APTA recently developed additional general information for members who may act in the capacity of a fact or expert witness. Reviewing the witness resources may assist in being better prepared when faced with receiving a subpoena or a request to act as a witness. Myriad legal issues come into play and the resources serve to provide information on topics such as qualifications of an expert, compensation, and discovery. APTA also provides a general information page to house existing materials that address a variety of legal matters, such as contracts, informed consent, and advertising. 

The expert/fact witness resources were developed in response to RC 22-12, a motion passed by the House of Delegates in June. 

Authors of a comparative effectiveness review issued by the Agency for Healthcare Research and Quality conclude that hyperventilation reduction techniques "may be a useful tool in the larger asthma management toolbox, which also includes medication and other components as needed, such as environmental controls, symptom monitoring, and a plan for handling exacerbations." However, given that none of the studies included in the review were conducted in the United States, available evidence is limited in its strength and applicability to the US population, they add.     

The authors searched MEDLINE; PsycInfo; Embase; Cumulative Index to Nursing and Allied Health Literature; Physiotherapy Evidence Database; Cochrane Central Register of Controlled Trials; AltHealthWatch; Allied and Complementary Medicine; Manual, Alternative and Natural Therapy Index System; and Indian Medical Journals from 1990 through December 2011. They supplemented searches with manual searching of reference lists and grey literature, including regulatory documents, conference abstracts, clinical trial registries, and websites of professional organizations.

APTA member Anne Swisher, PT, PhD, CCS, served on the technical expert panel that provided input on the analytic framework, key questions, and review protocol. Two independent reviewers screened identified abstracts against predefined inclusion/exclusion criteria. Two investigators reviewed full-text articles and independently quality-rated those meeting inclusion criteria. Data from fair- and good-quality trials were abstracted into standardized forms and checked by another investigator. The authors summarized data qualitatively and, where possible, used random effects meta-analysis.

The authors identified 4 types of interventions—hyperventilation reduction breathing techniques, yoga breathing techniques, inspiratory muscle training (IMT), and other nonhyperventilation reduction breathing techniques, which included physical therapy methods. They found the most robust body of evidence for hyperventilation reduction breathing techniques in adults, including the only large-scale trial (n=600, aged 14 and older). Hyperventilation reduction interventions (particularly those with 5 hours or more of patient contact) achieved medium to large improvements in asthma symptoms and reductions in reliever medication use of approximately 1.5 to 2.5 puffs per day, but did not improve pulmonary function. These trials also were more applicable, although still somewhat limited, to the United States than trials examining other interventions due to similarities in applicable treatment guidelines to US guidelines and similar levels of development in the countries in which these studies were conducted.

Limited evidence suggested yoga breathing may improve pulmonary function in adults in addition to reducing asthma symptoms, but medication use was rarely reported and applicability to the United States was very low. Evidence for IMT and other breathing retraining techniques was limited to small, heterogeneous trials providing insufficient evidence to determine effectiveness. The only harms of breathing retraining techniques identified were minor annoyances associated with taping the participants' mouths. Almost all trials were limited entirely or primarily to adults.

The authors include recommendations for future trials for hyperventilation reduction and other techniques in their review. 

For the first time in the last 10 years, the rate of private health insurance coverage has not decreased, according to a report released today by the US Census Bureau.

The percentage of people covered by private health insurance in 2011 was not statistically different from 2010, at 63.9%. The percentage covered by employment-based health insurance in 2011 was not statistically different from 2010, at 55.1%.

The number of people with health insurance increased to 260.2 million in 2011 from 256.6 million in 2010, as did the percentage of people with health insurance (84.3% in 2011, 83.7 % in 2010).

The percentage of people covered by government health insurance increased from 31.2% to 32.2%. The percentage covered by Medicaid increased from 15.8% in 2010 to 16.5% in 2011. The percentage covered by Medicare also rose over the period, from 14.6 % to 15.2%.

In 2011, 9.7% of children under 19 (7.6 million) were without health insurance. Neither estimate is significantly different from the corresponding 2010 estimate. The uninsured rate for children in poverty (13.8%) was higher than the rate for all children (9.4%).

