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  • Move Forward Radio: Former NBA All-Star Grant Hill Discusses Pain Management and Alternatives to Opioids

    As a 19-year player in the National Basketball Association (NBA), Grant Hill was no stranger to injury, both major and minor. Experiencing "aches and pains, bumps and bruises is kind of par for the course," he says.

    Now available from APTA's Move Forward Radio: a conversation with Hill, who describes his experience with injury, managing pain, and what he would do differently today. "We all have pain in some fashion. The most important thing is to educate yourself…about pain—how do you handle postsurgery? What are your rights as a patient?" With regard to opioids, he explains, "You have options."

    The 7-time all-star retired in 2013 after numerous ankle injuries and surgeries—and painful recoveries—over the course of his career. Hill is a strong proponent of nonopioid alternatives to pain management and is a spokesperson for Plan Against Pain, a national campaign that educates the public on the availability of nondrug approaches to pain treatment postsurgery. As a player, he was prescribed opioids after surgery and for very painful injuries but says, "I didn’t like the way I felt." Hill tried to find alternative ways to treat his pain, including physical therapy. "Physical therapy has been an integral part of my career and my longevity" as a player, he says.

    He tells listeners: "Listen to your body. This is your body. This is your health. You don’t have to rely on opioids to deal with pain."

    Like Hill, APTA is raising public awareness about the risks of opioids and the benefits of physical therapy via its #ChoosePT campaign, which includes TV and radio public service announcements, national advertising, and free resources at MoveForwardPT.com/ChoosePT.

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

    Other recent Move Forward Radio episodes include:

    Recovery From Debilitating Abdominal Pain Inspires a New Career Path
    Michelle Griffith had severe abdominal pain that was undiagnosed—until she saw a PT, who discovered her nerve damage and guided her recovery. Now she is an aspiring PT student.

    Pain Does Not Discriminate, Even in Hollywood
    Karen Joubert, PT, DPT, shares some insights into the needs of her famous clients, how they benefit from physical therapy, and her universal, back-to-basics approach in treating all of her clients.

    Neonatal Abstinence Syndrome
    Bertie Gatlin, PT, DSc, Divya Rana, MD, and Kalyani Garde, OTR, discuss signs and symptoms, treatment in the hospital, and aftercare for infants born with neonatal abstinence syndrome (NAS), which occurs when an infant who was exposed to opiates through his or her mother experiences withdrawal after birth.

    Diastasis Recti Abdominis: The Likely Cause of "Mummy Tummy"
    Carrie Pagliano, PT, DPT, discusses diastasis recti abdominis during or after pregnancy, including misconceptions about the condition and her perspective on how women can work with PTs to correct the condition.

    Amplified Pain Syndromes: Treating a Pediatric Population
    Brandi Dorton, PT, DPT, and Misty Wilson, OTR/L, discuss the variety of tools and interventions they use to effectively treat individuals with increased sensitivity to pain, and help them improve and reclaim their lives.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org.

    Innovation 2.0 Learning Lab to Focus on PTs as Key Players in PCMHs to Address Childhood Obesity

    Managing childhood obesity in a patient-centered medical home setting is the fourth and final installment of APTA’s online Learning Labs series based on the Innovation 2.0 initiative. Interested members are invited to register for the interactive session, scheduled for December 15, 1:00 pm–4:00 pm.

    Like the first 3 labs, the January 18 event will enable participating APTA members to hear firsthand from the physical therapist innovators who were selected to pursue new, creative models of care. This fourth lab is your chance to hear from your colleagues about working in a patient-centered medical home (PCMH).

    In this innovative health care model, the physical therapist (PT) plays a key role in measurements of obesity-related signs and symptoms that affect the human movement system, including aerobic fitness and strength deficit, lower extremity joint pain, gait dysfunction, and motor control deficit. The PT also evaluates and monitors children's physical activity and sedentary behaviors, and is trained in behavioral strategies to enhance physical activity and parental support. The model measures cost-effectiveness by tracking incidence of disease rates and hospitalization for obesity-related conditions.

