Physical activity is an important but underused intervention for adults with arthritis, says a report released yesterday by the Arthritis Foundation at a Capitol Hill briefing cosponsored by APTA. Physical activity, the report contends, decreases pain; delays the onset of disability; improves physical functioning, mood and independence; and enhances quality of life, aerobic capacity, and muscle strength.
Reps Anna Eshoo (D-CA) Sue Myrick (R-NC), cochairs of the Congressional Arthritis Caucus, also sponsored the briefing. Myrick attended the briefing, which included speakers Jack Klippel, MD, president and CEO of the Arthritis Foundation; Wayne Giles, MD, MS, director of the Division of Population Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention; Mary Wu, who told her story from a patient perspective; and Zarnaaz Bashir, MPH, director of Strategic Health Initiatives, National Recreation and Parks Association.
Despite the documented benefits of physical activity, adults with arthritis have higher rates of physical inactivity than those without arthritis. Furthermore, the highest rates of physical inactivity are among adults with arthritis and heart disease, arthritis and diabetes, and arthritis and obesity, when compared with adults with none of these conditions. The new APTA-sponsored report, titled Environmental and Policy Strategies to Increase Physical Activity Among Adults With Arthritis, aims to motivate health agencies, business, recreational facilities, and others as partners in providing physical activity opportunities that meet the needs of people with arthritis.
The report also answers the call of the National Public Health Agenda for Osteoarthritis and the Institute of Medicine's recent report Living Well with Chronic Illness: A Call for Public Action. It outlines an initiative that calls on the nation to address barriers and promote physical activity in a way that is safe, accessible, convenient, and inclusive of adults with arthritis in 6 key sectors—park, recreation, fitness, and sports; business and industry; community and public health; health care; transportation, land use, and community design; and mass media.
Walking speed is a feasible measure for patients admitted to an acute care hospital, illustrating that patients walk slowly relative to community requirements but that their speed improves even over a short course of therapy, say authors of an article published online in Journal of Geriatric Physical Therapy.
This observational cross-sectional study included 46 hospital inpatients (mean age 75 years (SD = 7.8) who were referred to physical therapy and able to walk at least 20 feet. Researchers obtained information regarding diagnosis, comorbidities, physical assistance, device use, body height, and weight for each participant. Speed was determined during initial and final physical therapy visits while patients walked at their self-selected speed over a marked course in a hospital corridor.
Therapists reported that measuring walking speed was clinically feasible, requiring inexpensive, available resources, 4 minutes' additional time, and simple calculations for documentation. Initial walking speed was a mean of 0.33 m/s (SD = 0.21), whereas final speed was 0.37 m/s (SD = 0.20). The Wilcoxon test showed the increase in walking speed (0.04 m/s) to be significant over a mean therapy period of 2.0 days (SD = 1.4) and total hospitalization period of 5.5 days (SD = 3.6). The effect size and standardized response mean were 0.19 and 0.36, respectively. Minimal detectable change was 0.18 m/s.
APTA member Heather J. Braden, PT, MPT, PhD, GCS, is lead author of the article. APTA members Richard Bohannon, PT, DPT, EdD, NCS, FAPTA, and Scott Hasson, PT, EdD, FACSM, FAPTA, are coauthors.
A new podcast featuring Jane Sullivan, PT, DHS, associate professor and assistant department chair in the Department of Physical Therapy and Human Movement Science at Northwestern University, outlines the process a Neurology Section-appointed task force used in developing preferred outcome measures for patients with stroke.
Widespread use of standardized outcome measures is "lacking," says Sullivan, who describes the task force's charges, the framework chosen to assess the outcome measures, and how the task force determined which outcome measures to review. She also illustrates the objectives achieved in the recommendations generated by the StrokEDGE group.
A transcript accompanies the prerecorded podcast. A list of the task force members and the recommended outcome measures are available on the Neurology Section's website.
Beginning June 1, the Centers for Medicare and Medicaid Services (CMS) will accept suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rulemaking years.
Documentation for each measure submitted must be received by 5 pm ET August 1.
Required documentation includes the Measure Submitted for Consideration Form, measure specifications (measure title, description, numerator, and denominator, including exclusions, exceptions, and inclusions), and electronic specification and data tables for electronic health record-specified candidate measures.
Suggesting individual measures or measures for a new or existing measures group does not guarantee that the measure(s) will be included in the proposed or final sets of measures of any proposed or final rules that address PQRS. CMS will determine what individual measures and measures group(s) to include in the proposed set of quality measures. After a period of public comment, the agency will make the final determination with regard to the final set of quality measures for PQRS.
To learn more about the PQRS Call for Measures, visit CMS' Measures Management System webpage, or contact Heather Smith at APTA with questions.
Patients' control of blood pressure improved when their care was provided by a team of health care professionals—a primary care provider supported by a pharmacist, nurse, dietitian, social worker, or community health worker—rather than by a single physician, says the Community Preventive Services Task Force following a review of 77 studies on team-based care. The task force is an independent, nonfederal, uncompensated body of public health and prevention experts, whose members are appointed by the Centers for Disease Control and Prevention.
The collection of studies showed that team-based care helped increase the proportion of patients with controlled blood pressure, led to a decrease in both systolic and diastolic blood pressure, and improved outcomes in patients who had diabetes and elevated blood lipids.
Team members supplemented the activities of the primary care provider by providing support and sharing responsibility for hypertension care. Support and responsibility included medication management, patient follow-up, and helping the patient adhere to his or her blood pressure control plan, including monitoring blood pressure routinely, taking medications as prescribed, reducing sodium in the diet, and increasing physical activity, says the task force.
Team-based care is a central pillar of the Million Hearts initiative, launched by the Department of Health and Human Services in September 2011. Million Hearts is a national, public-private initiative to prevent 1 million heart attacks and strokes over 5 years. The initiative is aligned with the Healthy People 2020 goal to reduce the number of people in the US with high blood pressure. Blood pressure control is 1 of 4 health behaviors targeted by the initiative—the others are aspirin as appropriate, cholesterol management, and smoking cessation.
Many opportunities and challenges are on the horizon for physical therapists as organizations attempt to eliminate health care silos and integrate patient care. In an effort to prepare physical therapists for health care integration, APTA has produced a video series that highlights innovative clinical practice models and the roles that physical therapists can play in today's health care environment. The videos and accompanying handouts can help physical therapists gain insight and inspiration as they look for ways to become involved in new models of care delivery.