose from programs on audits and appeals, how to overturn denials and get visits approved, the role of the PT in hospice and palliative care, and more.
Once you receive your order confirmation number, go to "My Courses" to launch the course.
This offer is nontransferable and expires November 30, 2014. Questions? Contact Member Services or call 800/999-2782, ext 3395, M-F, 8:30 am to 6:00 pm, ET.]]>
Early-bird registration discounts for the 2015 APTA Combined Sections Meeting (CSM) end at 11:59 pm, ET, Wednesday, November 5. Online registration is quick and easy—and this is your last chance to save big, so shift into high gear.
The 2015 CSM will be held February 4–7 in Indianapolis. Check out the CSM website to learn more about the programs and networking opportunities being offered.]]>
The 30-minute call-in program will begin at 12:30 pm, ET. To register for a spot in the session, e-mail firstname.lastname@example.com with "November 12 Call" in the subject line. Space is limited.
"Insider Intel" Q&A call-ins are dedicated to specific hot topics in policy and payment, free to APTA members. If you're unable to participate live, recordings of the calls will be available on the APTA website afterward.]]>
The DMEPOS rule (pdf) affects payment for DME—some of which is frequently used in physical therapy, such as standard power wheelchairs and orthotics—and regulates how CBP pricing will impact non-CBP areas.
The final rule, to be published on November 6, finalizes a limited phase-in of continuous bundled monthly rental payments for standard power wheelchairs and continuous positive airway pressure devices furnished under the CBP. The bundled monthly rental payments will replace capped rental policies, and cover equipment, supplies, accessories, maintenance, and repairs for the devices. However, no specifics on these special payment rules have been released, and physical therapists who deal with standard power wheelchairs in CBPs have nothing new to comply with at this time.
Details on the timeframe for the phase-in and impacted DME will be announced later, ahead of the bidding competitions. The advance announcement will include an explanation of why the items are bundled together, and will identify the specific standard power wheelchairs and HCPCS codes that will be subject to these special payment rules. APTA will alert members when this guidance is published.
The new rule also sets fee schedules for DME in areas where CBPs are not yet implemented based on existing pricing, and defines how competitive bidding contracts can be sold or transferred when DME businesses change ownership.
In addition, the 2015 DMEPOS rule defines how information from the CBP can be used to adjust fee schedules in areas without the bidding programs. The most notable provisions will limit adjustments to a "national ceiling" of 110% of average regional prices and a "floor" of 90% of average regional prices, and upwardly adjust the fee schedule amounts for certain areas based on competitive bidding prices from these areas or the national ceiling, whichever is higher.
Other changes to the rule:
The final DMEPOS rule did not include a proposed update to the definition of minimal self-adjustment for orthotics. The proposed update would have incorporated existing program guidance around the specialized training needed to provide custom fitting services when providers are not certified orthotists. Even though the regulation is not being updated, the program guidance still stands.
APTA will be posting a detailed summary of the new rule in the coming weeks.]]>
"A Tiny Stumble, a Life Upended," focuses on Joan Rees of San Francisco. Rees suffered her fall in Istanbul, Turkey, last year and only now considers herself fully recovered. NYT reporter Katie Hafner chronicles the warning signs and early falls experienced—and discounted—by Rees, and the sometimes-frustrating journey of recovery.
Hafner reports that Rees relied on physical therapy throughout her recovery, and that she suffered a "depressing setback" when she was forced to wait for nearly 2 weeks for Medicare to transfer her case so she could resume physical therapy after moving from her son's house back to her own apartment. During the gap, Rees developed sciatic pain and was prescribed Vicodin. "A few days later, [Rees' daughter] arrived at her mother's apartment to find her on the couch, unconscious and drooling," Hafner writes.
Hafter reports that "6 months after the accident, with regular physical therapy, Mrs. Rees had recovered remarkably well. But to watch her move through her days was to see a lingering tentativeness. Where once her gait was strong and assured, it had turned cautious." Now, according to the article, Rees considers herself fully recovered and "is back to taking lengthy walks around San Francisco."
Part 1 of the NYT series focused on challenges facilities face in reducing falls risks.
APTA's Balance and Falls webpage offers a wide variety of resources for physical therapists and consumers. Also check out PTNow for a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people.]]>
In the November issue's cover story "Opportunity of a Lifetime," PT in Motion Associate Editor Eric Ries takes a look at how APTA's vision statement, "Transforming society by optimizing movement to improve the human experience," is already being engaged in by PTs in a variety of settings. Ries interviews 8 PTs to find out how patient-centered medical homes and other innovative models are helping to establish PTs as "lifelong caretakers of the public's health." The article also explores the concept of an annual physical therapy exam to better address Americans' health and wellness needs.
The ambitious words of the APTA Vision Statement "at once pack a punch and present a conundrum," Ries writes near the beginning of the article. "Namely, how are [PTs] to go about attempting to meet such a hugely ambitious goal?"
Some interesting, real-world answers to that question can be found in what follows.
The PT in Motion article on physical therapy through the lifespan appears in the November issue of the magazine. Hard copy versions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.]]>
The wide variation not only begs further study into the effectiveness of both surgical and nonsurgical approaches but underscores the need for a more standardized shared decision-making process that better educates patients on risks and outcomes, according to the latest installment in the Dartmouth Atlas of Health Care series (.pdf).
