A new addition to APTA's Innovations in Practice video series highlights how a frequency-and-duration program has changed practice for some 80 therapists in the Children's Hospital of Philadelphia rehabilitation division. The program aims to ensure that the therapists' services are being used optimally, not only in mindfulness of insurance resources that may need to be spread among different health care providers but also to give the best possible care to their young patients. The program has focused on establishing guidelines for frequency and duration of visits for different levels of intensity of services; setting realistic goals for each patient based on the guidelines; and moving each patient and his or her parents, as appropriate and with monitoring as needed, toward self-care, independent from hospital visits. Hear Kim Nixon-Cave, PT, PhD, PCS, explain how the program was created and implemented, and check out the handout that illustrates this innovative model of care.
Slower walking speed may be a marker for incident knee osteoarthritis (OA), say authors of an article published online last month in Arthritis Care & Research.
For this study, 1,858 noninstitutionalized residents age 45 years or older who lived at least 1 year in 1 of 6 townships in Johnston County, North Carolina, completed questionnaires and clinical examinations at baseline and at follow-up testing. Walking time was assessed using a manual stopwatch in 2 trials over an 8-foot distance. Walking speed was calculated as the average of both trials. For the hip and knee, researchers examined 3 outcomes per joint site—radiographic OA (weight-bearing anteroposterior knee radiographs, supine anteroposterior pelvic radiographs of the hip), chronic joint symptom, and symptomatic OA. Covariates included age, gender, race, education, marital status, body mass index, number of prescriptions, depressive symptoms, self-rated health, number of lower-body functional limitations, smoking, physical activity, and number of self-reported, health care provider-diagnosed chronic conditions.
Faster walking speed was consistently associated with lower incidence of radiographic (adjusted odds ratio [aOR]=0.88) and symptomatic knee OA (aOR=0.84). Slower walking speed was associated with greater incidence of these outcomes across a broad range of different clinical and radiographic OA outcomes.
APTA member Jama L. Purser, PT, PhD, is lead author of the study. APTA member Yvonne M. Golightly PT, PhD, is coauthor.
APTA has posted a summary of the recent National Coverage Analysis Proposed Decision Memo from the Centers for Medicare and Medicaid Services (CMS) regarding transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP). For patients meeting the specified definition of CLBP in the memo, CMS proposes coverage only when those patients are enrolled in a clinical study. The clinical study must address whether TENS provides a clinically meaningful reduction in pain, improvement in function, or reduction in other treatments or services. In addition, the study must adhere to specified standards of scientific integrity and relevance to the Medicare population.
CMS will accept public comment on this proposed decision memo through April 12. APTA will submit comments on behalf of membership.
The summary is available to APTA members on the Medicare Coverage Issues webpage under the "TENS" heading.
The articles in this month's PTJ demonstrate documentation of effectiveness of current physical therapy interventions, proposed novel interventions, and the application of knowledge to different patient populations. As you listen to this month's Craikcast, keep in mind that—as illustrated in the article by Wiles, Matricciani, Williams, and Olds—in 1945, the typical paper in PTJ was anecdotal, authored by 1.4 US authors who worked in hospitals, and consisted of 4 pages and 4 references. In 2010, the typical paper used a cross-sectional survey or randomized controlled trial design, with 4.6 authors working in universities across the globe, and consisted of 12 pages and 49 references.