    Referrals to specialists (such as PTs when a cluster of impairments appear that indicate a movement disorder associated with obesity) are coordinated so that appropriate care is received. Regular follow-ups document progress and help the young patients and their families with self-management. This model also could provide support for including PTs in PCMHs that target other chronic health conditions that affect movement.

    The Learning Lab is a free online event intended as an advanced experience for providers who are currently active in innovative programs or ready to explore them. Participants will be expected to actively engage in the lab session, and materials will be provided beforehand to help them do so. If that’s you, visit the Innovation 2.0 webpage and scroll to the "Learning Lab" section to register.

    APTA will post a recording of the event afterward, which also will include the prerecorded presentation and downloadable template—all free to APTA members.

    Visit the Innovation 2.0 webpage to register for the PTs as Key Players in a PCMH Program for Childhood Obesity Learning Lab. For details on all of the projects selected for development, as well as projects that received honorable recognition, go to Innovation 2.0 Background. Profiles of each project were also featured in a September 2015 article in PT in Motion magazine.

    Move Forward Radio: Pain Does Not Discriminate, Even in Hollywood

    Karen Joubert, PT, DPT, treats patients of all ages and levels of fitness and ability—those recovering from injury and those seeking to maintain healthy lifestyles. But with an office in Beverly Hills, California, her clientele also happens to include famous entertainers and big-name athletes.

    Whether it is maintaining peak athletic performance for tennis superstar Serena Williams or achieving top fitness and stamina for Cher, Joubert says her physical therapist (PT) services provide a “back-to-basics” approach for all of her clients, celebrities and noncelebrities alike. “You don’t need expensive machines,” insists Joubert.

    “Everyone is unique; everyone has different goals,” Joubert notes, but reaching them “takes focus; it takes discipline.”

    Now available from APTA's Move Forward Radio: a conversation with Joubert, who shared her insights on the implications of living longer and “pushing our bodies harder” and described what she learned from swimmer Diana Nyad, who, at age 64, swam from Cuba to Florida without a shark tank after physical therapy for a rotator cuff injury.

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

    Other recent Move Forward Radio episodes include:

    Neonatal Abstinence Syndrome
    Divya Rana, MD, Bertie Gatlin, PT, DSc, and Kalyani Garde, OTR, discuss signs and symptoms, treatment in the hospital, and aftercare for infants born with neonatal abstinence syndrome (NAS), which occurs when an infant who was exposed to opiates through his or her mother experiences withdrawal after birth.

    Diastasis Recti Abdominis: The Likely Cause of “Mummy Tummy”
    Carrie Pagliano, PT, DPT, discusses diastasis recti abdominis during or after pregnancy, misconceptions about the condition, and how women can work with PTs to correct the condition.

    Amplified Pain Syndromes: Treating a Pediatric Population
    Brandi Dorton, PT, DPT, and Misty Wilson, OTR/L, discuss the variety of tools and interventions they use to effectively treat individuals with increased sensitivity to pain, and help them improve and reclaim their lives.

    Five Domains of Sustainable Health
    Jennifer Gamboa PT, DPT, describes how her team of collaborative health care providers approaches sustainable health through 5 domains—because when it comes to total health, diet and exercise are just part of the equation.

    Living With Ehlers-Danlos Syndrome
    Victoria Graham, a beauty pageant champion, describes how she manages her constant pain, which has involvedphysical therapy, medication, and multiple surgeries.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org.

    From PT in Motion: Going 'Fixer Upper' on Your Clinic

    You have the right team, the right tools, and the right training to serve your patients. But is the clinical space you're offering making the most of those assets?

    This month's issue of PT in Motion magazine includes a feature article on how physical therapists (PTs) are rethinking the design of their clinics, from a University-sponsored overhaul of a 10,000-square-foot facility to an individual PT (and his brother) rehabbing an old tire store into a state-of-the-art space.

    "Physical Therapy By Design" explores the ways PTs have created patient-centered layouts that combine functionality with aesthetics to make their clinics welcoming and efficient. Sometimes working in partnership with architects, sometimes working alone, the PTs interviewed for the article have at least 1 thing in common: a willingness to question old assumptions about how a physical therapy clinic should look.