The Dartmouth Atlas report on spinal stenosis looks at Medicare records from 2001 to 2011 for treatment of the condition, which is thought to affect about 30% of people 65 and older. Authors found "dramatic" variations in the 2 most prevalent surgical interventions and an overall increase in the use of spinal fusion surgery, which they described as a "controversial" procedure whose effectiveness "has not been clearly established."
The rate of more traditional decompression surgery—the removal of tissues compressing the spinal nerves—has decreased as spinal fusion surgery has increased, according to the study, but still accounted for 80 procedures per 100,000 Medicare beneficiaries across the US in 2011. But the overall rate masks significant variation in usage across the country, where some areas reported fewer than 35 procedures per 100,000 Medicare beneficiaries, and others—topped by Mason City, Iowa, at 216.7 per 100,000—exceeded a rate of 180 per 100,000 beneficiaries.
Between 2001 and 2011, spinal fusion surgery witnessed a 67% increase, to 52.7 per 100,000 Medicare beneficiaries. This intervention shows even more dramatic regional variation, according to the study, with a low of 9.2 procedures per 100,000 in Bangor, Maine, to a high of 89.2 per 100,000 in Mason City, Iowa—a region that also reported a highest rate of decompression surgeries (216.7).
"Prior work by the Dartmouth Atlas Project has shown that the marked regional variation in surgery for back pain reflects the local practice styles of spine surgeons," authors write. "For the individual patient, there is often not a single 'right' treatment choice. Each has the potential to benefit the patient, but benefit is not certain. Each also entails the possibility of harm or the need for further surgery."
Other findings in the study:
Authors of the study write that the general lack of definitive research supporting one intervention over another, coupled with the risks involved in surgery and the wide regional variation in approaches, make it extremely important for patients to participate in a careful decision-making process. "In ideal settings, patients should be informed about these options and given the opportunity to participate in shared decision-making," they write, "allowing their values and preferences to guide them to the best decision for them."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
In "Bracing for the Falls of an Aging Nation," NYT reporter Katie Hafner focuses on the Sequoias, a retirement community in San Francisco. Hafner's report touches on the design and structural changes the facility is making to reduce falls likelihood, and the efforts being taken to educate residents on falls prevention. Hafner writes that the Sequoias must take on these projects while respecting the "feisty independence" of its residents, who she describes as "former professors, physicians, and executives" who are "accustomed to telling others what to do, not the other way around."
The NYT report includes descriptions of how architects and interior designers are reexamining buildings from the perspective of a person who is elderly with failing eyesight. Designers are now looking at features such as stairs, thresholds, and shower stalls through special glasses that cloud and discolor their vision to simulate the challenges faced by a resident, Hafner writes, and making changes that they hope will reduce falls. Some of those changes at the Sequoias include installing dramatically contrasting color strips at the tops and bottoms of stairs, more clearly visible shower stall thresholds, and black toilet seats on white toilets.
The NYT article includes video links that show how low-contrast steps and showers appear to individuals with cataracts and glaucoma.
Hafner's report also examines the challenges faced by facilities to better educate residents on the importance of exercise, the realities of falls risk with age, and mitigation and response options. Often, she writes, residents deny the dangers and forgo exercise until it's too late. "Though the risk of a fall increases significantly once people reach their 80s, researchers have found that people 85 and older in excellent health have no greater risk than someone 20 years younger," Hafner writes.
The article explains how, once bedridden after a fall, individuals who are elderly can lose muscle mass at a rate of 1% per day; however, the gradual decreases in mobility or balance that can lead to a serious fall are often discounted—or purposefully ignored. The real work for facilities, Hafner writes, is to get residents to move past a sense of denial that causes them to "pay scant attention to their risk for a fall until it happens."
APTA offers a wealth of resources on balance and falls, most of them accessible via the association's Balance and Falls webpage. Offerings range from consumer-focused information including a video, a PT's guide to falls, handouts on falls prevention and physical therapy and the balance system (members-only .pdfs), to PT- and PTA-focused information on how to develop community events on balance, falls, and exercise. Members can also access several continuing education courses related to falls at the Balance and Falls page, and the PTNow evidence-based practice resource includes a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people.]]>
The final 2015 Medicare physician fee schedule rule released by the Centers for Medicare and Medicaid Services (CMS) includes an aggregate increase in payment for physical therapy services of 1%--provided Congress stops implementation of a payment cut due to the flawed SGR formula by March 31. In addition, despite objections from APTA and other organizations, the new rule increases the number of Physician Quality Reporting System (PQRS) measures required for reporting of physical therapists (PTs) in private practice and other health care professionals to as many as 9.
The new PQRS rules were opposed by many other professional health care provider organizations and APTA, which provided CMS with comments when the rule was first proposed.
The PQRS change will increase the number of individual measures required to be reported in order to avoid the 2017 2.0% PQRS penalty, from 3 to as many as 9, depending on whether the provider is using claims ( 6 measures available for 2015), or registry (9 required, or as many as apply to the provider). As in 2014, providers must report on at least 50% of eligible Medicare patients.
Other changes include:
In other rules announcements, CMS issued final rules on the methodology for adjusting the DMEPOS feel schedule payment amounts, and the establishment of alternative payment rules for a phase-in of a competitive bidding program.
