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  • APTA President Sharon Dunn Named Dean of LSU Shreveport's School of Allied Health Professions

    APTA President Sharon Dunn, PT, PhD, can now add another achievement to an already lengthy list: Dean of School of Allied Health Professions at Louisiana State University (LSU) Shreveport.

    On April 23, LSU Shreveport announced that Dunn will take over the reins at the school, which includes the Department of Rehabilitation Science (physical therapy, occupational therapy, speech-language pathology and postprofessional residencies) and the Department of Clinical Sciences (cardiopulmonary science, medical laboratory science, and the physician assistant program). The school is also responsible for a children's center, a rehabilitation faculty clinic, and the Mollie E. Webb speech and hearing center.

    The current chair of LSU Shreveport's Department of Rehabilitation Science, Dunn, a board-certified clinical specialist in orthopaedic physical therapy, has been on faculty at the university's school of allied health for 24 years. She served in multiple roles in the school, including program director of the DPT program for 15 years and director of the LSUHSC Orthopaedic Physical Therapy Residency Program, where she was instrumental in developing and gaining program accreditation. Dunn became president of APTA in 2015 and was reelected to the position in 2018.

    Dunn received her bachelor of science degree in physical therapy followed by a master’s in health sciences from the School of Allied Health Professions in Shreveport. She obtained her PhD, cellular biology, and anatomy at the School of Graduate Studies at LSU Health Shreveport.

    "It is gratifying that one of our own faculty members, Dr Sharon Dunn, has been selected as the Dean of the School of Allied Health Professions. Dr Dunn brings a strong clinical and administrative background with a clear vision for the future," stated LSU Health Shreveport Chancellor G. E. Ghali, DDS, MD, in an APTA news release.

    APTA Chief Executive Officer Justin Moore, PT, DPT, believes LSU Shreveport couldn't have made a better choice.

    "Sharon has been a tireless advocate for the profession, the highest standards of health care, and patients' rights everywhere," Moore said. "Her kindness, passion, commitment, and dedication have been an inspiration to me. She is an outstanding colleague and, more importantly, friend. I offer her my warmest congratulations on her new appointment and cannot think of anyone more deserving. I know she will serve the position well."

    And as for Dunn—she's ready for the challenge.

    "I am so thrilled to have the opportunity to serve our faculty, students, and our community in my home town and at my alma mater, LSU Health Shreveport!" Dunn said. "Becoming the dean during these times of economic challenge to higher education and while LSU is engaging in a new partnership with Ochsner Health System provides exciting opportunities to integrate and collaborate across disciplines in education, practice, and research. I have much to learn, but I am enthusiastic about our team and our potential! Geaux Tigers!"

    Beyond the Sessions: 7 NEXT Opportunities Worth Checking Out

    The APTA NEXT Conference and Exposition has a reputation for on-point educational sessions and inspiring lectures, and this year's event, taking place in Chicago June 12-15, is no exception.

    But as anyone who attended a NEXT conference can tell you, there's more to it than that: NEXT offers hands-on experiences, interactive learning opportunities, and plenty of ways to network and have a great time—this year, in 1 of the most vibrant cities in the country.

    If you've already registered for NEXT, think of the items below as possibilities for your conference "must do" list. And if you haven't registered, take a look at what you could be missing (besides all the sessions and lectures, of course), and then join in on the experience while there's still time—NEXT advance registration ends May 3.

    Celebrate!
    NEXT is all about connecting (and reconnecting) with others who share your passion for the profession—and those connections don't just happen around sessions. Plan on joining fellow attendees for the conference opening reception in the exhibit hall on Wednesday, June 12, and get things started right.

    Join the conversation.
    What would you do? The NEXT Experience Zone is the place for interactive learning, including a June 13 session on shoulder and knee issues, with speakers presenting cases and then involving the audience in discussion and, ultimately, a vote on the best course of treatment.

    Take a deep dive with a small group.
    The NEXT Inspiration Hub offers a series of discussions in a small group setting that allows for a more intimate look at topics including rural health, community collaboration, and the integration of education, practice, and research. There's even a session on how APTA can be your not-so-secret weapon in enriching your career.

    Get hands-on with GoBabyGo!
    The popular GoBabyGo! program returns to NEXT, with an opportunity for you to see firsthand how commercially available children's ride-on toys can be retrofitted to become effective assistive devices for children with mobility limitations. You'll come away inspired.

    Feel the blues.
    Join PT-PAC supporters for an evening of top-notch blues at Buddy Guy's Legends, which calls itself "the premier blues club in the world," on Wednesday, June 12. A $50 ticket, purchased at the NEXT registration desk onsite, buys you appetizers, drinks, and a night of live entertainment you won't soon forget.