    The article includes examples of design changes both big and small—from moving walls to adding PT equipment baskets containing scissors, tape, goniometers, and the like at every bed. A second piece provides basic tips on what to think about when you begin considering a redesign.

    "Physical Therapy by Design" is featured in the October issue of PT in Motion and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Registry to Collect Torticollis Data Through Collaboration With Academy of Pediatric Physical Therapy

    APTA's Physical Therapy Outcomes Registry (Registry) has taken another step in the development of resources that will provide "a continuous feedback loop" for the physical therapy profession—this time, by way of a clinical "module" focused on torticollis.

    Recently the association signed an agreement with the Academy of Pediatric Physical Therapy to collaborate on the creation and integration of a congenital muscular torticollis module within the Registry. The module will be based on the academy’s clinical practice guideline on the topic.

    In Registry terminology, a “module” is a set of data elements that describe and risk-adjust process-of-care and clinical outcomes for a defined patient population. These condition- or disease-specific data elements are based on evidence-based clinical practice guidelines and will help refine the way outcomes data is analyzed and interpreted for specific populations. Modules will build on the current functions of the Registry, which collects a core set of patient and outcomes data from an electronic health record.

    The torticollis module will include more granular information, such as description of the type of cranial deformity, right side or left side of the head, and torticollis severity, among other factors. Analyzing a large amount of this data will help describe typical physical therapist practice patterns, variations in care, and the effectiveness of physical therapy interventions in different types of patients—all key elements in the Registry's mission to amass outcomes data to inform practice and enhance research.

    “This is the Registry’s first module agreement with an APTA section, and we look forward to more such collaborations in the future,” said James Irrgang, PT, PhD, ATC, FAPTA, scientific director of the Registry’s Scientific Advisory Panel. “The process of care and clinical outcomes data from modules will provide a continuous feedback loop not only for physical therapists but for guideline developers.”

    APTA is working with other sections to develop guideline-based modules in other areas, such as shoulder pain and neck pain.

    For more information about participating in the Physical Therapy Outcomes Registry and how sections can play an integral role in module development, visit www.ptoutcomes.com.

    You Down With QPP? Watch and See (And Take the Quiz)

    Medicare payment is poised to change in big ways for physical therapists (PTs) in private practice. Are you ready?

    APTA can help. Since late 2015, the association has been rolling out new resources to help members prepare for what's coming down the pike as the US Centers for Medicare and Medicaid Services (CMS) implements its Quality Payment Program (QPP). The program already is significantly changing how some health care providers report to Medicare, and those changes likely will be required of PTs in the near future.

    The association's latest offering: a 4-minute video featuring Heather Smith, PT, MPH, APTA's director of quality, on reporting through MIPS and APMs, 2 of the biggest changes to how CMS will be doing business.

    Don't miss the video. But before you do, take this quick PT in Motion News quiz to find out just how much you know about what's happening. Consider it a kind of warm-up exercise—answers are at the bottom of this quiz. Also check out another quick questionnaire that looks at your readiness for payment reform in general.

    1. What does MIPS stand for?
    A. Meta-Inquiry on Performance Statistics
    B. Medicare-Implemented Payment Scale
    C. Madness-Inducing Participation Structure
    D. Merit-Based Incentive Payment System

    2. Successful participation in Advanced Alternative Payment Models (APMs) could result in a lump sum additional payment each year of how much?
    A. An amount equal to 2% of the previous year's fee-for-service payments
    B. An amount equal to 3% of the previous year's fee-for-service payments
    C. An amount equal to 5% of the previous year's fee-for-service payments
    D. An amount equal to 7% of the previous year's fee-for-service payments

    3. How soon can PTs expect to be required to participate in QPP?
    A. 2018
    B. 2019
    C. 2020
    D. They are required to participate this year

    4. Which MIPS performance category will include measures that were reported under the Physician Quality Reporting System?
    A. Advancing care information
    B. Improvement activities
    C. Cost
    D. Quality

