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PREVIEW 2020
Answering Today's Clinical Questions
Exploring Tomorrow's business Opportunities
By Michelle Vanderhoff
PREVIEW 2020, held in Las Vegas November 18-20, provided six
different clinical practice tracks to help physical therapists (PTs) and
physical therapist assistants (PTAs) gain the knowledge they need to
practice today and in the future. The November conference, the third
annual such program, delivered in-depth education programs necessary for
clinicians to run successful practices and prepare for the patients and
clients they'll manage in the decades to come.
In addition to the six clinical tracks--cervical spine disorders,
differential diagnosis, exercise for the complex medical patient,
management of obesity, Parkinson disease, and pharmacology for the adult
and geriatric patient--a seventh track addressed business management.
Each day's program also featured a plenary session.
Presented below are highlights from a few of the sessions.
Friday
Opening Welcome
In her opening remarks Friday morning, APTA Vice President Joan A
Bohmert, PT, MS, encouraged attendees to "plan for the future" of
physical therapy, to "share their stories," and to advocate for their
profession. She emphasized the importance of evidence-based practice,
stating "it was time" for more physical therapists to begin submitting
to Hooked on Evidence. She urged participants to join or develop Hooked
research groups in their home states. Added Bohmert, "We will probably
reach Vision 2020 before 2020."
Ken J Harwood, PT, PhD, CIE, continued the opening session,
"Evidence-Based Practice: Bringing It All Together." He explained how
evidence-based practice has wound its way into policy and regulations as
payers rely on published research with growing frequency when making
reimbursement decisions.
In addition, he said, clinically relevant research has become the
standard of care for health care practitioners across the board. Harwood
challenged attendees to "constantly ask yourself whether your
interventions are effective and cost-efficient." Harwood cited the
Interactive Guide to Physical Therapist Practice with the Catalog of
Tests and Measures, Hooked on Evidence, OPTIMAL, and CONNECT as
invaluable resources and tools for PTs.
Cervical Radiculopathy
Maj John D Childs, PT, PhD, OCS, delivered a session on the current
research on cervical radiculopathy and how it informs management of
patients with the disorder. He addressed the potential for
"overmedicalization" of back and neck pain [related to imaging]. Delitto
also discussed classification and its "goal of standardizing treatment"
as opposed to the medical diagnosis model. He also identified and
explained the appropriate tests and measures used to effectively
diagnose cervical radiculopathy and carpal tunnel, which also can cause
back pain.
Participants became actively involved in the session when Childs took
questions about diagnosis, research findings, and other topics related
to providing effective interventions to patients.
Screening for Medical Referral: Gastrointestinal and Urogenital
Systems
On Friday afternoon, Mary Bailey-Long, PT, DPT, MS, OCS, CHT, reviewed
common gastroinstestinal/urogenital disorders that may mimic
musculoskeletal conditions. She discussed the elements of a physical
assessment and tests for the abdomen. Bailey-Long also addressed
precautions PTs should take when managing a patient with a specific GI
or UG disorder.
Participants learned about the need for appropriate systems review
and follow-up questions. Bailey-Long instructed attendees to look for
specific symptoms that may indicate a GI or UG condition and referral of
the patient to another provider.
Practical Assessment of Excess Weight and Body Composition in
Health and Wellness
Reed Humphrey, PT, PhD, explored standard approaches to assessing
overweight and body composition. He examined the practical implications
of various techniques in applying them to clinical practice.
Physical Therapist Management: Deep Vein Thrombosis
In a lively, interactive session on deep vein thrombosis (DVT), Charles
D Ciccone, PT, PhD, and Steven H Tepper, PT, PhD, updated participants
on differential diagnosis, medical and pharmacologic management, and the
role of exercise for patients with DVT. In the first part of the
session, Tepper introduced evidence-based management of DVT. He also
reviewed the elements involved in normal blood-clotting vs DVT and
discussed risk factors and causes, as well as signs, symptoms, and
treatment.
In the second half of the presentation, Ciccone examined new research
and appropriate treatment with low molecular weight heparins. He also
addressed the risks and benefits of using other treatments, such as IVC
filters, to help prevent DVT from becoming an embolism.
Saturday
Pathfinding in a Doctoring Profession: What Does It Mean for
You?
In Saturday morning's plenary session, Janet Bezner, PT, PhD, explored
the elements necessary for the doctor of physical therapy (DPT) to
"equal a doctoring profession." These included formal professional
development, a "consistent, systematic approach" to providing physical
therapy, and others. Like many other presenters, Bezner stressed the
importance of evidence-based practice.
