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  • The Good Stuff: Members and the Profession in the Media, April 2019

    "The Good Stuff" is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy.

    When fear is the obstacle: Robert Gillanders, PT, DPT, discusses traumatophobia—fear of reinjury—and the way it can impact the lives of previously active people. (Medium).

    Kope-ing skills: Emily Younker, PTA, was involved in the physical therapy that helped 9-year-old Kope Hillary recover from injuries suffered in an ATV accident. (Wise County, Texas, Messenger).

    Roll with it: David Reavy, PT, MBA, shares consumer tips for choosing a foam roller. (Self) .

    The brain as healer: Andrew Butler, PT, PhD, FAPTA, explains his leading research in using the power of brain plasticity to help patients recover poststroke. (Georgia State University Research).

    The exercise crystal ball: Greg Hartley, PT, DPT, provides a PT's perspective on a fitness test that 1 study claims is a predictor of longevity. (The Washington Post).

    Finding a way out of the pain: Carrie Pagliano PT, DPT, explains the ways physical therapy can address vaginismus. (Huffington Post).

    Quotable: "We knew we had to stay active to keep living, and the boost we needed was going through pulmonary rehab alongside others with whom we could relate." – Charlton Harris, describing the benefits of group pulmonary physical therapy for his sarcoidosis. (Sarcoidosis News) .

    Improving care in Vietnam: Julie Gahimer, PT, is helping physical therapy students and professors in Vietnam as part of Health Volunteers Overseas. (University of Indiana Reflector).

    Yoga poses for pelvic pain: Casie Danenhauer PT, DPT, says that certain yoga moves can help ease endometriosis, pelvic pain, and menstrual cramps. (Everyday Health).

    Balance in all things: Patrick Sparto, PT, DPT, describes how physical therapy can improve balance problems. (Today.com).

    A passion for Special Olympics: Dominic Fraboni, PT, DPT, discusses the impact volunteering with Special Olympics has had on his life. (Medium).

    Backing up the value of physical therapy: Jeffrey Houser, PT, DPT, outlines the ways physical therapy can relieve low back pain. (Cleveland Clinic health essentials)

    Treating scoliosis from experience: April Gerard, PT, discovered a treatment method that helped her cope with her own scoliosis. Now she's sharing it with her patients. (Duluth, Minnesota, News Tribune) .

    Preventing rhabdo: Shannon Meggs, PT, offers advice on avoiding potentially organ-damaging rhabdomyolosis as a result of overly strenuous workouts. (Healthline.com).

    "Citizen science": Cole Galloway, PT, PhD, FAPTA, delivers the GoBabyGo! message of "crowdsourced manufacturing" to provide mobility opportunities for children. (Buffalo, New York, News).

    Quotable: "Every milestone we've reached has been because of [physical therapy]. Both of my kids took their first steps with their physical therapist," -Danielle Salamone, mother of two, advocating for the Monroe County, New York, school system to increase reimbursement for preschool special education service providers. (WHAM 13 News, Rochester, New York).

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    New Phys Ed Studies Say There's More Work to Do

    Despite concerns that US education policy over the past 2 decades may be squeezing out opportunities for physical activity in school, it turns out that average student attendance in physical education (PE) classes hasn't dropped since the mid-1990s—but then again, it hasn't increased either and remains below recommended levels. Those were among the conclusions in a pair of recently completed studies that also found public schools not fully embracing policies that could improve their PE programs.

    The 2 studies were conducted by the National Physical Activity Plan Alliance (NPAPA) at the request of the President's Council on Fitness, Sport, and Nutrition. APTA is an organizational partner of the NPAPA. [Editor's note: Want to learn more about the National Physical Activity Plan and the work of the NPAPA? Check out this video, and read the entire National Physical Activity Plan, a roadmap for community-level change.]

    To reach their conclusions, researchers looked at nationally representative survey responses. The attendance study focused on self-reported data from students, while the research on policy implementation was based on information primarily gathered from PE instructors. The study on PE attendance is an update on previous NPAPA research, while the policy study is a first-ever investigation into the degree to which schools have adopted best-practice recommendations from SHAPE America's Essential Components of Physical Education. The attendance study was published in Research Quarterly for Exercise and Sport (abstract only available for free); the PE policy study was published in the Journal of School Health (abstract only available for free).

