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  • OSHA Responds to APTA by Affirming the PT's Role in First Aid

    When it comes to workplace injury, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART): that's the bottom-line message from the US Department of Labor Occupational Safety and Health Administration (OSHA) in response to APTA’s request for OSHA clarification on the subject. The OSHA response definitively establishes physical therapists (PTs) among the providers able to perform soft tissue interventions that constitute first aid in work settings.

    The OSHA clarification is a response from a February 2019 meeting secured by APTA government affairs staff in partnership with the APTA Academy of Orthopaedic Physical Therapy’s Occupational Health Special Interest Group and the APTA Private Practice Section. It clears up a previously foggy area of agency regulation involving what is and isn't considered "medical treatment beyond first aid" in the workplace—an important distinction for OSHA, as any treatment beyond first aid must be reported as a work-related injury or illness.

    While the regulations state that "using massages" is considered first aid, APTA pointed out that previous OSHA guidance recognizing ART as a soft tissue intervention led some employers to mistakenly believe that only ART-certified individuals could provide “massage.” APTA asked OSHA to confirm in writing that soft tissue management is considered first aid when it is performed by individuals who do not have ART certification—including non-ART-certified PTs.

    OSHA did just that.

    "OSHA considers the treatments listed in…the regulation to be first aid regardless of the professional status of the person providing the treatment," writes Amanda Edens, director of OSHA's Directorate of Technical Support and Emergency Management. "Even when these treatments are provided by a physician or other licensed health care professional, they are still considered first aid for purposes of [the regulation in question]." Edens went on to state, “Accordingly, soft tissue massage is first aid whether or not such treatment is performed by individuals with ART certification.”

    The letter from OSHA also made it clear that the approach to recording soft tissue injuries and illnesses is the same as any other type of injury or illness, meaning that work-related injuries and illnesses "involving muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs" do in fact meet the general recording criteria if they involve medical treatment beyond first aid, days away from work, transfer, or restricted work.

    "Although this may seem like a minor clarification, it's a great win for PTs," said Kara Gainer, APTA director of regulatory affairs. "It's another affirmation that PTs play a valuable role in workplace health and safety, and can be an important part of employer prevention and wellness teams."

    Want more on the potential for PTs to contribute to population health in the workplace? Check out APTA's webpage "The PT's Role in Promoting a Productive and Healthy Workforce."

    From PT in Motion Magazine: The Power of Adaptive Sports

    Adaptive sports are on the move as a popular way for individuals with physical disabilities to reclaim—and, sometimes discover—their love for physical activity. Do physical therapists (PTs) and physical therapist assistants (PTAs) need to catch up?

    In "The Competitive Edge of Adaptive Sports," featured in the June issue of PT in Motion magazine, Associate Editor Eric Ries examines the ways participation in the modified sports has changed the lives of several individuals—some of whom are PTs—who believed their injuries would forever prevent them from taking part in their favorite activities, such as basketball, cycling, and surfing. When they discovered the possibilities available through adaptive sports programs and leagues, a world they thought was closed to them was reopened.

    However, despite the growing prominence of adaptive sports, many feel that PTs and PTAs are behind the curve when it comes to having sufficient experience and understanding to help patients participate in the programs, according to the article.

    "Still in its infancy" is how Katie Lucas, PT, DPT, chair of the APTA Academy of Sports Physical Therapy's Adaptive Sports Special Interest Group, describes the profession's role in adaptive sports to PT in Motion. "There's a lot of room for growth in research and in terms of identifying and taking advantage of all the ways in which adaptive sports fit into physical therapist practice, enhance wellness, and expand opportunities for patients."

    The article plumbs the possible reasons behind the general lack of awareness, with PTs familiar with adaptive sports offering ideas for changes in physical therapy education programs that would familiarize students with the potential value of the programs. Some of those changes could be as simple as merely exposing students to an adaptive sporting event, they say, but the payoff could be significant for patients and providers.