APTA will post detailed summaries of the new rules in the coming weeks.
Visit PT in Motion News for more information on recently-released rules from CMS, including the 2015 outpatient prospective payment system and home health prospective payment system.]]>
The rule includes the packaging of payment for certain ancillary services provided in the hospital as well as comprehensive payments for a list of 25 primary services. The comprehensive payments include adjunctive services and supplies that support delivery of the primary service, which may include some physical therapist services that occur in the perioperative period. Further, the rule requires physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.
Except for a small subset of ''sometimes therapy'' services delivered without a certified therapy plan of care, most physical therapist services provided in the outpatient hospital department are paid under the Medicare physician fee schedule (PFS), not the OPPS. CMS provides an annual update of these "sometimes therapy" services that are paid under the OPPS and subject to direct supervision requirements.
A detailed summary of the rule will be available for APTA members in the coming weeks.
Visit PT in Motion News for more information on recently released rules from CMS, including the 2015 physician fee schedule and home health prospective payment system.]]>
Recently, Medscape published a list of 15 "game changing" wireless health technology devices selected by cardiac electrophysiologist David Lee Scher, MD, clinical associate professor of medicine at Penn State University, director of a digital health consulting firm, and chairman of the Healthcare Information and Management Systems Society (HIMSS) Mobile Health Roadmap Task Force. While cardiac, records, and medications monitors made up much of the list, Scher also included 2 devices that could be of special interest to physical therapists and physical therapist assistants—"WoundRounds" and "Moticon."
WoundRounds combines a special app with a dedicated device that allows providers to record the state of a wound over time, and share that information with other providers. Though intended for use in facilities, the device and app can also be used in home care settings.
Moticon is a removable device that its developers describe as the world's "first integrated sensor insole." Once slipped into a wearer's shoe, Moticon wirelessly transmits data on gait to a special smartphone app and, according to Scher, could even help providers track when a patient is experiencing a growing risk for falls.]]>
Researchers compared Knee Injury and Osteoarthritis Outcome Scores (KOOS) of 84 patients who participated in progressive pre- and postoperative rehabilitation between 2007 and 2011 with 2,690 patients who received usual care between 2006 and 2010. The usual-care patient data were taken from the Norwegian National Knee Ligament Registry (NKLR); patients receiving the progressive pre- and postoperative care were from the US and Norway.
Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points.
Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills. Authors did not include a description of usual-care.
Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write.
Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
Under the final rule, set to be implemented January 1, 2015, physical therapists (PTs) must "perform the needed therapy services, assess the patient, measure progress, and document objectives and goals at least once every 30 calendar days during the home health episode of care." The reassessment policy applies to physical therapy, occupational therapy, and speech-language pathology, and must be conducted by a qualified therapist from each discipline. In the case of physical therapy, "qualified therapists" would be limited to PTs.
CMS had originally proposed that the reassessment be performed every 14 calendar days, but increased the requirement to 30 days after receiving comments from the public, including APTA.
CMS also announced that it will eliminate the mandate for a "narrative" to be supplied by a physician in order to comply with a physician "face to face" requirement. APTA supported this change, expressing concerns that the current rule creates an undue burden on the home health community. The physician (or nonphysician practitioner) will still be required to certify that a face-to-face patient encounter occurred in order to meet the requirements for the home health stay. That encounter must take place no more than 90 days before the start of home health care or within 30 days after it begins.
The final rule also includes 0.3% ($60 million) reduction for Medicare home health payments in 2015. This decrease is caused by a 2.1% increase to the home health market basket, which was then reduced by 2.4% for the second phase of home health rebasing. In addition, there are new provisions for the home health quality reporting program.
The rule has been posted on the federal register. APTA will draft a complete summary of the final rule in the coming days, and will offer educational programs on this and other CMS rule changes for 2015.
CMS will also be issuing rules for 2015 on the physician fee schedule and the outpatient prospective payment system. Visit APTA's PT in Motion News page to get the latest reports.]]>
In an effort to determine how aquatic exercise training stacked up both to no exercise and land-based programs, researchers analyzed 16 aquatic training studies that included 866 women and 15 men. Aquatic exercise was compared with a non-exercise control group in 9 studies, and compared with land-based programs in 5 studies. In 2 studies, different types of aquatic exercise were compared with each other.
When it comes to the benefits of aquatic exercise compared with no exercise, researchers found that individuals with fibromyalgia who participated in the aquatic programs reported improvements in physical function, pain, and stiffness. The studies also noted improvements in muscle strength and cardiovascular fitness. Although improvements were characterized as statistically significant across all measures, only stiffness and muscle strength met researchers' 15% threshold for clinical relevance. In general, authors described the evidence as "low to moderate quality" in favor of aquatic training.
Comparisons of aquatic programs with land-based exercise yielded no clinically relevant differences between the 2, according to the study's authors, with evidence characterized as "very low to low quality."
The final analysis is that there can't really be a final analysis when it comes to an assessment of aquatic vs land-based exercise for improvement of fibromyalgia symptoms, according to the review. "As so few studies have been done so far, we are very uncertain about the results," authors write.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
"If Greatness Is a Goal," by James Gordon, PT, EdD, FAPTA, is now available to watch on APTA's website.
