Manual physical therapy provided benefits over usual care that were sustained to 1 year for patients with osteoarthritis of the hip or knee, say authors of an article published online in Osteoarthritis and Cartilage. Exercise physical therapy also provided physical performance benefits over usual care. There was no added benefit from a combination of the 2 therapies. 

In this 2x2 factorial randomized controlled trial conducted in New Zealand, 206 adults (mean age 66 years) who met the American College of Rheumatology criteria for hip or knee osteoarthritis were allocated to receive manual physical therapy (n=54), multimodal exercise physical therapy (n=51), combined exercise and manual physical therapy (n=50), or no trial physical therapy (n=51). The primary outcome was change in the Western Ontario and McMaster osteoarthritis index (WOMAC) after 1 year. Secondary outcomes included physical performance tests. Outcome assessors were blinded to group allocation.

Of 206 participants recruited, 193 (93.2%) were retained at follow-up. Mean (SD) baseline WOMAC score was 100.8 (53.8) on a scale of 0 to 240. Intention-to-treat analysis showed adjusted reductions in WOMAC scores at 1 year compared with the usual care group of 28.5 for usual care plus manual therapy, 16.4 for usual care plus exercise therapy, and 14.5 for usual care plus combined exercise therapy and manual therapy. There was an antagonistic interaction between exercise therapy and manual therapy. Physical performance test outcomes favored the exercise therapy group.

As private and governmental payers continue to ramp up efforts to curb fraud and abuse, physical therapists are facing more audits of their services. APTA recently published FAQs on audits that identifies strategies to prepare for and respond to private insurance audits. The FAQ document also identifies additional resources available through APTA, including APTA's Medicare Claims Audits webpage, and external entities.

APTA has released a statement commending the final report of the Blue Ribbon Panel on Medical Rehabilitation Research at the National Institutes of Health (NIH). The association supports the panel's call for the development and implementation of a NIH rehabilitation research plan that is periodically updated, elevation of the role of the National Center for Rehabilitation Research within NIH's structure, and the elimination of "Medical" from the name of the center to better reflect the inclusive and multidisciplinary nature of rehabilitation, among other recommendations.

APTA members Rebecca Craik, PT, PhD, FAPTA, Anthony Delitto, PT, PhD, FAPTA, and Alan M. Jette, PT, PhD, FAPTA, served on the 13-member panel. The panel, formed in August 2011, was charged with assessing rehabilitation research across NIH while focusing on the National Center for Medical Rehabilitation Research. 

APTA congratulates the following association members for their winning entries to the 2012 photo contest: Jan Black, PT, MSPT, first place; Megan Herrman, PT, and Gayati Mathur, PT, second place; and Bob Wellmon, PT, PhD, NSC, third place. Black will receive $500. Herman and Mathur will receive a total of $250. Wellmon also will receive $250. 

Physical therapists, physical therapist assistants, and students submitted 73 entries to the contest. The 3 winning photos and 5 honorable mentions are available at www.apta.org/PhotoContest/. They also will be displayed at association headquarters and may appear in APTA's online or print publications.  

Submissions to the contest were judged on how well they:

• Reflected the full scope of practice and depict strides in contemporary physical therapy practice, education, or research
• Depicted models of excellence in a variety of settings
• Portrayed a diverse population of physical therapists, physical therapist assistants, patients, researchers, faculty, or students
• Reflected high quality in terms of aesthetics, composition, and technical standards  

Information on the 2013 photo contest will be available February 1 on APTA's website.

Be a part of this important time in the history of your profession and join us April 14-16 for the 2013 Federal Advocacy Forum. At the event, you will hear from decision makers on Capitol Hill, learn to effectively communicate with your elected officials, receive an update on the legislative and regulatory issues affecting the physical therapy profession, and lobby your members of Congress on behalf of your profession.

The programming for the 2013 Federal Advocacy Forum will begin on Sunday, April 14, with an evening reception. Monday, April 15, will be dedicated to advocacy programming and preparation for your hill visits. The event will conclude with the opportunity for you to take your message directly to your members of Congress on April 16.

The number of CEUs earned for this event is pending. To claim CEU credit, you must attend the live event and complete the online posttest with at least 70% accuracy. The online posttest will be available on APTA's Learning Center by April 16.

For a full agenda and more information, visit www.apta.org/FederalForum. APTA encourages you to get the word out to your friends and colleagues and bring someone with you to the event. Register now and bring your voice to Capitol Hill on behalf of your profession.

The Magistro Family Foundation recently bestowed a gift of $500,000 to support the Magistro Family Foundation Endowment Fund.

This fund was created in 1998 to support relevant clinical research that evaluates the effectiveness of interventions most commonly delivered by physical therapists.  

Going forward, the fund will support health policy research. This most recent gift to the Foundation for Physical Therapy includes support for the campaign to establish a Center of Excellence for Health Policy Research.

With this donation, the Magistro Family Foundation Endowment Fund now exceeds $2 million and will continue to provide vital grant funding well into the future.

To view the news release, click here. 

"It is with a heavy heart that I share the news of the sudden passing of our friend and colleague, APTA Board Member Dave Pariser, PT, PhD," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement released this morning. "Dave was an outstanding gentleman and professional whose friendship, devoted service, and leadership we will sorely miss."

A member of APTA since 1981, Pariser served in various capacities within APTA and the Kentucky and Louisiana chapters, including on APTA's Nominating Committee, as Louisiana Chapter president, and as chair of the legislative committees for both the Louisiana and Kentucky chapters. Most recently, he was elected in June 2011 by APTA's House of Delegates to serve on the Board of Directors. Pariser received numerous awards in recognition of his service, including the Dave Warner Award for Distinguished Service (Physical Therapist of the Year) from the Louisiana Chapter (2001) and induction into the chapter's “Hall of Fame” in 2006 for career achievement. 

