Results of a study that investigated the comparative effectiveness of early use of thrust manipulation (TM) and nonthrust manipulation (NTM) in patients with mechanical low back pain (LBP) suggest that there is no difference between early use of TM or NTM, and, secondarily, that personal equipoise affects study outcome. Intra-group changes were significant for both groups, say authors and APTA members Chad Cook, PT, PhD, MBA, FAAOMPT, Kenneth Learman, PT, PhD, OCS, COMT, Christopher Showalter, PT, OCS, FAAOMPT, Vincent Kabbaz, PT, and Bryan O'Halloran, PT, OCS, SCS.

For this trial, patients aged 18 and older with mechanically reproducible LBP were randomized into 2 treatment groups. The main outcome measures were the Oswestry Disability Index (ODI) and a Numeric Pain Rating Scale, with secondary measures of rate of recovery, total visits and days in care, and the work subscale of the Fears Avoidance Beliefs Questionnaire work subscale.

A total of 149 subjects completed the trial and received care over an average of 35 days. There were no significant differences between TM and NTM at the second visit follow-up or at discharge with any of the outcomes categories. Personal equipoise was significantly associated with ODI and pain.

The deadline to submit nominations to participate in APTA's Innovation Summit 2013: Collaborative Care Models is October 22.

The Summit will bring together innovators and thought leaders from physical therapy, health policy, payment, and other health professions to explore the role of physical therapists in new models of health care delivery and payment. Participation in the Summit will be available to all members through live web streaming. Attendance onsite will be limited to speakers, panelists, and invited attendees, including the member innovators selected through this nomination process. 

APTA sections, chapters, and the Student Assembly are each invited to nominate a member who is involved in an innovative model of care to attend the March 7-8, 2013, onsite meeting in Alexandria, Virginia. A panel of member experts will select 20 member innovators to share their innovative practice models as a part of the Summit. Those selected will receive free registration and a stipend for travel and lodging expenses. Chapters and sections whose nominees are selected will receive special recognition during the Summit. 

Members involved in innovative models of care or payment may want to contact their chapter or section directly to ask to be nominated to attend the Summit. 

Information and nomination materials are available at this link. Components may direct questions about the nomination process to innovationsummit2013@apta.org.   

It's your last chance to weigh in on the topics to be covered in the final House proposal town hall scheduled for Tuesday, October 23, 9:00 pm-10:30 pm, ET. What would you like to discuss? What topic have we missed? Let us know. Suggest ideas via the Additional Thoughts comment blog posted to www.apta.org/governancereview. Contact Amber Neil if you are interested in attending. Can't join a town hall? Have your voice heard via the comment blogs on the following topics: House constituency, House activity, and Resolutions Committee.

"Communicating With Older Adults: An Evidence-Based Review of What Really Works," the latest report from The Gerontological Society of America, provides 40 pages of recommended guidelines for health care providers interacting with the fastest-growing age segment of America's population.

The report provides 29 specific recommendations in 4 categories: general tips for improving interactions with older adults, general tips for improving face-to-face communication with older adults, tips for optimizing interactions between health care professionals and older patients, and tips for communicating with older adults with dementia.

Among the specific steps outlined in the report, providers are encouraged to avoid speech that might be seen as patronizing to an older person, verify listener comprehension during a conversation, and pay close attention to sentence structure when conveying critical information.

The recommendations were contributed by experts in the fields of gerontology and communications. Each is accompanied by a brief explanation of the rationale, tips for implementing the recommendation in busy health care settings, and selected references for further reading. The objective is to encourage behaviors that consider the unique abilities and challenges of older adult patients and produce positive, effective interactions among everyone involved. 

Encourage your Spanish-speaking patients to visit Ejercicioy estado físico, a comprehensive web resource from MedlinePlus that offers tips on becoming and staying active based on the Department of Health and Human Services' 2008 Physical Activity Guidelines for Americans, the latest news on the benefits of physical activity, and information on exercise-specific topics—such as strength training, aerobics, and interval training. Users can find links to a heart rate calculator, food tracker, and calories-burned calculator. Tutorials and videos, information tailored to women, and patient handouts also are available.    

The role of family caregivers has dramatically expanded to include performing medical/nursing tasks once only provided in hospitals, says a new report by the AARP Public Policy Institute and the United Hospital Fund. The report is based on a nationally representative population-based online survey of 1,677 family caregivers to determine what medical/nursing tasks they perform.