    PE Attendance
    Researchers found that the percentage of students attending 1 or more PE classes per week continues to hover at around 50%--more or less the same rate reported since tracking began in 1991. The latest data, from 2015, puts the average number of days a high schooler attends PE classes at 4.11 per week; however, nearly half (48.4%) of students reported attending no PE classes on average. Only 29.8% of students reported attending the recommended 5 days of PE per week.

    While authors of the study say that their findings challenged a recent Institute of Medicine report that claimed "political and economic pressures" on school systems were reducing PE curricula, they also acknowledged that, though relatively stable, the attendance numbers aren't good enough.

    "The prevalence of PE attendance among US high school students is still well below the recommended national guidance of daily PE attendance and is far from reaching the [Healthy People 2020] national health objectives," authors write.

    PE Policies
    For the policy study, researchers analyzed the degree to which schools have adopted the 7 policy recommendations contained in the SHAPE resource: providing daily PE; prohibiting waivers, substitutions, and exemptions; limiting class size; not assigning or withholding PE as punishment; ensuring full inclusion of all students in PE; and having state-regulated teachers endorsed to teach PE.

    The results were mixed at best.

    The good news: about 75% of schools said they didn't allow substitution of other activities (such as sports teams or marching band) for PE, and nearly the same rate required certified or licensed PE teachers. More than half didn't allow PE to be assigned or withheld as punishment, and just over 40% enforced maximum student-to-teacher ratios in PE classes.

    The less-good news: Only a quarter of schools prohibited exemptions from PE, and just 4% of schools provided daily PE for the recommended amount of time. A mere 0.2% of schools reported implementing all 7 policy recommendations, and about half (49.3%) were implementing only 2-3 policies. The findings also uncovered regional variations.

    "The findings of this study suggest that many elementary, middle, and high schools across the United States are not implementing essential policies to ensure effective [PE] programs," authors write. They identified the provision of daily PE, class size limits, and prohibiting exemptions from PE as the policies most in need of wider adoption.

    APTA Senior Practice Specialist Hadiya Green Guerrero, PT, DPT, says that the studies shine a spotlight on the gap between widely accepted standards and day-to-day reality in schools.

    "This study is a reminder of the overall lack of progress in improving the well-being of our children by incorporating more movement in schools," Green Guerrero said. "There are progressive policies out there, but these reports show that what's needed is more advocacy in our own communities for their adoption. We can develop any number of great ideas, but without implementation we'll continue to see an increasingly unhealthy population of children of all backgrounds."

    APTA has long supported the promotion of physical activity and the value of physical fitness. In addition to representation on the NPAPA and other organizations, the association offers several resources on obesity, including a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity. Interested members also are encouraged to join the APTA Council on Prevention, Health Promotion, and Wellness to engage with a community of shared interest. APTA is also a board member of the National Coalition for Promoting Physical Activity.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    APTA Annual Report: 2018's Achievements Are Shaping the Future of the Profession

    "I'm excited about where we're headed—together."

    Those words, from a statement from APTA President Sharon Dunn, PT, PhD, in the 2018 APTA Annual Report, are exactly what the document is all about. Taken as a whole, it's a story of how creating connections can pay off—not only in meeting current challenges, but in setting a course for the profession's future.

    Now available online, the report combines elements of the association's 2018 Year in Review, published in late December 2018, with new information that takes a deeper dive into an important year for the association. In addition to recounting how members came together to fuel a long list of achievements, the 2018 Annual Report includes a recap of work at the APTA component level, membership statistics, a report from the APTA treasurer, and financial statements of activities and financial positions.

    The report emphasizes the ways in which APTA leveraged its leadership to build a passionate and impactful community of physical therapists (PTs), physical therapist assistants (PTAs), and students of physical therapy education programs, and how that community in turn powered the association's ability to lead. That synergy paved the way for some significant achievements in 2018, including:

    • Elimination of the hard cap of therapy services under Medicare Part B
    • The end of functional limitation reporting
    • A white paper, Facebook Live event, media tour, and other activities that positioned APTA as an important voice in the fight to end the opioid crisis
    • Passage of a law that provides better federal protections for PTs and PTAs traveling with teams across state lines
    • Expansion of use of telehealth by PTs and PTAs in US Department of Veterans Affairs care systems
    • Growth of the physical therapy licensure compact to 21 states by year's end
    • Finalization of plans for a new APTA headquarters, with an early 2021 completion date

    Those are just some of highlights. Check out the complete report to learn more about how APTA and its members are making a difference in the lives of PTs, PTAs, and their patients and clients—and how a sense of unified energy is propelling the association toward a future of more bold, transformative moves.