    Maria Thomassie, PT, DPT, can attest to the benefits of understanding adaptive sports. She tells PT in Motion that being involved in adaptive sports has shed light on "how far we've come in creating an accessible world but how much further we have to go," adding that "there are insights to be gained by PTs and PTAs regardless of practice area."

    "The Competitive Edge of Adaptive Sports" is featured in the June issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: "Let Her Roll," a look at how PTs help roller derby athletes compete in the rink.

    Move Forward Radio: Individuals Who Are Transgender Deserve Person-Centered Care – Just Like Everyone Else

    Sometimes the journey toward better health must begin at the beginning—with an actual acknowledgement that there's a problem, and a sense of self-worth strong enough to allow a person reach out for help. Just ask "Greg," a transgender man who endured pelvic pain for years.

    "My body was, for me, this thing that I fed, and got it in a car, and drove places, and it did the work I wanted it to do," Greg said. "Because I spent so much of my life feeling betrayed by it, it was just this thing I didn't want to pay attention to."

    That all changed when he met Hannah Schoonover, PT, DPT.

    Now available on Move Forward Radio: a conversation with Greg and Schoonover, the physical therapist (PT) who helped Greg see his body—and his connection to it—in a new way. The podcast is a must-listen for anyone seeking a better understanding of not just the challenges faced by the transgender population, but the importance of providers honoring the individual stories every patient brings to the clinic.

    The episode, hosted by PT in Motion magazine associate editor Eric Ries, follows Greg's initial reluctance to seek treatment for pelvic pain, his tentative first steps with Schoonover, and, finally, the development of a strong therapeutic alliance that brought relief—and helped Greg embrace a body he once viewed with disdain. Schoonover and Greg talk about the ways in which pelvic floor physical therapy can address pain, but they also discuss the obstacles to care that can arise when providers see patients simply as a collection of symptoms.

    Schoonover believes that health care providers need to understand that trauma plays a particularly powerful role among individuals who are transgender—and that this can deter them from seeking care.

    "Their experience is going to be different," Schoonover tells Ries. "There's going to be more sexual assault, there's going to be more violence, there's going to be more discrimination, more bias." That understanding is at the heart of Schoonover's Washington, DC, clinic, Body Connect and Wellness, which specializes in physical therapy for the transgender community. The clinic's baseline is that "all bodies are good bodies, and we're going to make sure that all bodies feel the way they're supposed to feel," she explains.

    It's a philosophy that has made a difference in Greg's life.

    "I'm feeling more open, I'm feeling more confident in my body," Greg says in the podcast. "We carry around emotional pain and we don't think it affects our bodies, but it does."

    Move Forward Radio is hosted at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes, Google Play, or Spotify.

    5 Ways to Get Up to Speed on Interprofessional Health Care in Education and Practice

    Working across health care disciplines isn't a pipe dream: it's an increasingly important fact of professional life for physical therapists (PTs) and physical therapists assistants (PTAs). And physical therapy education programs are helping future PTs and PTAs respond to this reality by adapting curricula to respond to an increasingly collaborative health care environment.

    In honor of National Interprofessional Health Care month, APTA has refreshed its resources on interprofessional practice and education, offering a range of perspectives on the topic. From research papers to PT in Motion magazine feature articles, there's a little something for everyone.

    Don't know where to start? Here's a basic roadmap for getting yourself familiar with the issue, all drawn from the APTA Interprofessional Education and Collaborative Practice Resources webpage.

    1. Get an understanding of what interprofessionalism takes.
    APTA and many other professional health care organizations anchor their approach to interprofessional education and practice in the core competencies developed by the Interprofessional Education Collaborative (IPEC). IPEC developed a document that clearly lays out 4 main competencies and related sub-competencies that are necessary for success.

    2. Find out how you're doing.
    Understanding the skills needed to be effective in interprofessional behaviors isn't the same thing as actually engaging in those behaviors. This assessment instrument from the Interprofessional Professionalism Collaborative can help you get a clearer view of the extent to which you live out interprofessional values in your day-to-day work.