    Make a kid's day.
    Again this year, APTA is working with Shoes4Kids to provide underprivileged children with new athletic shoes and socks. This service opportunity will benefit Chicago's Woodlawn Community Elementary School, which is part of the Small Schools Coalition offering students an African culture-centered curriculum in reading, language arts, math, science, cultural arts, and social science. Shoes4Kids collection bins will be located outside of the House of Delegates beginning Monday, June 10, and at NEXT through Wednesday, June 12. Find out more, and how you can help.

    Party with the Foundation.
    The Foundation for Physical Therapy Research has funded groundbreaking research and researchers for 40 years. This year’s PT Party, on Thursday, June 13, will be a celebration of this special anniversary and the research that keeps making our profession stronger. Join colleagues, friends, and Foundation family in celebration. PT Pintcast's Jimmy McKay will liven up the evening as emcee. And don't forget to wear your dancing shoes. You can register for this event online.

    APTA Sheds Light on Upcoming MIPS, Registry Deadlines

    The Merit-based Incentive Payment System (MIPS) is now a professional reality for many physical therapists—as are upcoming deadlines for reporting MIPS data and potentially switching reporting methods. Do you know what you need to do, and when you need to do it? APTA can help.

    Now available from APTA: a detailed annotated list of "MIPS Milestones" and key dates for 2019 and 2020, and a recent #PTTransforms blog post that breaks down options for reporting and how to transition to using APTA's Physical Therapy Outcomes Registry as your MIPS reporting agent.

    In addition to explaining why it's important to be paying attention to MIPS- and Registry-related deadlines—the next of which is coming up June 30—the blog post provides insight into how the Registry works, and includes tips on succeeding in the MIPS environment.

    Proposed SNF Rule Relaxes Group Therapy Requirements, Increases Payment by 2.5%

    In a proposed change strongly supported by APTA, skilled nursing facilities (SNFs) could see more flexibility when it comes to the number of residents considered acceptable for "group therapy" under Medicare. The loosened definition is part of the proposed fiscal year (FY) 2020 payment rule for SNFs recently issued by the US Centers for Medicare and Medicaid Services (CMS), a plan that also includes an overall 2.5% payment increase.

    Currently, treatment of 4 patients performing same or similar activities qualifies as "group therapy" for purposes of Medicare payment in SNFs. The proposed FY 2020 rule—which would go into effect on October 1, 2019—would allow qualified rehabilitation therapists including physical therapists (PTs) to form groups with as few as 2 and as many as 6 patients. The change would make SNF group therapy rules more consistent with other care settings and "create opportunities for site-neutral payments," according to a CMS fact sheet on the proposed rule.

    "The expanded definition of group therapy is very much in line with APTA's ongoing effort to advocate for the value of the PT's clinical judgment by allowing for more clinical flexibility in determining the most appropriate number of participants in a particular group," said Kara Gainer, APTA's director of regulatory affairs. "The change makes sense in terms of both payment and providing appropriate patient care."

    The proposed rule would also boost payments to SNFs by about $887 million in FY 2020, with average increases varying depending on, among other things, the location of a particular SNF: facilities in urban areas would likely receive a 1.8% increase on average, while SNFs in rural areas could average a 6.4% increase.

    PDPM System Moves Ahead—and Aims to Keep Up With ICD-10 Tweaks
    As anticipated, the proposed rule proceeds with implementation of the Patient-Driven Payment Model (PDPM). The model is based on a resident's classification among 5 components (including physical therapy) that are case-mix adjusted, and employs a per diem system that adjusts payment rates over the course of the stay. APTA has developed a number of resources on PDPM.

    The CMS proposal also would allow the agency to use a "subregulatory" process to keep up with nonsubstantive updates to the ICD-10 codes used in PDPM, while substantive changes will be made through the traditional notice-and-comment rulemaking process. CMS writes that the change would "help ensure SNFs have the most up-to-date ICD-10 code information as soon as possible, in the clearest and most useful format."

    Patient Assessment and Quality Reporting Data Requirements Expand
    Also not much of surprise—CMS is proposing to continue its efforts to standardize patient assessment data collection across postacute care settings as required by the 2014 IMPACT Act.

    Similar to its proposed FY 2020 rule for inpatient rehabilitation facilities (IRFs), CMS plans to require SNFs to report resident data on admissions and discharges in the following areas: cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidity; impairment; and a new category—social determinants of health. SNFs have been reporting on some components of these areas since 2018, mostly related to function, pressure wounds, and skin integrity.

    In another proposed change that echoes the rule being considered for IRFs, the SNF Quality Reporting Program (QRP) would increase from 11 to 13 measures, adding assessments related to transfers of current reconciled medication lists at resident discharge or transfer; as well as the transfer of a similar list to the patient/resident, family, or caregiver upon discharge from a postacute facility.

    The proposed rule also requires SNFs to collect and submit minimum data sets (MDS) on all SNF residents regardless of payer, a change that CMS says "may create additional burden" but would "ensure that Medicare residents are receiving the same quality of SNF care as other residents." As for MDS reporting related to post-hospital SNF care, the proposed rule clarifies that the "5-day assessment" requirement must be completed no later than the eighth day of the SNF stay, and that the requirement will go under a new name—"initial patient assessment"—beginning in FY 2020.