In his lecture, Gordon called for fewer physical therapy programs. These programs, he said, should consist of faculties committed to a 3-part academic mission of research, education, and clinical practice.
Members can also read Gordon's lecture in the October issue of PTJ, as well as view a NEXT dispatch interview. A PTJ podcast discussion with Gordon, Editor-in-Chief Rebecca Craik, PT, PhD, FAPTA, and other participants will be available in December at PTJ's Podcast Central.
The McMillan Lecture is part of the APTA Honors and Awards program now seeking nominees for recognition in 2015. Visit the Honors and Awards webpage to learn more. Nominations close December 1.]]>
Whether you participated in the "7 Myths" campaign or created your own ways to honor the profession, APTA would like to know. Share your NPTM 2014 celebration images and descriptions by using the #PTmonth hashtag on Twitter, Facebook, and Instagram, or by e-mailing us at firstname.lastname@example.com.]]>
The New York Times reports that CDC officials continue to describe the cases as "extremely rare," and they are not supporting a connection between the polio-like condition and respiratory virus enterovirus 68, although some doctors "suspect a link." The NYT article quotes Mark Pallansch, director of the division of viral diseases at CDC, as saying, "We don't have a single clear hypothesis that's the leading one at this point."
Early reports cited the condition as appearing in 40 states. Since those initial reports, CDC ruled out several cases that do not meet its definitions for inclusion, which require the presence of spinal lesions largely in the gray matter, among other factors.
The condition seems to strike younger children and advances rapidly, becoming most acute within 1-3 days of initial symptoms of weakness. The paralysis varies in severity, and most recovery is made within the first 2 months, with a slowdown in gains as time progresses. A pediatric neurologist quoted in the NYT story describes recovery as "highly variable," saying that "some patients recover very well, others not."
CDC updates case tallies every Thursday, and continues to ask state and local health departments to report cases that meet its criteria for inclusion: sudden-onset acute limb weakness experienced in August or after in a patient 21 or younger, and the presence of a spinal cord lesion largely restricted to gray matter. The agency has also posted a report on its investigation into the cluster of cases in Colorado in August and September.]]>
A clinical commentary authored by Phil Page, PT, PdD, ATC, CSCS, FACSM, is the subject of the new post, which describes Page's efforts to bring attention to so-called "magnitude-based inferences" that rely less on a simple black-or-white analysis of statistical significance, and more on an evaluative process that factors in whether and how that intervention will benefit the patient in a meaningful way.
Along the way, the blog reports, Page also encourages physical therapists to take little for granted and never assume that research is good simply because it appears in a respected journal.
Check out the blog, follow the link to Page's article, and join the conversation.]]>
The workshop, held September 30 through October 1, brought together leaders in health care, academia, and the federal government to talk about the present and future of home health care, with particular emphasis on how data can inform and improve outcomes. Highlights of the workshop were featured in US News & World Report.
The workshop touched on issues that affect the entire home health system, including innovation, the role of social support, silos in postacute care settings, customized technologies, and the creation of a standard definition that combines skilled, unskilled, and caregiver services. Cindy Krafft, PT, COS-C, president of APTA's Home Health Section, participated in the workshop along with APTA staff.
The Alliance for Home Health Quality and Innovation will hold a follow-up symposium on January 13 in Washington, DC. Registration information will be posted on the Future of Home Health website.]]>
In a multicenter, randomized study published in the November issue of Anesthesiology, researchers tracked treatment outcomes for 3 groups of patients with neck pain that radiated through the shoulders and arms. A total of 55 patients received epidural steroid injection (ESI); 59 received pain medication and physical therapy; and 55 had both treatments. The study measured pain scores at outset, and 1, 3, and 6 months after treatments began.
What researchers found was that both the conservative and steroid-only treatment groups improved at the same rate, and that while patients in the combination group reported greater rates of pain reduction, "the difference reached statistical significance only at 3 months." At that measurement point, 56.9% of the combination group reported decreased arm pain, compared with 36.7% of the steroid-only group and 26.8% of the conservative treatment group.
"The main finding is that although the combination group experienced superior results for some outcome measures compared with stand-alone therapies, most differences generally fell shy of statistical significance, including for the primary outcome measure," authors write. "On the basis of these findings and the risks associated with ESI, one might reasonably conclude that ESI should not be a first-line, stand-alone treatment for cervical radiculopathy."
Although authors did acknowledge that the combination group seemed to fare better than the stand-alone groups, they noted that "the effect size was more modest than we anticipated." Still, they offer several explanations for the differences, including the ways the treatments may enhance each other, the potential placebo effect of experiencing all treatments offered in the study, and the possibility that ESI treatments "provide significant short-term pain relief that allows optimal participation in [physical therapy], which provides long-term benefit."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>
The APTA Nominating Committee is seeking candidates for the 2015 slate for the open positions of president, vice president, 3 directors, and a Nominating Committee member. The committee encourages APTA members to fill out an online nomination form (NC1) to identify leaders eager to serve in a national position. Deadline is November 3.
But don't stop there. Once you've submitted your nominations, be sure to reach out to your nominees to encourage them and tell them exactly why you think they have what it takes to help APTA achieve its vision of transforming society.]]>
Take the quick and simple survey by November 3. Just pick the design you think is likely to get you to open up the magazine, and then check out the December/January issue to see which cover was most popular.]]>
There's no admission charge. If you submitted your RSVP, a brown ticket to the event will be included with your conference badge then head over to Buckhead Saloon, 1044 Old World 3rd Street, to hang out, catch up, see, be seen, and get excited about this year's Challenge to benefit physical therapy research. For those who didn't RSVP, additional tickets will be given out onsite to the first 100 students arriving.