Read Rockar's full statement on APTA's website.    

APTA has created a tribute page for members of the physical therapy community and others to share their memories about Pariser.   

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that has important implications for Medicaid beneficiaries who require rehabilitative and habilitative services and devices.

In the rule, CMS proposes changes to provide states more flexibility to coordinate Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act (ACA), such as coordination of benefits between Medicaid and health plans offered in the health insurance exchanges (Exchanges).    

Specifically, CMS is soliciting comments on whether the habilitative benefit should be offered in parity with the rehabilitative benefit under the Medicaid program (as they must be under the Exchanges). Additionally, CMS requests input on whether the state defined habilitative benefit definition for the Exchanges should apply to Medicaid or states should be allowed to separately define habilitative services for Medicaid. Habilitative and rehabilitative benefits are part of the mandatory essential health benefits (EHB) established by the ACA to ensure that certain health plans offered in Exchanges provide this baseline of coverage, benefits, and services to their enrollees.

In December 2012, CMS released guidance to help states align Alternative Benefit Plans under Medicaid programs with the EHB requirements. In that guidance, CMS stated that it intended for the provisions of the EHB proposed rule, released on November 20, generally to apply to Medicaid, but noted that it would address EHB in future rulemaking.

The newly released proposed rule also proposes to update and simplify the complex Medicaid premiums and cost-sharing requirements, to promote the most effective use of services, and to assist states in identifying cost-sharing flexibilities. 

APTA will comment on the proposed rule. Comments are due February 13. 

In a study evaluating the financial impact of providing early physical therapy for intensive care patients, researchers at Johns Hopkins found that the up-front costs are outweighed by the financial savings generated by earlier discharges from the intensive care unit (ICU) and shorter hospital stays overall.

"The evidence is growing that providing early physical and occupational therapy for intensive care patients—even when they are on life support—leads to better outcomes," says Dale M. Needham, MD, PhD, senior author of the study. "Patients are stronger and more able to care for themselves when they are discharged."

Hospital administrators' concerns about costs have been cited as barriers to implementing early rehab programs in the ICU. "However, our study shows that a relatively low investment up front can produce a significant overall reduction in the cost of hospital care for these patients," Needham says. "Such programs are an example of how we can save money and improve care at the same time."

For the study, the researchers developed a financial model based on actual experience at The Johns Hopkins Hospital's medical intensive care unit (MICU) and projections for hospitals of different sizes with variable lengths of stay.

The Johns Hopkins MICU admits about 900 patients each year. In 2008, the hospital created an early rehabilitation program with dedicated physical therapists and occupational therapists, which added about $358,000 to the cost of care annually. However, by 2009, the length of stay in the MICU had decreased an average of 23%, down from 6.5 days to 5 days, while the time spent by those same patients as they transitioned to less-intensive hospital units fell 18%. Using their financial model, the authors estimated a net cost saving for the hospital of about $818,000 per year, even after factoring in the up-front costs.   

The researchers then analyzed the potential impact of early rehabilitation services in 24 different scenarios, accounting for variations in the number of ICU admissions, cost savings per day and reductions in length of stay.

They found that in 20 out of the 24 scenarios, hospitals would have an overall cost savings by providing early rehabilitation to patients in the ICU, and in the 4 remaining scenarios, using the most conservative assumptions, there was a modest net cost increase of up to $88,000 per year.

APTA member Michael Friedman, PT, MBA, is a coauthor of the study.

APTA's innovative models of care video series includes an interview with a physical therapist who was instrumental in starting an early physical therapy program for patients in a Houston hospital's ICU.

A new policy statement by the American Heart Association (AHA) encourages clinicians to assess cardiorespiratory fitness with the hope that researchers can gather more information on aerobic fitness and its related variables to identify individuals who might be at risk for adverse clinical outcomes.

The AHA writing committee also advocates for the creation of a national registry that includes data on cardiorespiratory fitness that would allow researchers to track aerobic fitness over long periods of time, just as is being done with other variables such as cholesterol, blood pressure, physical activity levels, and body weight, among others. It also would provide more information on normative aerobic fitness levels in subsets of the population.

According to a Heartwire article, one of the goals of the national registry is to increase awareness about the importance of cardiorespiratory fitness. Many of the assessments are performed in exercise centers and research settings, but not as frequently in clinical practice.

While information is available in pockets of the country, including data from the Aerobics Center Longitudinal Study, the hope is more information would allow researchers to determine normative cardiorespiratory fitness levels, via direct measurements of VO₂, in groups stratified by age, gender, and body composition in large samples representative of the US population.

The registry also would help define normative values of aerobic fitness across strata of physical activity levels. Chair of the AHA policy statement, Leonard Kaminsky, PhD, told Heartwire that "physical activity is simply a behavior, and while both are inversely associated with the risk of cardiovascular disease, there are factors that contribute to aerobic fitness than other physical activity levels, including age and genetics. In addition, cardiorespiratory fitness is a more clinically meaningful measure than self-reported physical-activity levels, which are prone to considerable error."

APTA member Ross Arena, PT, PhD, is a coauthor of the statement, which was published online ahead of print January 7 in Circulation.   

A new APTA podcast that focuses on screening for physical inactivity distinguishes between physical activity and physical fitness, explains the use of physical activity to screen for issues of impaired physical fitness, and provides information on what to do with the results of the screen. It also gives examples illustrating various types of patients and the role that physical activity plays in their overall health.