Guest Editor and PTJ Editorial Board Member Patricia Ohtake, PT, PhD, joins Editor in Chief Rebecca Craik, PT, PhD, FAPTA, in this month's Craikcast, which highlights the articles in the December issue Special Series on Rehabilitation for People With Critical Illness. Ohtake summarizes the articles, and Craik adds her thoughts on important research conducted by established authors in the field, including physical therapists from across the United States and from Australia. Ohtake also discusses a 2-fold challenge of the critical care and rehabilitation communities—to continue to develop effective rehabilitation interventions and to increase awareness of postintensive care syndrome.    

The special series will be published in 2 issues—December 2012 and February 2013.     

The Department of Veterans Affairs (VA) published a proposed rule on December 10 to amend regulations regarding certain service-connected conditions associated with traumatic brain injury (TBI). Under the amendment, veterans who have a service-connected TBI and are also diagnosed with Parkinsonism, dementia (pre-senility, Alzheimer type), unprovoked seizures, hypopituitarism, or depression will have those diagnoses classified as service-connected secondary conditions if they manifest within 3 years of a moderate to severe TBI or within 12 months of mild TBI. Diseases related to hypothalamo-pitutitary changes must manifest within 12 months of moderate to severe TBI. This new service-connected diagnoses may impact disability status and related VA compensation.

Yesterday, the Department of Health and Human Services (HHS) released an FAQ document on state health insurance Exchanges, other market reforms, and Medicaid expansion. The document includes a section on what states should expect if they opt for a federally operated Exchange, including how states can work with the federal government to ensure the needs of a particular state are being met. HHS reiterates that there is no deadline for a state to declare to the federal government its intention to participate in Medicaid expansion to individuals at and below 133% of the federal poverty level (FPL) and that states have flexibility to start and stop the expansion. However, the federal match rates for medical assistance to states for this expansion population are tied to specific calendar years by law (eg, 100% support for newly eligible adults in 2014, 2015, and 2016). Additionally, HHS clarified that the law does not provide for a phased-in or partial expansion to less than 133% of the FPL, something some states had been considering but were unsure if it was an allowable option.

In support of APTA's Fit After 50 campaign, spokesperson Patrice Winter, PT, DPT, MHA, FAAOMPT, blogs on Boomer Café about how she manages to stay active and fit as she nears age 60.

A new study finds that knee replacement surgery may raise a person's risk of gaining weight, says a Reuters News  article based on a study published in Arthritis Care & Research.   

For this study, lead investigator Daniel Riddle, PT, PhD, FAPTA, and his group used a patient registry from the Mayo Clinic in Rochester, Minnesota, which collected information on 917 knee replacement patients before and after their procedures.

The researchers found that 5 years after surgery, 30% of patients had gained at least 5% of their weight at the time of the surgery.

In contrast, fewer than 20% of those in a comparison group of similar people who had not had surgery gained equivalent amounts of weight in the same period.

Riddle's team said that this degree of weight gain can lead to "meaningful effects on cardiovascular and diabetes-related risk as well as pain and function."

One possible explanation for the counter-intuitive results, experts said, is that if people have spent years adapting to knee pain by taking it easy, they don't automatically change their habits when the pain is reduced, reports Reuters.

"After knee replacement we get them stronger and moving better, but they don't seem to take advantage of the functional gains," said Joseph Zeni, PT, PhD, a physical therapy professor at the University of Delaware, who was not part of the study. "I think that has to do with the fact that we don't address the behavioral modifications that have happened during the course of arthritis before the surgery."

Part of the explanation for the weight gain could be the age at which patients get surgery. People in their 50s and 60s tend to gain weight, anyway. Still, in light of the lower rates of weight gain in the comparison group, which was also middle aged and older, Riddle said something else may also be at work.

In fact, the team found that patients who had lost weight before their surgery were slightly more likely to gain weight afterwards—perhaps because when people lose weight in anticipation of an event, such as surgery, they are more likely to put it back on after they're achieved the goal, says the article.