Need more incentive? Free drink tickets will be handed out to the first 350 students who arrive. Buckhead Saloon is also offering $2 drink specials throughout the evening.]]>
According to a report released last month (pdf) by the Healthcare Cost and Utilization Project (HCUP), the total rate for ED visits rose 4.5 % from 2006 to 2011, from 40,200 per 100,000 to a 2011 rate of 42,100 per 100,000 population.
The uptick was not consistent across all areas studied, however. HCUP reports that while some of the most common reasons for an ED visit—conditions including abdominal pain, nonspecific chest pain, and nausea and vomiting—continued to rise, the 2 top reasons for visits to the ED—sprains and strains, and superficial injuries and contusions—actually decreased. Visits for sprains and strains dropped by 9% to 1,933 per 100,000 population during the study period; superficial injuries and contusions saw an 11% decrease, to 1,832 per 100,000.
Other findings in the report:
HCUP is a project within the Agency for Healthcare Research and Quality.
Find out more about the integral role of physical therapists in emergency care: check out APTA's webpage devoted to physical therapy practice in EDs.]]>
Longtime contributor Brad Cooper, PT, MSPT, MBA, MTC, ATC, CWC, writes the monthly column, which begins with the November 2014 issue is now posted ahead of print.
This month's timely topic: during the same 8-day period in October that marked the tragic death of an American from the Ebola virus and diagnosis of 2 others, 13,144 Americans died of heart disease and 3,491 of lung cancer. "We can impact these other—far more prevalent—causes of death in both our lives and the lives of those around us," Cooper writes.
Read why in this debut column—and get a quick tip on a specific aspect of wellness that may not be on your radar.
Encouraging healthy, active lifestyles is central to the physical therapy profession's ability to transform society. Keep up with the latest resources at APTA's Prevention and Wellness webpage.]]>
The "Transforming Clinical Practice Initiative" unveiled by the CMS Innovation Center is a 4-year project that aims to "support clinician practice through nationwide, collaborative, and peer-based learning networks that facilitate practice transformation," according to a CMS fact sheet.
Funding will be awarded in 2 general areas: "practice transformation networks" that involve peer-to-peer learning, and "support and alignment networks" that involve learning opportunities created by professional associations, societies, and other organizations.
CMS envisions successful practice transformation network applicants as those that have relationships and share data with multiple clinician practices, and can lead "clinicians and their practices through the transformation process." CMS-funded support and alignment networks will be organizations that generate evidence-based guidelines, promoting measurement, supporting efforts to reduce unnecessary testing and procedures, and "effectively incorporating safety and patient and family engagement," according to CMS.
CMS encourages applicants to submit a letter of intent by November 20, with completed applications due by January 6, 2015. The awards are scheduled to be announced in spring or summer of 2015.]]>
APTA posted a summary of the proposed rule (under the "Patient Protection" header) from OIG. Many of the proposals deal with carving out new "safe harbors" for the anti-kickback statute, and refining—and in some cases, loosening—rules around what activities would be considered illegal remuneration. Some of the proposed changes codify existing statutory provisions of the Affordable Care Act (ACA).
Of particular importance to PTs, according to the APTA summary, are the "safe harbor" proposals, which would permit some forms of free or discounted patient transportation services. Also of note: a proposal to define what is meant by ACA-mandated remuneration exceptions allowing activities that "promote access to care" and have a "low risk of harm."
Comments on the proposed rule are due on December 2. APTA will provide comments to the proposals, and will post those comments in the coming weeks.]]>
November 5 is the deadline for saving on registration fees for CSM, set for February 4–7, 2015. Registering now will ensure you're on track for a 1-of-a-kind event that will feature 300 forward-thinking sessions, multiple social events, and a host of lectures, platforms, and poster presentations.
Start your planning engine: grab an early-bird discount before November 5, take advantage of special rates on housing and travel, then explore the programming coming your way.]]>
The page contains ideas for educating patients and clients, infographics, and downloadable artwork that you can use to help spread the truth about how physical therapy can transform society. You can also do double debunking by referring patients and community members to www.MoveForwardPT.com for consumer-oriented information on the myths.
Think you have another myth about physical therapy that needs a good busting? E-mail it to APTA!]]>
The list was developed by the Physiotherapy Evidence Database (PEDro), an Australia-based project and collaborative partner with PTNow, in celebration of its 15th anniversary. PEDro solicited nominations from PTs for the clinical trials that had the most impact on the field of physical therapy, then turned over those nominations to an expert panel for final selection.
Among other trials that made the list: a 2009 trial on early physical therapy in mechanically ventilated, critically ill patients, a comparison of approaches to tennis elbow from 2006, and results of a trial published in 1999 that looked at management of genuine stress incontinence in women.
For a complete linked list of the trials, check out the PTNow blog—then let PTNow know what you think of the list.]]>
A study published in the October 23 issue of the New England Journal of Medicine (summary available for free) reports on polling data that show a dramatic drop in Americans' confidence in the medical profession between 1966 and 2014. The decline is significant: in 1966, nearly 3 quarters (73%) of Americans expressed "great confidence in the leaders of the medical profession," but that rate is now 34%.