    PTJ: Falls Are 'Critical Health Hazard' for Individuals With Upper Limb Loss

    Arm motion is critical to helping compensate for losing one's balance and avoiding a fall. For individuals with upper limb loss (ULL), the lower extremities take on the burden of reacting to avoid a fall, and the lack of upper arm movement may put them at greater risk for falls than older individuals, say authors of a new study in PTJ (Physical Therapy). This "critical health hazard," they write, requires falls screening and "targeted physical therapy to enhance postural control and minimize fall risk."

    Via an anonymous online survey, researchers asked 109 individuals with an average age of 43 with ULL about their body and health characteristics, upper and lower limb loss characteristics, physical activity level, fall history in the previous year and circumstances, and upper limb prosthesis use. Participants also completed the the Activities-specific Balance Confidence (ABC) Scale. 

    Authors found:

    Falls are prevalent in this population, surpassing fall rates for older individuals and stroke survivors. Including individuals with ULL and those with upper and lower limb loss, 45.7% fell at least once in the past 12 months, while 28.6% reported 2 or more falls. Those numbers were slightly lower for respondents with only ULL, with 40.7% reporting 1 fall and 22.0% reporting 2 or more falls. The percentage of respondents experiencing a single fall is higher than for older individuals (33%) and community dwelling stroke survivors (~40%).

    Of all those who reported falls, 31.7% were injured in the most recent fall and 14.6% required medical attention.

    Most falls were due to slips, trips, and loss of balance. Of the reported falls, 30% occurred while walking outdoors, and 30% occurred while walking up or down stairs. Only 11% of falls occurred during physical exercise or playing sports. Most fell because they lost their balance (27%), tripped (25%), or slipped (18%).

    Balance confidence and self-perception play a role. Respondents were significantly more likely to fall if they had lower balance confidence and low perceived physical capabilities. They also were 6 times more likely to fall if they reported using an upper limb prosthesis.

    These results, especially the high rate of injuries, have "considerable clinical importance because it suggests the presence of a critical health hazard for individuals with ULL," authors write. "Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics."

    While further research is necessary on which interventions are best to address these fall risks, authors suggest that balance-targeted therapies, as well as interventions developed for older adults to better recover from trips, could also help individuals with ULL "refine their motor response to perturbations and enhance overall stability."

    "Monitoring these patients during rehabilitation would help create awareness of this health concern, and identify individuals at risk of falling in the community who could benefit from intervention," they write.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    CDC Reiterates Limits of Opioid Prescribing Guideline

    The US Centers for Disease Control and Prevention (CDC) wants to make it clear: its guideline on the use of opioids for the treatment of chronic pain is not intended to apply to pain related to cancer treatment, palliative care, or end-of-life care. The clarification is consistent with messaging used by APTA in its #ChoosePT opioid awareness campaign and its MoveForwardPT.com consumer-focused website.

    In a February 28, 2019, letter from CDC Chief Medical Officer Deborah Dowell, MD, MPH, the agency restates its intentions around the prescribing guideline, issued in 2016, that recommends nonopioid approaches including physical therapy as a preferred first-line treatment for some—but not all—types of chronic pain.

    "The Guideline was developed to provide recommendations for primary care physicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care," Dowell writes. "Because of the unique therapeutic goals, and balance of risks and benefits with opioid therapy in such care, clinical practice guidelines specific to cancer treatment, palliative care, and end-of-life care should be used to guide treatment and reimbursement decisions regarding use of opioids as part of pain control in these circumstances."

    The letter was written in response to concerns voiced by the National Comprehensive Care Network, the American Society of Clinical Oncology, and the American Society of Hematology that some payers were balking on paying for opioid prescriptions in circumstances outside the scope of the CDC guidelines.

    Even without the clarification, the original guideline is explicit in its intent, which appears in the first sentence of the document and again when the CDC describes the scope of the guideline and intended audience. Similarly, APTA makes it clear that doctor-prescribed opioids are appropriate in some cases and has included that message in both its #ChoosePT webpage and its public service announcement related to the opioid crisis.