    5. How high will MIPS noncompliance payment penalties be by 2022?
    A. 5%
    B. 7%
    C. 9%
    D. 12%

    6. True or false: clinicians participating in an advanced APM must continue to participate in MIPS.

    7. True or false: the Comprehensive Care for Joint Replacement model is considered an APM.

    8. To qualify as an approved APM, a program must require at least 50% of eligible clinicians to use certified electronic health record technology during the first year. What percentage is required in the second year?
    A. 50%
    B. 64%
    C. 70%
    D. 75%

    9. How can the APTA Physical Therapy Outcomes Registry help PTs participate in QPP?
    A. Participation in the Registry earns PTs points toward MIPS improvement activities.
    B. The Registry can package data for submission to MIPS.
    C. PTs are able to receive real-time feedback on their performance throughout the year.
    D. All of the above.

    10. True or false: QPP changes will be limited to only Medicare Part B for the forseeable future.



    1. Answer: D. It's the Merit-based Incentive Payment System, and although the change might spark the fear of madness among PTs, things may not be as dire as all that: PTs who report to PQRS already know how to do much of the quality reporting required by MIPS, and PTs can voluntarily participate in MIPS risk-free this year so they can hit the ground running when QPP participation becomes a requirement.

    2. Answer: C. When APMs succeed in reducing providers’ spending, they may receive a payment equal to 5% of the previous year's payments. The payments will be made 2 years after the performance period being evaluated.

    3. Answer: B. While not certain, there is a strong likelihood that PTs will be required to participate beginning in 2019.

    4. Answer: D. Data previously reported under PQRS will be included in the Quality category. The Cost category will contain new measures still being worked out by CMS; Improvement Activities will include elements such as practice access, population management, care coordination, and beneficiary engagement; and Advancing Care Information encompasses the former electronic health records (EHR) "meaningful use" program under PQRS. Although PTs weren't required to participate in the meaningful use under PQRS, they will be required to do so under MIPS—meaning if you haven't established a relationship with an EHR program, now would be a good time to start.

    5. Answer: C. CMS is not playing around. Penalties for noncompliance could be as steep as 9% by 2022.

    6. Answer: False. Clinicians can choose to participate in QPP either through MIPS or through participation in an APM—they don't have to do both; in fact, they have to choose 1 or the other.

    7. Answer: True – for the most part. One of the CJR tracks is an APM, along with several others listed on the CMS Centers for Medicare and Medicaid Innovation webpage.

    8. Answer: D. At least 75% of eligible clinicians must use certified EHR technology by the second year of operation.

    9. Answer: D. APTA's Physical Therapy Outcomes Registry is a storehouse, a data packaging service, and an ongoing feedback loop all in 1.

    10. Answer: False. Look for QPP provisions to spread to private payers—and probably sooner than you think.

    From PTJ: PTs Should Wake Up to Their Role in Promoting Sleep Health

    The old "you snooze, you lose" adage couldn't be further from the truth.

    Researchers are gaining more and more insight on the role of sleep in overall health, and physical therapists (PTs) should be equipped to help their patients and clients understand that role, according to authors of an article that provides guidance on basic screening tools and sleep hygiene education. In fact, authors argue, it's an especially important consideration for PTs, who often work with patient populations whose conditions are associated with sleep disruption.

    Appearing the August issue ofPhysical Therapy(PTJ), APTA's scientific journal available for free to all members, the "Perspective" article lays out some stark numbers: between 50 and 70 million adults in the US experience chronic sleep disturbances, and 62% of all Americans experience a sleep problem several nights a week—and it's likely those numbers are low, authors write, because estimates are that as many as 90% of sleep problems go undiagnosed. The problem is so pervasive that the US Centers for Disease Control and Prevention has designated insufficient sleep as a public health problem.

    Writing that sleep "has an important role in the proper functioning of most, if not all, body systems," authors explain sleep's role in immune function and tissue healing, pain modulation and perception, cardiovascular health, depression and anxiety, motor skill learning, and cognitive function. Among the physical therapy patient population, sleep disturbance can be an especially prevalent issue for individuals with Parkinson disease, Alzheimer's diseases, multiple sclerosis, spinal cord injury, neck and back pain, and postoperative status, among a host of neurological and orthopedic conditions, authors write.