    3. Keep up with the latest developments.
    The National Academies of Practice (NAP) is a leader in the promotion of interprofessional health care and home to the Journal of Interprofessional Education & Practice. Find out what's happening across disciplines, and visit individual academies member microsites—including 1 for physical therapy.

    4. Dive deeper into physical therapy's role in interprofessional practice.
    The National Interprofessional Education Consortium (NIPEC), sponsored by the American Council of Academic Physical Therapy (ACAPT), is designed as a resource for faculty at ACAPT member institutions; however, NIPEC's website contains plenty of information available to everyone, including assessments, development resources, and webinars—all specifically aimed at how physical therapy integrates with crossdisciplinary collaboration.

    5. Explore how the next generation of PTs and PTAs are being prepared for interprofessionalism.
    Physical therapy education programs are taking creative steps to hone the crossdisciplinary collaboration skills of their students. ThisPT in Motion magazine article describes how PT and PTA students are working with, and benefitting from, students and clinicians from other professions both in the classroom and in their clinical internships.

    Congressional Roundup: What's on APTA's Legislative Advocacy Radar

    Believe it or not, there's much more going on in Washington, DC, than the stuff that becomes fodder for late-night talkshow hosts. Important legislation is being considered, and APTA and its members are there to advocate for changes that help the physical therapy profession's ability to deliver patient-centered care, and improve patient care overall.

    Here's a roundup of recent federal legislative activity on APTA's radar.

    Better coverage for kids under Medicaid is now law.
    On April 18, President Donald Trump signed a law that includes APTA-supported provisions to expand a state option for health homes for children under Medicaid. That particular provision, known as the Advancing Care for Exceptional (ACE) Kids Act of 2019, is included the Medicaid Services Investment and Accountability Act of 2019 signed by Trump.

    The ACE Kids Act addresses existing challenges facing children with medically complex conditions by expanding access to patient-centered, pediatric-focused coordinated care models tailored for these children across multiple providers and services, and by easing access to out-of-state care.

    The legislation builds off of current law to establish specially designed health homes for children with medically complex conditions beginning Oct. 1, 2022. Participation is voluntary for children and their families, providers and states; however, states that opt to create these health homes will receive a higher federal matching rate for 6 months.

    The broader legislative package also provides $20 million for the Money Follows the Person demonstration for fiscal 2019. The demonstration is aimed at transitioning Medicaid beneficiaries from facilities to community-based long-term support services.

    A bill to end the physician self-referral loophole under Medicare is back.
    Reps Jackie Speier (D-CA) and Dina Titus (D-NV) have introduced a bill, known as the Promoting Integrity in Medicare Act (PIMA) of 2019 (HR 2143), that seeks to close Medicare self-referral loopholes for physicians. That loophole allows physicians to refer Medicare patients for physical therapy and other services to a business that has a financial relationship with the referring provider, a gap that has been a target of APTA advocacy efforts for several years.

    The proposed legislation would tighten up self-referral prohibitions under federal law (known as the “Stark Law”) to remove physical therapy, advanced imaging, radiation oncology, and anatomic pathology from the so-called "in-office ancillary services" exception. And it's not without supporters: in addition to APTA's advocacy for the change, previous versions of PIMA have received support from AARP and the Alliance for Integrity in Medicare, a coalition that includes APTA. The 2019 PIMA has been referred to the House Energy and Commerce Committee as well as the Ways and Means Committee.

    Student debt relief options are being considered again.
    It's back: APTA-supported legislation that would list 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).

    And that's not all—by a long shot.
    APTA's government affairs staff is tracking and speaking out in support of multiple pieces of legislation at various stages of consideration, all of which are consistent with the association's recently adopted public policy priorities.. [Editor's note: want to know how you can get involved in advocacy? Be sure to sign up for APTA’s PTeam, a vital grassroots link to APTA's work on Capitol Hill. All PTeam members receive a quarterly newsletter on legislative activity on Capitol Hill as well as Legislative Action Alerts on federal legislative issues. The alerts let you know when you to contact your members of Congress on particular issues of concern to your patients and the physical therapy profession.]