Americans' lukewarm level of confidence in the medical profession in general puts the US near the bottom of 29 countries surveyed from 2011 to 2013, tied for 24th place with Croatia in terms of the percentage of respondents who agreed with the statement, "All things considered, doctors [in your country] can be trusted." A total of 58% of Americans agreed, putting the US behind countries such as the Philippines (#17), Turkey (#5), and Portugal (#16). Switzerland ranked highest in this category, with an 83% rate of agreement. Only Chile, Bulgaria, Russia, and Poland scored lower than the US.
But in a shift that authors describe as "unique among the surveyed countries," Americans tend to rate their satisfaction with their own medical treatment higher than all but 2 other countries, with 56% of American respondents reporting that they were "completely" or "very" satisfied with their last visit to a physician. Switzerland had the highest rate (64%), followed by Denmark (61%). Lithuania (13% rate) and Russia (11% rate) were at the bottom of the list. Authors note that the rate of institutional trust and personal satisfaction tends to be similar in nearly all countries, and that the US is an "outlier."
Authors of the study write that the lack of trust in the medical institution puts doctors at risk of losing political clout as the future of US health care is shaped.
"If the medical profession and its leaders cannot raise the level of public trust," they write, "they're likely to find that many policy decisions affecting patient care will be made by others, without consideration of their perspective."
Authors suggest that public trust could be improved "if the medical profession and its leaders deliberately take visible stands favoring policies that would improve the nation's health and health care, even if doing so might be disadvantageous to some physicians."
Other findings in the study related to Americans' perceptions:
This fall, the DOT launched "Safer People, Safer Streets (.pdf)," an effort to curb a recent uptick in the rate of fatalities among bicyclists and pedestrians, which accounted for 16% of all traffic-related fatalities in 2012.
The initiative will begin with a survey of pedestrian and bicyclists "gaps" across the country—places where safety is compromised by lack of sidewalks or other safety infrastructure. With gaps identified, DOT and its agencies will work with state, local, and private industry partners to help create so-called "road diets" that are more attentive to safe space allocation for pedestrians and bicyclists.
The initiative will also include public education campaigns on safety, according to DOT.
Encouraging healthy, active lifestyles is central to the physical therapy profession's ability to transform society. Keep up with the latest resources at APTA's Prevention, Wellness, and Disease Management webpage.]]>
According to an article in the Guardian, Darek Fidyka is believed to be the first person to recover from a complete severing of the spinal cord, an injury he sustained in a knife attack in 2010.
Polish surgeons accomplished the recovery by transplanting olfactory ensheathing cells (OECs) from Fidyka's nose into the severed ends of his spinal cord. The cells connected and allowed nerve impulses to once again travel through the entire spinal cord. The technique was developed by the University College of London's Institute of Neurology.
Although Fidyka's recovery is not complete, 1 of the authors of a study on the procedure published in Cell Transplantation described the technique as one that "opened the door to a treatment of spinal cord injury which will get patients out of wheelchairs," according to an article in the Washington Post.]]>
The new guidelines focus on better training, more extensive personal protective equipment (PPE), and more rigorous monitoring of donning and doffing. The enhanced recommendations are informed by practices at Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center—facilities that have had success in handling patients with the disease. The CDC reports that the guidelines are similar to those developed by Doctors Without Borders.
A story in Modern Healthcare (free access with one-time registration) quotes CDC Director Thomas Frieden as describing Ebola care as "hard," saying that "the way care is given in this country is riskier than in Africa. There's more hands-on nursing care, and there are more high-risk procedures."
CDC is recommending all of the same PPE included in the August 1, 2014, guidance, with the addition of coveralls, disposable hoods, and full-face shields instead of goggles. Also recommended:
The CDC warns, however, that "focusing only on PPE gives a false sense of security of safe care and worker safety," and urges extensive training and practice, as well as a careful monitoring process as health care workers put on and take off PPE.
Other recent Ebola-related developments:
Members interested in being considered to serve on the committee should complete the application on the ABPTRFE website by November 30, 2014. The Accreditation Services Council will make appointments in December 2014. Notification about appointments will be sent in January 2015.
Appointed members must be available for training at APTA headquarters in Alexandria, Virginia, on March 2, 2015. APTA will reimburse all travel expenses for this meeting.]]>
Stanley Paris can. And he's getting ready to kick that particular part of his qualifications into high gear.
Stanley Paris, PT, PhD, adventurer, has announced that he will make another attempt to set the age and speed record for solo circumnavigation of the globe by sailboat as a way to raise awareness for the Foundation for Physical Therapy (Foundation) and physical therapy research in general. The adventure is set to begin in early November in St Augustine, Florida. Last year's attempt raised more than $250,000 for the Foundation.
Paris made his first attempt to break the age record of 56 years and the speed record of 150 days in early December 2013, but he suffered equipment failure that prevented him from completing the voyage. Since that time, both records have been broken, with the speed record now set at 137 days, and the age record now 70. If he's successful, Paris will beat the new age record by 7 years.