    "The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management," Dowell writes. "Rather, the Guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options."

    Foundation Announces 2019 Grant Opportunities

    The Foundation for Physical Therapy Research (Foundation) now is accepting applications for a host of 2019 Research Grants—including a new mechanism, made possible through a bequest from a lifetime APTA member, that will award up to $360,000 for a 3-year research project.

    The new Goergeny High Impact/High Priority Research Grant is the result of a $1.58 million bequest from the estate of Magdalen and Emil Goergeny. Originally from Hungary, the Goergenys immigrated to the United States in 1960, where Magdalen received physical therapist training and established a practice. The Goergenys' bequest, received after their deaths in 2013, is among the largest personal donations ever received by the Foundation.

    Application deadline for all grants is early August 2019, with 2 grants requiring letters of intent due May 31. Grant opportunities include:

    • Goergeny Research Grant (High Impact/High Priority): Up to $360,000 (2-year total of $240,000 with third year competitive renewal) for research focused on the role of physical therapy in the prevention of secondary health conditions, impairments of body structures and functions, activity limitations, and/or participation restrictions. Interested applicants must submit a letter of intent by May 31, 2019, at noon ET.
    • Magistro Family Foundation Research Grant: $100,000 for a research project investigating physical therapist interventions. Investigators at any level are welcome to apply regardless of funding history. A letter of intent is required; applicants will be invited to submit full applications based on content. Letter of intent is due May 31, 2019, at noon ET. This grant is made possible by the Magistro Family Endowment Fund.
    • Foundation Marquette Challenge Research Grant: $40,000 for an investigator-initiated research project by an emerging investigator. This grant is named in honor of the annual student fundraising effort, the Marquette Challenge.
    • Health Services Research Pipeline Grant: $40,000 awarded to support research that examines how patients obtain physical therapy-related health care, how much that care costs, and outcomes, with an emphasis on the most-effective ways to organize, manage, finance, and deliver high-quality physical therapy-related care while potentially reducing medical errors and improving safety for patients. Investigators at any level are welcome to apply regardless of funding history. This grant is made possible by APTA.
    • Pediatric Research Grant: $40,000 to an emerging investigator for research consistent with the current Academy of Pediatric Physical Therapy Research Agenda. This grant is made possible by the Academy of Pediatric Physical Therapy.
    • Women's Health Research Grant: $40,000 to an emerging investigator for research in abdominal and pelvic health physical therapy that aligns with the mission and vision of the APTA Section on Women’s Health. This grant is made possible by the APTA Section on Women's Health.

    Questions? Email the Foundation, or call 800/875-1378.

    Note: Before starting your funding application, be sure to carefully read all eligibility guidelines, instructions, and information on funding mechanism deadlines. Also, it's a good idea to start the submission process early to allow for potential questions to be answered.

    New Pilot Study Opportunities Available From CoHSTAR

    The Center on Health Services Training and Research (CoHSTAR) has opened a call for the development of multiple pilot studies that would help set the stage for larger efforts to advance a wide range of health services research. APTA was a major financial contributor to the development of CoHSTAR, having donated $1 million toward the center's startup in 2015.

    The selected pilot studies would address research questions in CoHSTAR's 4 areas of specialization—analysis of large data sets, rehabilitation outcome measurement, cost-effectiveness, and implementation of science and quality improvement research—and the CoHSTAR Pilot Study Program webpage lists examples of specific types of studies that would qualify for funding. Each pilot study will receive $25,000 in funding for direct costs.

    Priorities for funding will be given to applications that align with 1 of the 4 areas of CoHSTAR specialization, have a strong likelihood of leading to broader research with major external funding, and have good potential to result in future research with high societal or policy impact for physical therapy. Principal investigators must include at least 1 physical therapist (PT) who is a US citizen or a certified permanent resident of the United States.

    Letters of intent are due to CoHSTAR by June 1, 2019. Based on those letters, in early July CoHSTAR will invite applicants to submit a full application by August 26. Award winners will be notified on October 15. For more information, visit the CoHSTAR Pilot Study Program webpage.

    CoHSTAR was established with a Foundation for Physical Therapy Research grant of $2.5 million. In addition to APTA’s $1 million donation, funding for CoHSTAR also came from APTA components, individual PTs, foundations, and corporate supporters.