    These include:

    IDEA Full Funding Act (HR 1878/S 866). This bill would increase spending over the next decade to bring the federal share of funding for special education up to 40%, the amount committed when the law was first enacted in 1975.

    Critical Access Hospital Relief Act of 2019 (HR 1041/S 586). This legislation repeals the 96-hour physician certification requirement for inpatient critical access hospital services under Medicare.

    Lymphedema Treatment Act (HR 1948/S518). The bill provides for the coverage of lymphedema compression treatment items under Medicare.

    Disability Integration Act of 2019 (HR 555/S 117). The proposal would prohibit discrimination against individuals with disabilities who need long-term services and supports.

    Home Health Payment Innovation Act of 2019 (S 433). The bill would require Medicare to implement adjustments to home health reimbursement rates only after behavioral changes by home health agencies that affect Medicare spending actually occur, instead of assuming changes might happen.

    Community and Public Health Programs Extension Act (S 192) This bill provides funding extensions for community health centers and the National Health Service Corps through 2024.

    Improving Access to Medicare Coverage Act of 2019 (HR 1682/S 753). The proposal would define an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the 3-day inpatient hospital-stay requirement related to Medicare coverage of skilled nursing facility services.

    PHIT Act of 2019 (HR 1679/S 680). The PHIT (Personal Health Investment Today) Act would allow a medical care tax deduction for up to $1,000 ($2,000 for a joint return or a head of household) of qualified sports and fitness expenses per year. The bill defines "qualified sports and fitness expenses" as amounts paid exclusively for the sole purpose of participating in a physical activity, including fitness facility memberships, physical exercise or activity programs, and equipment for a physical exercise or activity program.

    Concussion Awareness and Education Act of 2019 (HR 280). This legislation provides for research and dissemination of information on sports-related and other concussions, and establishes a Concussion Research Commission.

    Mobile Health Record Act of 2019 (HR 1390) This bill requires CMS to establish a program that enables Medicare enrollees to connect claims data with "trusted applications, services, and research programs." The program must allow an enrollee to access claim information through a mobile health record application that is chosen by the enrollee and approved by CMS.

    Geriatrics Workforce Improvement Act (S 299). The proposed law would reauthorize the Geriatric Workforce Enhancement Program (GWEP), which provides grants to geriatric education centers to educate and train health care professionals in the care and treatment of older people. The bill would extend the GWEP for another 5 years, with authorized funding increased to $45 million per year.

    Home Health Care Planning Improvement Act of 2019 (HR 2150/S 296). This proposal would allow Medicare payment for home health services ordered by a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant. Currently, coverage is provided only for services ordered by a physician.

    Rural Hospital Regulatory Relief Act of 2019 (S 895). The bill would create a permanent extension of instructions issued by CMS to not enforce the supervision requirements for therapeutic services provided to outpatients in Critical Access Hospitals and small rural hospitals. Those instructions are set to expire on December 31, 2019.

    Veterans' Access to Child Care Act (HR 840). This bill would provide child care assistance to veterans receiving certain medical services and includes a provision to include Deparmtnet of Veterans Affairs-provided physical therapy for a service-connected disability.

    Protecting Access to Complex Rehab Manual Wheelchairs Act (HR 2293). This proposal would permanently exempt complex rehab manual wheelchairs from the Medicare Competitive Bidding Program and also would stop Medicare from applying competitive bidding payment rates to critical components (accessories) of complex rehab manual wheelchairs for 18 months.

    There's more to come.
    APTA is awaiting introduction of key legislation later this summer that would expand the use of telehealth under Medicare to include physical therapy, and a bill that would add PTs as primary health care providers in community health centers. To receive information and legislative action alerts, sign up for PTeam today and download the APTA Action App on your mobile phone.

    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.

    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.