"I am looking forward to taking on this challenge once again and using this opportunity to raise awareness for the Foundation," said Paris in a Foundation news release (pdf). "We need more research that demonstrates the value of physical therapy, and the Foundation is doing just that."
Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, praised Paris's commitment and generosity and said that his efforts are "important in the Foundation's determination to support research that helps physical therapists improve the quality of life."
Paris will once again sail in his 63-foot yacht, the Kiwi Spirit, a craft that will run solely on wind and solar energy. If successful, Paris will also become the first person to circumnavigate in a completely "green" way—or at least the first person to do so in a really, really long time.
Paris will document his journey, post videos, and provide other information on his Facebook page, www.facebook.com/uofstaugsolo. Visit the Foundation's website to find out how to contribute to physical therapy research.]]>
The program, which provides a set of 10-year national objectives, has issued proposed new objectives in the areas of arthritis, osteoporosis, and chronic back conditions; early and middle childhood; heart disease and stroke; maternal, infant, and child health; and tobacco use. The objectives include issues around hypertension, chronic pain, and attention deficit-hyperactivity disorder. Participants may review and comment on the proposed objectives.
APTA is a member of the Healthy People Consortium, and will gather comments from member experts to develop a formal response from the association.
Plan on submitting individual comments? Be sure to identify yourself as a PT sharing your own perspectives to avoid confusion with the official APTA response.]]>
The funding is intended to help address state-identified needs for personnel preparation in special education, early intervention, related services, and regular education to work with children with disabilities. Special attention is being focused on ways to ensure that personnel have the necessary skills and knowledge using scientifically based research and experience.
Some of the "Personnel Development to Improve Services and Results for Children with Disabilities—Personnel Preparation in Special Education, Early Intervention, and Related Services" grants will be awarded to projects associated with preexisting education programs in special education, early intervention, or a related field; however, grants may also be awarded to projects associated with various assistant programs—among them physical therapist assistant programs. Primary focus areas include projects that prepare related services personnel, such as physical therapists (PTs), to serve children, infants, and toddlers with disabilities. OSERS intends to fund 8 awards under this focus area.
Other award areas include projects related to preparation for professions in "related" services that include physical therapy.
For details, requirements, and application instructions, refer to the program posting on the Federal Register (pdf).]]>
The Kaiser report surveyed Medicaid directors in all 50 states and the District of Columbia to gather information on program changes implemented in the 2014 fiscal year or planned for the next year. Authors of the study write that these years "will stand out as a time of significant change and transformation." Among the findings:
While the Kaiser report shows more variation in how states are adjusting provider rates, authors note that generally "more states implemented provider rate increases across most major provider types … inpatient hospital rates being the exception."
"States are expanding their reliance on managed care but also implementing new innovative delivery systems and care coordination arrangements, some of which are new options made available by the ACA," according to the authors. In turn, this expansion could be putting some programs to the test, with most directors "report[ing] staffing and resource constraints in the face of the magnitude of the changes occurring in the program today."
Keep up with Medicaid as it continues to evolve: check out APTA's Medicaid webpage for resources, including a members-only guide titled "Making Sense of Health Care Reform: Medicaid Expansion."]]>
The AMA's Competition in Health Insurance: A Comprehensive Study of US Markets (summary available for free) uses commercial enrollment data from 2012 to create lists of the country's most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.
The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.
The AMA analysis of metropolitan areas found a "significant absence" of competition in 72% of the areas studied, and identified a single insurer as capturing 50% or more of the market share in 41% of the areas.
Overall, Wellpoint Inc was found to be the largest insurer in most markets, with a "commanding position" in more than 20% of metropolitan areas—more than double the number of the next 2 largest insurers, Health Care Services Corporation and UnitedHealth Group.
Carmen Elliott, senior director of payment and practice management at APTA, thinks the shrinking competitiveness contributes to a larger picture of insurers looking to reduce costs and control utilization.
"The lack of competition is a reality," she said. "At the same time, insurers are trying to keep costs down by doing things like narrowing the network of providers covered by the system, increasing copays and deductibles, and implementing utilization management programs. The insurers argue that some of these efforts, like the shift of a greater payment burden to patients, will make consumers more accountable around health care costs and lifestyle choices, but the real challenge is to reduce costs while ensuring high-quality care. That can be a difficult balance."
Keep up with the insurance industry as it continues to evolve. Check out the APTA Private Insurance webpage to find resources including toolkits, videos, podcasts and FAQs on topics ranging from payment methodologies to patient and client advocacy.]]>
Had it been implemented, the final local coverage determination (LCD) would have imposed restrictions for PCDs that would only allow their use after a 6-month period of "chronic and severe" lymphedema, and would have attached other requirements including the presence of lymphedema into the trunk or chest, the use of manual lymphatic drainage prior to PCDs, and the use of medications. Additionally, the new policy would have denied PCDs to patients who experience any kind of improvement through conservative therapy. The requirements were set to become effective on November 1.
In an October 13 statement to the Medicare Durable Equipment Medicare Administrative Contractors (DME MACs) responsible for the change, the Alliance of Wound Care Stakeholders wrote that "many of the new requirements have no basis in either published medical literature or professional standards of practice," and that the proposed LCD "virtually eliminates access to medically necessary equipment for a significant portion of Medicare beneficiaries" who need the devices for treatment of lymphedema and venous ulcers. APTA is a member of the alliance.