After examining the importance of self-assessment and the process of
goal-setting to self-empowerment to achieve a DPT or transitional DPT,
Bezner asked participants to fill out a self-assessment questionnaire,
set professional goals for themselves, and then discuss those goals with
fellow participants. She encouraged attendees to consider the question:
"The sacrifices I would have to make in order to get a DPT--are they
worth it?"
Bezner identified one key to success: To change one's paradigm and
expose oneself to new information. It also is useful, she offered, to
have a mentor to provide advice and alternate viewpoints. Bezner
encouraged successful PTs to mentor others, and reminded all
participants of the career-planning tools and resources on the APTA Web
site (such as "Find-a-PT"), in PT Magazine, at APTA events, and
more.
CPT Coding 2005-2006: Meeting the Needs of the Clinician and
the Administrator
Helene M Fearon, PT, reviewed the status of the therapy cap legislation
and potential congressional action related to the cap and the Medicare
physician fee schedule conversion factor. She also described APTA
principles for "pay for performance" and highlighted ongoing APTA
initiatives regarding reimbursement, such as CONNECT and advocacy for
direct access.
In addition, Fearon addressed areas of compliance, audits, and fraud
and abuse, and reminded attendees of APTA's many resources for
facilitating compliance with payers, including the Guide to Physical
Therapist Practice, the Code of Ethics, the Standards of Practice, the
Guide for Professional Conduct, and Vision 2020.
Pharmacology: Medications for Hyperlipidemia and Diabetes
Mellitus
Peter Panus, PT, PhD, explained the use of lipid-lowering medications
and insulin and hypoglycemic medications for diabetes mellitus. After
describing the metabolic processes involved in hyperlipidemia and
diabetes, Panus explored the effects of hyperlipidemia and
differentiated between type 1 and type 2 diabetes and their respective
signs and symptoms. This led to a discussion about the use of statins
and other lipid-lowering pharmaceuticals, as well as oral and injectable
antidiabetics.
Panus also examined ways to apply this knowledge to clinical
situations for nonpharmaceutic interventions, such as exercise
programs.
Screening for Medical Referral
As a follow-up to Friday's "Screening for Medical Referral:
Gastrointestinal and Urogenital Systems" and Saturday morning's
"Screening for Medical Referral: Cardiovascular and Pulmonary Systems,"
LeeAnne Carrothers, PT, PhD, and Mary Bailey-Long, PT, DPT, MS, OCS,
CHT, demonstrated screening techniques and special tests for GI, UG,
pulmonary, and cardiac systems. The presenters covered various visual
signs of illness, such as posture, skin color, observable stress,
wheezing, clubbing of fingers, and others.
Urging attendees to watch out for signs of respiratory distress in
patients, Bailey-Long and Carrothers played recordings of common
respiratory sounds, such as wheezing and rattling, and cardiovascular
sounds such as heart murmurs. Participants practiced palpation,
auscultation, and percussion techniques.
Parkinson Disease
In a well-attended symposium, Terry Ellis, PT, MSPT, NCS, and Margaret
Schenkman, PT, PhD, examined the most recent research on specific
components of a rehabilitation program for individuals with Parkinson
disease. The presenters introduced conceptual frameworks for the
management of these patients. Ellis emphasized the benefits of inpatient
rehab to maximize patient outcomes.
The session included several videotaped case studies demonstrating
the use of certain interventions with patients. Attendees asked many
questions about the use of assistive devices, length of stay, and other
related topics.
On Sunday, using several video clips of case studies of individuals
with Parkinson disease, Ellis and Schenkman explored the practical
application of various tests and measures. "You want to be well-versed
in a variety of tests" so you can narrow down the choice of tests for a
specific patient, said Ellis. Schenkman said, she would choose the test
depending on where the patient would be in 5 years. The two speakers
gave recommendations on appropriate interventions for specific case
studies.
Sunday
The Entrepreneurial Physical Therapist
In Sunday's plenary session, APTA Board Member Connie Hauser, PT, DPT,
ATC, delivered remarks on the subject of the PT as entrepreneur. Hauser
shared her personal experience in becoming "business savvy" and
fine-tuning her business skills in her practice. Citing courage,
persistence, and grace under pressure as some of the main ingredients
for success, she urged attendees to "know your customer," "know your
product better than anyone else," and "have a burning desire to
succeed."
In addition to providing an overview of the nuts and bolts of
starting a private practice, including budgeting, scheduling, and
planning, Hauser described effective marketing strategies. She
emphasized the value of political activism and networking to a
profitable practice. However, she offered: "The bottom line is customer
service."
__________________
Michelle Vanderhoff is editor and project manager in APTA's
publications department.
PT Magazine - March 2006
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