    Statehouse Roundup: Licensure Compact Progress; Chapters Press for Changes to Direct Access, Pain Management Policy, Payment, and More

    Providing all goes as hoped during current state legislative sessions, the Physical Therapy Licensure Compact could pass the halfway mark in its progress toward adoption in every state, with a potential for 28 states to be participating in the system that allows physical therapists (PTs) and physical therapist assistants (PTAs) licensed in 1 compact state to obtain practice privileges in others.

    "Thanks to the hard work of APTA state chapters and state licensing boards, we've been able to keep up the momentum around the compact," said Angela Shuman, APTA's director of state affairs. "As more states join, it will make the case even stronger for the remaining non-compact states to sign on."

    Compact bills are now being considered in Georgia, Maryland, Massachusetts, Michigan, Nevada, and Pennsylvania. If the legislation is successful, those states will join 23 others already in the system: Arizona, Arkansas, Colorado, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, and West Virginia.

    But that's not all that's been going on at the state level during an extremely active legislative season. Here's a roundup of other activity:

    Practice

    • Direct access. Efforts to expand direct access to physical therapist (PT) services and remove restrictions on existing laws continue, with Wyoming becoming the 19th state to adopt unrestricted direct access—"a very, very big win," according to Shuman. Other states that are considering positive direct access changes include Alabama, Indiana, Missouri, North Carolina, South Carolina, and Texas.
    • Dry needling. Legislation is being considered in Hawaii, New Jersey, and Washington that would lift prohibitions on dry needling by qualified PTs, while advocates in Indiana are seeking to include the treatment as part of a sweeping revision of the physical therapy practice act. Meanwhile, PTs and supporters in Nevada are fighting an attempt to make dry needling the exclusive practice of oriental medicine practitioners.
    • Telehealth. "There's a lot going on right now related to telehealth," Shuman said. "State legislatures are considering everything from changing practice standards that would increase telehealth options for all health providers to legislation that would require insurers to cover remotely delivered services in the same manner they cover in-person visits." States that are considering other changes include Florida and South Dakota, which are debating the adoption of statewide telehealth standards; and North Dakota, where the legislature is asking the governor sign a bill that adds a definition of telehealth to the physical therapy practice act.
    • Concussions. Bills to add PTs as providers authorized to remove student athletes from activity due to a concussion, as well as make return-to-activity decisions, are being considered in Colorado, Massachusetts, and Texas. A similar change in West Virginia already has been signed into law.
    • Disability determinations. PTs in Florida and Texas soon may be permitted to make disability determinations for license plates and placards; the provision is now law in Minnesota.
    • PTA Issues. Montana is considering a law that would allow PTAs to be supervised through telecommunications, while New York is looking to change the status of PTAs from "certified" to a licensed profession. In North Dakota, a bill that changes supervision requirements for assistive personnel has been sent to the governor to be signed into law.
    • Mandatory reporting. Legislators in Michigan are considering including PTs and PTAs as mandatory reporters of suspected child abuse.

    Payment and referral

    • Copays and patient cost-sharing. Four states—Georgia, Rhode Island, New Mexico, and New York—are moving on legislation that would set limits on out-of-pocket patient costs, with New Mexico's bill already on the governor's desk.
    • Utilization management and other insurance issues. Lawmakers in California, Michigan, Washington, and Oregon are considering changes that would decrease unnecessary delays in care caused by prior authorization and other utilization management practices by insurance companies. The California legislation focuses on workers' compensation.
    • Medicaid. PTs and supporters in Iowa are fighting a proposal to implement multiple procedure payment reduction (MPPR) in Medicaid, while legislators in Maine are looking at improving provider reimbursement for physical therapy.
    • Tax breaks for PTs. It isn’t payment per se, but a move that would keep more money in the pockets of PTs and PTAs: New Mexico may adopt a law that would provide state tax credits for PTs and PTAs working in rural areas.
    • Referral sources. Oklahoma is considering a change that would allow nurse practitioners to make referrals to physical therapy; North Dakota and South Carolina are discussing similar legislation that would apply to physician assistants.