    JAMA Oncology: Telerehab Makes a Difference in Patients With Advanced-Stage Cancer

    "Collaborative telerehabilitation" isn't a regular part of care for patients with advanced-stage cancer, but maybe it should be, say authors of a study recently published in JAMA Oncology (abstract only available for free). They found that the approach, which combines remotely delivered rehabilitation instruction with outpatient physical therapy and regular communication, can reduce pain, improve function, shorten hospital says, and decrease the use of postacute care facilities.

    The findings are based on results from the Collaborative Care to Preserve Performance in Cancer (COPE) program, a randomized clinical trial designed to address what the JAMA authors describe as a "knowledge gap" in the application of collaborative care models (CCMs) focused on patient function. The COPE trial includes patients with stage III or IV solid or hematologic cancer with a life expectancy of more than 6 months, and who reported moderate functional impairment (a score of 53-60 on the Activity Measure for Postacute Care assessment, or AM-PAC).

    The 516 participants in the study were divided into 3 groups studied over 6 months: a control group that was encouraged to self-report on pain and function via telephone or web-based surveys (every other week for the first month and monthly thereafter), an "arm 2" group that received a collaborative telerehabilitation program led by 2 physical therapist (PT) fitness care managers (FCMs) with 15 years or more of specialization in cancer rehab, and an "arm 3" group that added pharmacological pain management to the collaborative telerehab model, overseen by a nurse pain care manager (PCM).

    The collaborative telerehabilitation model put patients in touch with FCMs who provided instruction on "an incremental pedometer-based walking program" as well as the Rapid Easy Strength Training (REST) resistance training program, individualized based on patients' physical impairments. Participants also reported to the FCMs on pain and function, where FCMs "encouraged the use of compensatory strategies and initiated rehabilitative analgesic modalities when indicated," authors write.

    The participants in the telerehab model also were referred to local outpatient PTs "to further adapt their conditioning and analgesic regimens," with the outpatient PTs and FCMs working together to advance step and REST goals. Participants in arm 2 reported on progress, pain, and function weekly for the first month of the study and were then allowed to drop back to every other week or even once a month. FCMs received an alert if participants reported loss of function or increased pain, or if they failed to achieve the recommended 4 REST sessions per week.

    The arm 3 participants received the same rehabilitation approach but at the direction of a PCM, with the only real difference being that during the monitoring phase participants could request a call from the PCM, who could recommend the prescription of pharmacological treatments to address pain and function.

    Among the findings:

    • Physical function, as measured by the AM-PAC, improved for the arm 2 and 3 groups versus control by about 1.3 points—a difference that exceeded the minimum clinically important difference (MCID) threshold of 1 point.
    • Both the arm 2 and arm 3 groups reported clinically significant, albeit similar, reductions in pain compared with control as measured by the Brief Pain Inventory—pain interference dropped by 0.4 for arms 2 and 3, while pain intensity dropped by 0.4 for arm 2 and 0.5 for arm 3.
    • When it came to quality-of-life measures, a slightly different picture emerged: arm 2 telerehab-only participants reported significant improvement over control via the 5-item EQ-5D-3L assessment, but arm 3 participants (telerehab plus pain management) did not.
    • Hospitalization days were on average 57% higher for the control group (7.4 days) than for arm 2 participants (4.2 days), and 18% higher than for arm 3 participants (7.2 days). Authors note that the differences had to do with shorter, not fewer, hospitalizations in arms 2 and 3.
    • Among patients who were hospitalized, arms 2 and 3 were 4.3 times more likely to be discharged home than was the control group.

    "Although modest, the COPE interventions' effect sizes of 0.23 for mobility and -0.24 for pain are nonetheless notable given the remote, low-touch delivery; the known positive effect of the control condition; and the trial's vulnerable, high-needs participants," authors write. "Furthermore, our findings agree with reports suggesting that surprisingly modest functional losses and gains among individuals with borderline dependency…can profoundly affect their requirement for inpatient care."

    The researchers were surprised by the data that showed the addition of pharmacological pain management to be less effective than telerehab alone when it came to improving function and about equally effective in decreasing pain. They believe more study is needed but speculate that the greater reliance on nonpharmacological approaches in both arms, as well as a "more seamless integration of pain- and function-directed treatments in arm 2, may have contributed to the outcomes.