Almost half (46%) of caregivers performed medical/nursing tasks for family members with multiple chronic physical and cognitive conditions. Three out of 4 (78%) family caregivers who provided medical/nursing tasks were managing medications, including administering intravenous fluids and injections. Caregivers reported finding wound care very challenging; more than a third (38%) wanted more training.

The report reveals the complexity and difficulty of specific tasks, the lack of support and training family caregivers receive, and the effect on their quality of life. It makes 10 recommendations, including:

• revisiting measures used to define what caregivers do
• strengthening oversight of how effectively institutions meet family caregiver needs and requiring corrective steps to address deficiencies
• conducting further studies to understand medical/nursing tasks performed by different types of family caregivers and their needs for training and support

"No single profession or health care provider is solely responsible for ensuring that family caregivers who take on these daunting responsibilities are trained and supported," the authors write. "This effort requires the coordinated efforts of all sectors—hospitals, home care agencies, community agencies, nursing homes, hospices, and physician and other clinician practices—and a level of teamwork that challenges attitudes and behaviors so firmly entrenched in the current system."

The Centers for Medicare and Medicaid Services (CMS) will hold a special open door forum (ODF) on October 22, 2:00 pm-3:30 pm ET, to allow providers to ask questions about the manual medical review of therapy services that exceed $3,700. 

During this special ODF (conference call only), CMS will discuss therapy documentation requirements and answer any questions providers may have. CMS requests that providers who order or provide therapy services nationally participate in the call. The therapy cap applies to all Part B outpatient therapy settings and providers in:

• private practices
•  Part B skilled nursing facilities
•  home health agencies hospital
• outpatient departments rehabilitation agencies (outpatient rehabilitation facilities)
• comprehensive outpatient rehabilitation facilities

Participants may submit questions prior to the special ODF to therapycapreview@cms.hhs.gov. To participate, call 866/ 501-5502 and enter conference ID 44803009.

APTA's newest publication, Adult Fitness Examination: A Physical Therapy Approach, brings together a series of tests and measures that enables physical therapists to build lifelong health and wellness plans with their asymptomatic adult clients.

Written by APTA member Dan Millrood, PT, MEd, and Charlotte Chua, PT, DPT, this groundbreaking assessment tool contains the ready-to-use instructions and resources PTs need to identify, quantify, and qualify key components of physical health and wellness.

For educators, it's a textbook that addresses educational objectives related toprevention, health promotion, fitness, and wellness.

Adult Fitness Examination includes:

• preparticipation health screening overview
• 16 ready-to-use examinations, complete with step-by-step instructions and full color photos; normative data, charts, flowcharts, illustrations; and notes and warnings (when to terminate testing)
• equipment supply checklist
• clinician workbook to promote easy, accurate record-keeping
• client take-home form to help clients follow treatment plans, track results, and stay motivated to achieve health and fitness goals

Order Adult Fitness Examination (AFE-001, $34.99 for APTA members) from APTA's online bookstore.

Diabetic foot ulceration (DFU) is associated with a nearly 2-fold increased risk for all-cause mortality above that of diabetes alone, says a Medscape Medical News article based on a meta-analysis published in Diabetologia.   

The authors included 8 studies in their analysis. The studies were published between 1996 and 2011 and reported on a total 17,830 patients with 81,116 patient-years of follow-up. Patients with both type 1 and type 2 diabetes were included in all but 1 study, in which all patients had type 2 diabetes.

The 3,095 patients with DFU had a significantly longer duration of diabetes (12.72 years) compared with the 14,735 patients without DFU (7.19 years). The prevalence of coronary artery disease was significantly higher among patients with DFU (31.4% vs 14.7%), as was that of both hypertension (57.6% vs 35.7%) and hypercholesterolemia (47.6% vs 11.1%).

During follow-up, there were a total 3,619 deaths from any cause. The population with DFU had a 1.89 pooled relative risk for all-cause mortality compared with the patients with diabetes without DFU. Unadjusted rates of all-cause mortality were 99.9 per 1,000 person-years for the population with DFU vs 41.6/1,000 in the group with diabetes only.

Further analysis of 3,138 patients in 4 studies for whom information on cardiovascular mortality was available showed that rates of fatal myocardial infarction and fatal stroke also were higher among patients with DFU. However, the overall proportion of deaths resulting from cardiovascular causes was almost the same in the DFU and non-DFU groups—43.6% of the 117 DFU patients and 44.2% of the 952 diabetes-only patients.

The higher mortality rate in patients with DFU may also "relate to their more advanced stage of diabetes, with greater overall disease burden and noncardiovascular complications of foot ulceration such as sepsis," Medscape says.