    The Opioid Crisis

    • Nonpharmacological approaches to pain management. "There's so much going on in this space at so many levels," Shuman said, "but the trend is definitely toward changes that increase patient access to nonopioid and nondrug options for pain."

      Several APTA chapters have been directly involved in policy discussions, including in Connecticut, which is establishing guidelines for nonpharmacological pain treatments that include physical therapy; and Minnesota, which is considering a bill that would direct a new Health Services Policy Committee to seek consultation with PTs as it develops recommendations on pain management. In Tennessee, changes are being considered that would add physical therapy as an "alternative treatment" that prescribers may discuss with patients before prescribing opioids, while in Indiana, lawmakers are considering requiring certain health insurers to include physical therapy as a medically necessary (and thus covered) service in the treatment of chronic pain.

    Practice acts, licensing boards, and the National Physical Therapy Exam (NPTE)

    • Improving terms and protecting titles. Terms such as "PT," "DPT," "physiotherapy," and "doctor of physical therapy" could be reserved for the exclusive use of PTs in Alaska and Indiana if legislation moves ahead in those states. North Dakota has sent a similar bill to its governor to be signed into law.
    • Licensing boards. PTs could be getting better representation and autonomy in the state regulatory arena. Indiana is looking at moving away from its current regulatory system based on a physical therapy committee under the state's medical board and toward a freestanding board of physical therapy. Connecticut and North Dakota are making changes to the composition of their physical therapy boards, with Connecticut possibly eliminating rules that require a physician to be a member of the board and North Dakota reducing physician board members from 2 to 1—and adding a PTA member. The North Dakota bill is now on the governor's desk.
    • The NPTE. Indiana, South Carolina, and North Dakota are discussing imposing a lifetime limit of 6 NPTE attempts, while Utah, Pennsylvania, and South Carolina are considering changes that would allow PT students to take the NPTE before they graduate.

    Your Help Needed to Guide Movement System Integration

    APTA is leading the way in advancing the integration of the movement system as the core of physical therapist (PT) practice, education, and research. Now the association needs input from you to take an important next step: making the crucial leap from the conceptual to the practical through the development of a movement system diagnosis framework and movement screen.

    Draft diagnosis and screening templates have been created by the Movement System task force and work groups, and APTA would like you to take them for a test drive and provide your comments by the June 1, 2019, deadline.

    "We're at an exciting point in the evolution of the movement system concept and now need the widest possible stakeholder input," said Sue Whitney, PT, PhD, APTA Board of Directors member and chair of the Movement System Task Force. "Many PTs have been incorporating movement system concepts into their practice and teaching for some time now, but the development of these diagnosis and screening resources has the potential to accelerate the adoption of these concepts across the profession. That's why participation in the review and comment process is so critical—with the development of a repository of movement system diagnoses and the development of the screening templates, we hope to move the bar and create excitement about using the movement system in daily practice."

    Evaluation of each template involves a 2-step process. For the diagnosis template, reviewers are asked to submit an example of a movement system diagnosis using a specially developed online form, and then provide feedback about the template itself. The movement screen—a tool that helps PTs identify patient movement impairments observed during functional tasks and activities so that they can pinpoint which additional tests and measures should be brought into play—doesn't need to be filled out, just reviewed and evaluated through an accompanying survey. Click here to view the templates and provide your feedback.

    Work toward the development of the movement system concept in the physical therapy profession began in 2013, when APTA adopted a new vision statement with guiding principles that characterized the system as "the foundation of optimizing movement to improve the health of society." The association produced a white paper on the movement system in 2015 and held a Movement System Summit in 2016 that brought together 100 thought leaders to discuss how best to integrate the system throughout all facets of the profession. Since then, members of APTA’s Movement System Task Force have been developing resources to make widespread integration a reality.

    Want to learn more about the movement system? Visit APTA's Movement System webpage for a history of the association's work.

    APTA Working for You: Practice-Related Updates, February 2019

    APTA brings the profession's insights and expertise to bear in a variety of settings. Here's a quick rundown of some of the latest news and APTA activities.