    Authors also note that in addition to reduced pain and improved function, results of the COPE trial shed more light on possible avenues for reining in the costs of care for individuals with late-stage cancer.

    "Our findings of reduced hospital use among participants in the telerehabilitation arms add to growing evidence that proactively addressing functional impairment among vulnerable patients reduces hospital utilization," authors write "Reducing the requirement for institutional care among patients with late-stage cancer has the potential for high financial return given that hospitalizations account for a large proportion of health care spending in this population, drive regional variation in costs of care, and are not associated with survival or [quality of life]."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    CMS Home Health Preclaim, Postpayment Review System Again Ready to Launch in Illinois

    After false starts, restarts, postponements, and more than a little pushback from APTA and other stakeholders, CMS is ready to once again roll out a home health agency (HHA) payment program in Illinois that would force HHA providers in the state to participate in preclaim or postpayment reviews—or choose a third option that would involve "minimal" postpayment review but cut payment by 25%.

    Called the "Review Choice Demonstration for Home Health Services," the program will require HHAs in Illinois to choose 1 of 3 program options: submit documentation for 100% of Medicare patients while they are receiving care (a "preclaim review"), submit 100% of all claims for a postpayment review, or opt for "minimal" postpayment review and swallow a 25% payment cut. HHAs can begin making their choice on April 17 but must submit a final decision to CMS by May 16. The system will begin on June 1.

    If parts of the system sound familiar (particularly to HHAs in Illinois), that's because they are: CMS first introduced the project in Illinois in 2016, with plans to roll out the system to 4 additional states in 2017. In the face of criticism from most HHA organizations about the excessive burden of the demonstration, CMS put the brakes on the rollout. In June 2018, CMS announced that it would move ahead with a revised demonstration in 5 states—but then held off again and announced that once the delay was over, the program would begin in Illinois.

    According to CMS, the 3-option system will serve as a kind of audition for HHAs, which, after 6 months of compliance, would be allowed additional choices including "relief from most reviews except for a review of a small sample of claims." The demonstration is intended to offer more flexibility and choice for providers, as well as reward providers who show compliance with Medicare home health policies.

    APTA staff and members of the Home Health Section submitted extensive feedback to CMS on the demonstration as it was being considered and reconsidered—and considered again. Like many other stakeholders that provided comments to CMS, APTA argued that the program was excessively burdensome and could decrease patient access to care.

    With the demonstration program ready to begin, many HHAs are wondering the same thing: will the program be expanded to other states and, if so, when?

    "At this point, it's nearly impossible to say how or if CMS will move to expand this system," said Kara Gainer, APTA director of government affairs. "Although some tweaks were made to the project, we believe it's still based on a flawed approach that could put unsustainable pressure on some HHAs. We will closely monitor the demonstration as it plays out in Illinois and take every opportunity to press CMS for significant improvements before it's applied to other states."

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    Student Loan Repayment Program to Include PTs? Health Services Corps Bill Reintroduced in US Senate

    It's back: APTA-supported legislation that would list physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME).

    APTA is a strong supporter of legislation that extends student loan forgiveness to PTs, particularly as a way to improve access to physical therapist services in areas already experiencing shortages. But according to APTA Vice President of Government Affairs Justin Elliott, there's an additional important reason that the association is advocating for the bill's passage.

    "The opioid epidemic has been especially devastating in rural and medically underserved areas," said Elliott. "And while the role of physical therapy as an important nonpharmacological alternative in the prevention, treatment, and management of pain is well-established, the current services corps law doesn't include any physical rehabilitation component. Allowing PTs to participate in the NHSC could help increase patient access to better ways to manage pain, especially for individuals who have or at risk of developing a substance use disorder."

    Advocacy for S.970 (and its yet-to-be-introduced companion in the US House of Representatives) was a major focus of Capitol Hill visits conducted by APTA members as part of the APTA Federal Advocacy Forum held from March 31 to April 2. APTA encourages members to join the push for the bill by contacting their senators to urge them to become cosponsors by way of a prewritten letter, available at the APTA Legislative Action Center, that helps to deliver a unified message (member login required).

    APTA staff will closely track the progress of this legislation—be on the lookout for more opportunities to advocate for this important change.