The annual review and revision of the association strategic plan conducted in late 2012 by the APTA Board of Directors has resulted in a revised plan for 2013. Members can access the plan and related materials on the website at this link. The strategic plan represents the highest priorities of the Board of Directors as it manages the work of the association and was informed by member and external stakeholder input.

In a follow-up of a randomized controlled trial, a strategy of rehabilitation plus early acute anterior cruciate ligament (ACL) reconstruction did not provide better results at 5 years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear, say the authors in their article published this month in BMJ. 

This study included 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. One patient was lost to 5-year follow-up.

The main outcome was the change from baseline to 5 years in the mean value of 4 of the 5 subscales of the knee injury and osteoarthritis outcome score (KOOS₄). Other outcomes included the absolute KOOS(4) score, all 5 KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at 5 years.

Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (7 between 2 and 5 years). The mean change in KOOS₄ score from baseline to 5 years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points after adjustment for baseline score). At 5 years, no significant between-group differences were seen in KOOS₄, any of the KOOS subscales, SF-36, Tegner activity scale, or incident radiographic osteoarthritis of the index knee. No between-group differences were seen in the number of knees having meniscus surgery or in a time-to-event analysis of the proportion of meniscuses operated on. The results were similar when analyzed by treatment actually received.

If you are interested in leadership development, collaborating with colleagues, and lending your expertise to APTA, then you need to join the Volunteer Interest Pool. Current opportunities include all awards subcommittees: Advocacy, Catherine Worthingham Fellows, Education, Lecture, Practice and Service, Publications, Research, and Scholarship. 

To answer the call for these opportunities, you must first complete a volunteer interest profile. Creating this profile allows you to include your preferred level of involvement, willingness to travel, current availability, and interest/experience in a variety of areas. You only need to create the volunteer profile once. It can be updated at any time. Once you have created a profile, you will need to review the current opportunities and answer the questions specific to each committee.

Deadlines will vary by group, so don't delay in checking out these opportunities! To learn more about the Volunteer Interest Pool, please contact Angela Boyd.

A new report that seeks to move the nation from "sick care" to "health care" encourages all employers, including federal, state, and local governments, to provide effective, evidence-based workplace wellness programs.

Trust for America's Health's (TFAH) A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years outlines top policy approaches to respond to studies that show that (1) more than half of Americans are living with 1 or more serious, chronic diseases, a majority of which could have been prevented; and (2) today's children could be on track to be the first in US history to live shorter, less healthy lives than their parents.

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective. Some recommendations include:

• Advance the nation's public health system by adopting a set of foundational capabilities, restructuring federal public health programs, and ensuring sufficient funding to meet these defined foundational capabilities;
• Ensure insurance payment for effective prevention approaches both inside and outside the physician's office;
• Integrate community-based strategies into new health care models, such as by expanding accountable care organizations into accountable care communities; and
• Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs.

Healthier America features more than 15 case studies from across the country that show the report's recommendations in action. It also includes recommendations for a series of 10 key public health issues.

After the report's release, economic experts came out against TFAH's position on preventive care's role in reducing health care spending. (See related article posted in News Now titled "Experts Say Preventive Care Produces Limited Savings.")   

While some disease-prevention programs do produce net savings, such as childhood immunizations and counseling adults about using baby aspirin to prevent cardiovascular disease, most preventive care does not save money, says an article by Reuters News.

Following the release yesterday of a new report from Trust for America's Health (TFAH) that calls for putting more resources into preventive care, economic experts challenged TFAH's position on preventive care's role in reducing health care spending. (See related article posted in News Now tilted "TFAH Releases Strategies to Improve Nation's Health in 4 Years.")

"Preventive care is more about the right thing to do" because it spares people the misery of illness, economist Austin Frakt of Boston University told Reuters. "But it's not plausible to think you can cut health care spending through preventive care. This is widely misunderstood."

A 2010 study in Health Affairs, for instance, calculated that if 90% of the US population used proven preventive services, more than do now, it would save only 0.2% of health care spending.

One reason why preventive care does not save money, say health economists, is that some of the best-known forms don't actually improve someone's health. These low- or no-benefit measures include annual physicals for healthy adults.

The second reason preventive care brings so few cost savings is the large number of people who need to receive a particular preventive service in order to avert a single expensive illness.

A promising approach is to target preventive care at those most likely to develop a chronic disease, not at low-risk people. Such "smart" prevention increases the chances of preventing expensive diseases and saving money.

In contrast, unthinking expansion of preventive medicine is the wrong prescription, the article says.