The alliance also asserted that the final policy released in October was "significantly different" from the draft policy released in 2011, and that no additional public comment period was provided.
On October 16, the DME MACs announced that the change would be placed on indefinite hold. The brief announcement stated only that "Additional clinical information published since the release of the draft policy is being reviewed."
"This is a significant victory for beneficiaries who need PCDs and the physical therapists who are providing treatment," said Gillian Leene, JD, senior regulatory affairs specialist at APTA. "In the end, the alliance was able to halt a policy that not only lacked support in medical literature, but also would have been damaging to patients and severely restricted access to an effective home treatment option for this progressive and chronic condition."
As part of its "7 Myths About Physical Therapy" campaign, APTA is offering free online ad graphics that you can copy and share on social media channels. It's a fun and cool way to get the word out that physical therapy can change lives in ways that might surprise some people.
Get your graphics today, and let the mythbusting begin.
In a 35-minute video session that covered everything from Senate races to the politics of lame duck sessions, APTA Director of Grassroots and Political Affairs Michael Matlack answered questions about the current political landscape in Washington, and how APTA and its members can continue to influence legislation on issues such as the therapy cap, locum tenens, and direct access.
In addition to insight on politics and the legislative process, the session also provides viewers with an overview of how APTA relies on its members to identify important issues in the profession, and how those issues take root as advocacy through grassroots efforts and the work of PT-PAC, the profession's political action committee.
Want to keep up with where your members of Congress stand on the issues important to the physical therapy profession? Download the free APTA Action App for the latest information and easy ways to make your voice heard. Search "APTA Action" in your Apple or Google Play app store to download the app.]]>
Registration for the event is now open for the Congress, to be held at the Suntec Singapore Convention and Exhibition Centre. APTA is a member of WCPT. For more information, contact Rene Malone.]]>
The inFlow Intraurethral Valve-Pump is a replaceable device consisting of a sterilized single-use urethral insert, an introducer, an activator, and a sizing shaft. According to a news release from the FDA, the device "draws urine out to empty the bladder and blocks urine flow when continence is desired."
Patients with IDC are unable to spontaneously urinate, a condition that can result from stroke, spinal cord injury, diabetic neuropathy, or other neurologic disease or injury. Typically patients with IDC must use some type of catheter, and are unable to experience continence.
The FDA reported that in testing, more than half of the 273 women who used the new device stopped using it because of leakage or discomfort. Or those who continued to use the device, 98% had post-void urine volume similar to those recorded with clean intermittent catheterization (CIC). The FDA reported that though urinary tract infection was the most significant adverse event associated with the new device, rates of infection were lower than those associated with CIC.
After initial sizing and training by a physician, insertion and removal of the device can be performed by the patient or caregiver. Inserted components must be replaced every 29 days.
"The inFlow device allows women with IDC to urinate, without the need to catheterize daily or be attached to a urine drainage bag," said William Maisel, deputy director for science and chief scientist in the FDA's Center for Devices and Radiological Health. "This may allow for increased mobility and the ability to be more self-sufficient."
APTA has provided guidance to the federal Agency for Healthcare Research and Quality (.pdf) in its research efforts around urinary incontinence, and the association offers several resources to members and the public, including the APTA Section on Women's Health and the PT's Guide to Incontinence. PTs looking for evidence-based research on UI treatment can find resources at PTNow.]]>
In the Strengthening and Stretching for Rheumatoid Arthritis of the Hand study (SARAH), 438 participants representing "the population of people with rheumatoid arthritis in the UK in terms of age and sex" were divided into 2 groups, 1 receiving usual care and the other receiving usual care plus special strengthening and stretching exercises overseen by a physiotherapist or occupational therapist. More than 90% of participants in both groups had been placed on a stable regimen of disease modifying drugs (DMARDs) for at least 3 months before the study, and all continued to take the drugs.
Results of the study were e-published ahead of print in the October 10 issue of The Lancet. Currently only the study's abstract is available for free; however, APTA members will have access to the full article in 2 months via PTNow ArticleSearch. More detailed data on the trial have been posted online.
Researchers administered the Michigan Hand Outcome Questionnaire (MHQ) at 4 and 12 months after a 20-day baseline to both groups, and found that the exercise group's reported level of improvement was "more than double" the usual care group's ratings. The usual-care group's ratings on the 1-100 MHQ scale averaged 3.56 after 12 months, compared with the exercise group's 7.93 average.
Other indicators were equally significant. "Changes in secondary outcomes mirrored these trends," authors write, "with significant differences in … activities of daily living, work, and satisfaction subscales, MHQ summed score, and self-efficacy." Global ratings of change in the exercise group improved for 45% of the participants, compared with 21% reporting improved ratings in the usual-care group.
The 12-week exercise program included 7 mobility exercises and 4 strength training or endurance exercises using bands, balls, or putty, and was tailored to the individual after assessment for baseline strength, pain, and flexibility. Physiotherapists or occupational therapists conducted 6 sessions with each participant, and participants were instructed to perform the exercises daily.
The mean cost per participant for the exercise therapy was approximately $165 higher than usual care; however, authors noted that "the costs of the intervention were small compared with the annual cost of providing drug regimens." Authors speculate that they may have actually underestimated cost-effectiveness "because the analysis was limited to a time horizon of 1 year."
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.]]>