    Amid all the additional requirements, CMS is proposing 1 reduction: baseline nursing facility residents would be excluded from the QRP related to discharge to community.

    What APTA's Doing—and What You Can Do
    The association will submit comments on the proposed rule by the June 18, 2019, deadline. Interested PTs, PTAs, students, and other stakeholders also are invited to provide comments, and will be able access information on how and where to submit comments at APTA's regulatory Take Action webpage in the coming days.

    Members with an interest in postacute care are also encouraged to join APTA's online postacute care community on The Hub. The community is a staff-administered collaborative space for members to ask questions, share information, and identify areas of opportunity in relation to the new postacute care payment methodologies and other CMS postacute payment reforms. If you are interested in joining this online community, please email Kara Gainer at karagainer@apta.org with “Join PAC Community” in the subject line and your member ID number in the body of the email.

    IRFs Could See 2.5% Increase From CMS in FY 2020; Additional Reporting Requirements in FY 2022

    If a proposed rule from the US Centers for Medicare and Medicaid (CMS) is adopted as planned, inpatient rehabilitation facilities (IRFs) will see a 2.5% payment increase in the 2020 fiscal year (FY), which begins October 1, 2019—an approximate boost of $195 million. But they'll also need to prepare for some expanded reporting measures in the years to come—including a requirement to report data on social determinants of health (SDOH).

    Reporting requirements wouldn't change much in fiscal year (FY) 2020 (beginning October 1, 2019). However, beginning with the FY 2022 IRF Quality Reporting Program (QRP), IRFs would be required to provide certain standardized patient assessment data (SPADE) to CMS. The additional SPADE requirements are aimed at bringing IRFs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care (PAC) settings.

    Beginning in the 2022 fiscal year, IRFs would be required to report patient data on admissions and discharges dating back to October 1, 2020, in the following areas: cognitive function and mental status; special services, treatments, and interventions; medical conditions and comorbidity; impairment; and a new category—social determinants of health (SDOH). IRFs have been reporting on some components of these areas since 2018, mostly related to function, pressure wounds, and skin integrity.

    The new SDOH would gather data on race, ethnicity, preferred language, interpreter services, health literacy, transportation, and social isolation—factors that CMS writes "[have] been shown to impact care use, cost, and outcomes for Medicare beneficiaries."

    CMS also wants to introduce 2 new process measures; one having to do with whether a provider receives a current reconciled medication list at discharge or transfer, and another relating to whether the patient, family, or caregiver receives a similar list upon discharge from a PAC setting.

    Among other elements of the proposed rule:

    The compliant IRF list may go. CMS is proposing to stop publishing a list of compliant IRFs on the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP) website.

    Reporting for some baseline nursing facility residents would decrease. Specifications of the discharge-to-community PAC measure would be altered to exclude baseline nursing facility residents.

    IRFs could make the call on who's considered a "rehabilitation physician." The proposed rule would loosen the definition of "rehabilitation physician," allowing individual IRFs to make the determination. At the same time, CMS is seeking comments on refining the definition in light of the proposed change.

    As is typical, CMS is also seeking input on several areas not related to specific impending rule changes for FY 2020, including stakeholder comments on pain interference on sleep, therapy activities, and day-to-day activities—provisions that CMS is considering adding in light of the opioid crisis. The agency also seeks general feedback on possible additional SPADE data elements including dementia, bladder and bowel continence, care preferences, advance care directives and goals of care, caregiver status, veteran status, health disparities and risk factors, and sexual orientation. Potential measures CMS would like feedback on include assessments related to opioid use, and frequency and exchange of electronic health data as well as interoperability.

    APTA will submit comments on the proposed rule by the June 17 deadline. To weigh in on the proposed rule, check out APTA's regulatory "Take Action" webpage in the coming days for information on how and where to submit comments.

    CMS Adds to DMEPOS Prior Authorization List

    Physical therapists (PTs) who are providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) will see an expansion of the range devices that require prior authorization under Medicare, when the US Centers for Medicare and Medicaid Services (CMS) adds 12 more items to its list beginning July 22 of this year.

    Seven of the 12 new codes are related to power mobility devices, with the additional 5 related to pressure-reducing support surfaces. The additions follow last year's introduction of 31 DMEPOS items that CMS moved to a nationwide preauthorization system. Prior to that, the preauthorization policies for those devices were limited to a demonstration project in 18 states.

    CMS also added 4 new items to the master list of DMEPOS that are considered frequently subject to unnecessary use, including a particular back brace (L0650). CMS uses the master list to decide which items it will add to the prior authorization list.

    CMS offers a webpage focused on the DMEPOS prior authorization program and has published a notice and list of the 12 codes to be added. A full list of DMEPOS requiring prior authorization is also available from CMS. APTA offers more resources at its DMEPOS webpage as well as through a clinical mobility device documentation guide.

    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.