The uninsured rate remained statistically unchanged for people aged 26 to 34 and 45 to 64. It declined, however, for those aged 19 to 25, 35 to 44, and 65 and older.

In 2011, the uninsured rates decreased as household income increased from 25.4 % for those in households with annual income less than $25,000 to 7.8% in households with income of $75,000 or more.

The findings are available in Income, Poverty, and Health Insurance Coverage in the United States: 2011. The results were compiled from information collected in the 2012 Current Population Survey Annual Social and Economic Supplement.

Osteoarthritis (OA) should be considered—and treated—in a more multidisciplinary, coordinated, and prevention‐oriented way, similar to other chronic diseases, says a call to action recently issued by the Chronic Osteoarthritis Management Initiative (COAMI), a program of the United States Bone and Joint Initiative (USBJI).   

The COAMI work group met in May to assess current practice in the management of osteoarthritis. Work group members included physical therapists; orthopedic nurses and surgeons; specialists in rheumatology, rehabilitation, and sports medicine; osteopathic physicians; and athletic trainers.

Changing the paradigm of intervention for OA, especially among health care providers, was a primary focus of the meeting. OA should be "subject to screening for risk factors, prevention‐oriented interventions, ongoing monitoring, and comprehensive care models typical of other chronic diseases. Instead, many patients and health care providers tolerate and expect pain and disability as an inevitable trajectory of OA and aging," says COAMI.

In addition, the work group identified 7 priority actions to undertake, with the help of partners in other organizations who share COAMI's goals for improved patient outcomes.

The priority actions are:

• developing a call to action geared specifically to health care professionals who treat patients with OA, as well as policymakers and the public;
• convening a larger conference that leads to further recommendations that would build agreement across disciplines and specialties within the health care system, so that current inconsistencies in approach could be resolved, and models of care developed;
• reaching out to other partners beyond the Work Group members (both existing and new) to include them in future COAMI work;
• exploring standardized screening tools and indicators of OA to make early diagnosis both more consistent and more likely;
• developing tools and prompts that promote patient engagement in learning about and managing OA (especially before symptoms become debilitating);
• lending COAMI's support to existing advocacy and awareness efforts that are already underway; and
• developing and supporting an OA-specific research agenda that would fill gaps in evidence and practice.

APTA is a founding member of the USBJI and serves on its board of directors.  

The annual cost of chronic pain is as high as $635 billion a year, which is more than the yearly costs for cancer, heart disease, and diabetes, say health economists from Johns Hopkins University in this month's The Journal of Pain.

The researchers estimated the annual economic costs of chronic pain in the United States by assessing incremental costs of health care due to pain and the indirect costs of pain from lower productivity. They compared the costs of health care for people with chronic pain with those who do not report chronic pain. The authors defined people with pain as those who have pain that limits their ability to work, are diagnosed with joint pain or arthritis, or have a disability that limits capacity for work.

Data from the 2008 Medical Expenditure Panel Survey was used to gauge the economic burden of pain. The sample included 20,214 individuals 18 and older to represent 210.7 million US adults.

Results showed that mean health care expenditures for adults were $4,475. Prevalence estimates for pain conditions were 10% for moderate pain, 11% for severe pain, 33% for joint pain, 25% for arthritis, and 12% for functional disability. Persons with moderate pain had health care expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Similar differences were found for other pain conditions: $4,048 higher for joint pain, $5,838 for arthritis, and $9,680 for functional disabilities.

Also, adults with pain reported missing more days from work than people without pain. Pain negatively impacted 3 components of productivity—work days missed, number of annual hours worked, and hourly wages.

Based on their analysis of the data, the authors determined that that the total cost for pain in the United States ranged from $560 to $635 billion. Total incremental costs of health care due to pain ranged from $261 to $300 billion, and the value of lost productivity ranged from $299 to $334 billion. Compared with other major disease conditions, the per-person cost of pain is lower but the total cost is higher.

The authors noted their conclusions are conservative because the analysis did not consider the costs of pain for institutionalized and noncivilian populations, for persons under 18, and for caregivers.