A new systematic review provides evidence that, in the short term, energy conservation management (ECM) treatment can be more effective than no treatment in reducing the impact of fatigue and improving quality of life in patients with multiple sclerosis-related fatigue.

For this review, the authors searched PubMed, CINAHL, EMBASE, and Web of Knowledge to identify relevant randomized controlled trials (RCTs) and controlled clinical trials. To select potential studies, 2 reviewers independently applied the inclusion criteria. Two reviewers independently extracted data and assessed the methodological quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.

The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and quality of life (QoL); 1 study reported short- and mid-term effects on participation but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the: (1) Fatigue Impact Scale: cognitive, physical, and psychosocial; and (2) SF-36: role physical, social function, and mental health. Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short- or mid-term. None of the studies reported long-term results.

This systematic review is published online in Archives of Physical Medicine and Rehabilitation. 

APTA's Public Policy and Advocacy Committee is seeking members to provide strategic advice, counsel, and options to the Board of Directors regarding: (1) how APTA can be responsive to and advocate for society’s needs provided by physical therapists and physical therapist assistants; (2) current and emerging public policy issues impacting the provision of physical therapy, rehabilitation, and  health care services; and (3) how to advance the profession within public policy arenas. Interested members should respond to the call by completing a volunteer interest profile found on the Volunteer Interest Pool webpage. The first step is creating a "profile" for service. After developing a profile, to be considered for this committee members must then access the "current opportunities for service page" and respond to the question specific to this committee. The deadline to respond to this call is March 7. For more information on this task force, click on the link above or contact Justin Moore, PT, DPT, vice president, public policy, practice, and professional affairs.

APTA sent a letter to the editor of The New York Times regarding its February 20 article "No Consensus on a Common Cause of Foot Pain" by Gretchen Reynolds. APTA clarified the physical therapist's role in treating plantar fasciitis and explained PT education and how consumers may use direct access. 

Fewer Americans reported having employer-based health insurance in 2012 than did in 2008, 2009, and 2010, but at 44.5% it is unchanged from 2011, says a new Gallup poll. At the same time, more Americans continue to report having a government-based health plan—Medicare, Medicaid, or military or veterans' benefits—with the 25.6% who did so in 2012 up from 23.4% in 2008.

The percentage of Americans (11.9%) who say they get their coverage through "something else," which could mean they buy it for themselves, has been relatively unchanged over the years. While more Americans remain uninsured than in the past, the percentage who are uninsured decreased slightly in 2012 (16.9%), after having risen each year previously going back to 2009.

High unemployment is partly to blame for the decrease in employer-based health insurance from 2008-2010. The decline also may caused by fewer employers offering insurance or by employees opting to not take their employers' plan due to rising health insurance costs for employees, reports Gallup.

The decline in employer-based coverage from earlier years is apparent for workers employed full time for an employer or for themselves. However, the percentage of part-time workers who have employer-based insurance rose in 2012. This group leans toward younger workers, who are likely to be insured since enactment of the health care law provision allowing those up to age 26 to stay on their parents' plans.

The Department of Health and Human Services (HHS) issued a final rule last week implementing several consumer protections under the Affordable Care Act (ACA) to prevent insurance companies from discriminating against people with preexisting conditions and protect consumers from insurance company abuses.

Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

These 5 key provisions are applicable to nongrandfathered health plans:

• Guaranteed Availability—Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
• Fair Health Insurance Premiums—Health insurance companies offering coverage to individuals and small employers will be allowed to vary premiums based only on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
• Guaranteed Renewability—Health insurance companies will no longer be permitted to refuse to renew coverage because an individual or an employee has become sick. Consumers may renew coverage at their option.
• Single Risk Pool—Health insurance companies will no longer be able to charge higher premiums to higher-cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single statewide risk pool for the individual market and single statewide risk pool for the small group market.
• Catastrophic Plans—Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.

In preparation for the health insurance marketplaces and to streamline data collection for insurers and states, the final rule amends certain provisions of the rate review program. HHS has increased the transparency by directing insurance companies in every state to report on all rate increase requests. A new report has found that the law's transparency provisions have already resulted in a decline in double-digit premium increases filed, from 75% in 2010 to, according to preliminary data, 14% in 2013.

Building on previous studies that show many factors beyond medical care affect people's health, the Institute of Medicine (IOM) recently established the Roundtable on Population Health Improvement to explore the interactions of these influences. The new roundtable will provide opportunities for experts on education, urban planning, medicine, public health, social sciences, and other fields to interact and share their knowledge and perspectives with the goal of catalyzing joint action. 

As a recent study by the National Research Council and IOM documented, Americans experience worse health and shorter lives than people in other rich, industrialized nations despite spending more on medical care than any other nation. Several IOM studies have described the effects of social and environmental factors that can lead to poor health even when people have access to good health care. The nation's lagging health burdens businesses, communities, and families, these reports note.

The roundtable will engage roundtable members and outside experts, practitioners, and stakeholders on 3 core issues:

1. supporting fruitful interaction between primary care and public health
2. strengthening governmental public health
3. exploring community action in transforming the conditions that influence the public's health

IOM hosts more than a dozen roundtables and forums, providing a neutral setting for diverse groups of individuals to discuss issues of mutual interest and concern and gain fresh insights and new understanding. A list of individuals who serve on the roundtable can be found on IOM's website. 

The US Preventive Services Task Force (USPSTF) recently released its updated 2012 Guide to Clinical Preventive Services—an authoritative source that can help primary care clinicians and patients decide together what preventive services are right for a patient's needs. This edition of the guide includes the USPSTF’s evidence-based recommendations on clinical preventive services from 2002 through March 2012, topics in development, and at-a-glance clinical summary tables.

Go to USPSTF's A-Z Topic Guide to access recommendation statements on interventions to prevent low back pain, falls in older adults, and osteoporosis. USPSTF also makes recommendations on screening for and management of obesity in adults and children.

The 2012 guide can be found on the Agency for Healthcare Research and Quality's website.