    Professional Issues

    • APTA helps the National Institutes of Health's (NIH’s) "Go4Life" exercise campaign spread the word about the benefits of exercise: APTA was featured on the Go4Life website for the strong ties between APTA and NIH's National Institute on Aging (NIOA). APTA Senior Staff Specialist Hadiya Green Guerrero, PT, DPT, a certified sports physical therapy specialist, is working with NIOA on consumer fact sheets about physical activity for people with musculoskeletal conditions.
    • Understanding of the APTA Physical Therapy Outcomes Registry continues to grow: APTA is working with US Department of Health and Human Services Office of the National Coordinator for Health Information (ONC) and professional societies toward standardization of elements of practice, a key concept for the Registry. APTA staff also are collaborating with professional organizations on getting electronic health records to understand certain standard data elements.
    • APTA is helping staff at the Medstar National Rehabilitation Hospital (NRH) better understand the elements of culturally competent practice: APTA Practice Department staff will emphasize APTA’s mission, vision, and strategic plan at an upcoming NRH event, and explain how being a culturally competent practitioner can improve outcomes and patient satisfaction.
    • A list of consumer questions on pain management is now part of the #ChoosePT online toolkit: APTA practice staff helped to create a set of questions on pain and pain management for patients to ask their providers. Those questions are now featured within the #ChoosePT toolkit.
    • Could primary care become the next APTA board-certified specialty? An APTA House of Delegates charge to explore the role of physical therapists on the primary care team is being pursued. Led by member John Heick, PT, DPT, PhD, board-certified clinical specialist in 3 different areas--orthopaedics, neurology, and sports—APTA is petitioning for primary care to be recognized as a board-certified clinical specialty area of practice by the American Board of Physical Therapy Specialties (ABPTS). Signatures are being collected now for the ABPTS petition.

    APTA at the Table

    • National Coalition for Promoting Physical Activity
      APTA representatives attended the National Coalition for Promoting Physical Activity’s congressional briefing promoting the release of the latest edition of the Physical Activity Guidelines for Americans. Hadiya Green Guerrero has been named to the coalition's board of directors.
    • National Institutes of Health
      Staff from APTA took part in a strategic planning session for NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases.
    • Movement is Life National Caucus
      APTA Director of Minority Affairs Johnette Meadows, PT MS, who serves on the Movement is Life national caucus steering committee, provided leadership on understanding health disparities at the group's most recent gathering.
    • Osteoarthritis Action Alliance (OAAA)
      APTA continues its participation in OAAA and is helping the alliance to promote the Arthritis Foundation's evidence-based self-directed "Walk With Ease" program guidebook on creating a community-based walking program for individuals with OA.

    Clinical Practice Guidelines: Updates

    • Adults With Neurologic Conditions
      The APTA Academy of Neurologic Physical Therapy (ANPT) has published an APTA-funded clinical practice guideline titled "A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation." APTA is working with the ANPT now on implementing the CPG and sharing resources that have been developed by the section.
    • Total Knee Replacement
      The American Academy of Orthopedic Surgeons (AAOS) is working with APTA practice staff to finalize action steps related to a clinical practice guideline on total knee replacement.The CPG will appear in an upcoming issue of PTJ (Physical Therapy) in 2019.

    Clinical Practice Guidelines: Resources

    APTA offers a wide range of resources for learning more about practice-related topics and staying connected. PTNow is a central source for evidence-based practice information including CPGs; other online resources include APTA's Annual Checkup by a Physical Therapist and Cultural Competence webpages. Members can stay connected by joining 1 or more APTA practice-related councils—the Council of Health Systems Physical Therapy, the Council on Prevention, Health Promotion, and Wellness, and Frontiers in Rehabilitation, Science, and Technology (FiRST) Council—and keep up with the latest practice-related news by subscribing to the Professional Issues and Evidence and Care editions of APTA's Friday Focus newsletter series to receive monthly compilations of practice-related news and resources. Questions? Email Practice-Dept@apta.org.