    "It is suspected that the prevalence of sleep disorders and disturbances in physical therapy clients is very high, although studies are needed to verify this concentration," state the study's authors. "There is much opportunity for PTs to play an active role in providing sleep health education … and potentially reduce the onset of chronic conditions in addition to promoting sleep health in all clients."

    So what can the PT do? Authors suggest a multistep approach that begins with an assessment of overall sleep health and screening for the risk of a sleep disorder, with a referral for additional assessment if the PT finds increased risk. Additionally, PTs should provide "sleep hygiene education"—the basics of health sleep that include regular sleeping and waking hours, changes to diet to avoid eating large meals close to bedtime, and avoiding light-emitting electronics within 30 minutes of trying to sleep, among other tips (the entire sleep hygiene education list is included in the article).

    Authors write that PTs also should provide an appropriate exercise program that can help regulate sleep, and consider discussions about body positioning in bed, as well as bed mobility issues for clients where indicated.

    In addition to the sleep hygiene tip list, the article includes charts on suggested screening tools to assess for the 3 most common sleep disorders—chronic insomnia, obstructive sleep apnea, and restless legs syndrome—as well as questionnaires to help determine overall sleep quality and daytime sleepiness. Authors also discuss the use of wearable consumer electronics to track sleep, saying evidence supporting their reliability is slim but that they may be useful as a way to help individuals feel they have more control over regulating their sleep patterns.

    Authors of the study also argue that given the increasing weight of evidence showing the relationship of sleep to almost all facets of health, PT clinical education programs "should consider including information about sleep, screening for sleep disorders, and methods to optimize sleep in their curriculum."

    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.

    'Choosing Wisely' App Now Available

    Now it's easier than ever for consumers to make well-informed health care choices—including choices about physical therapist interventions.

    The American Board of Internal Medicine Foundation has unveiled the first "Choosing Wisely" app for iPhone (iPad and Android versions to follow soon), a tool that enables consumers and clinicians to access more than 500 specialty society recommendations on procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. The program was developed in partnership with Consumer Reports.

    Through the new app, clinicians and consumers will be able to search the recommendations using keywords and filter by specialty, age, setting, and service (for example, imaging, medication, treatment, lab, or test). Recommendations are linked to relevant patient-friendly resources, and information can be shared via text or email.

    APTA was the first nonphysician group to release a "Choosing Wisely" list in the fall of 2014, joining more than 50 medical specialty societies participating at the time. The 5 APTA recommendations, which are expanded upon with citations at the Choosing Wisely website and in the downloadable list of "5 Things Physical Therapists and Patients Should Question," are:

    • Don't use (superficial or deep) heat to obtain clinically important long-term outcomes in musculoskeletal conditions.
    • Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual’s abilities and goals.
    • Don’t recommend bed rest following diagnosis of acute deep vein thrombosis (DVT) after the initiation of anti-coagulation therapy unless significant medical concerns are present.
    • Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement.
    • Don’t use whirlpool for wound management.

    The process for developing the list began with an open call for APTA members to submit their lists of questionable procedures. After receiving more than 170 submissions, APTA convened an expert group of physical therapists from a wide range of practice settings and areas of clinical expertise. The group reviewed all nominations and conducted extensive literature reviews to narrow down the list to 9 procedures. The list of 9 was presented to the members of APTA, who voted on the final 5.

    APTA's participation in "Choosing Wisely" is part of the association's Integrity in Practice campaign to support the profession of physical therapy as a leader in the elimination of fraud, abuse, and waste in health care. The APTA Center for Integrity in Practice houses information on the "Choosing Wisely" program as well as a primer on preventing fraud, abuse, and waste, an online course on compliance and professional integrity, and other resources.

    APTA Launches New Nutrition Webpage

    Yes, there's a role for the physical therapist (PT) in helping patients understand how nutrition affects function, but there are nuances to be considered and no shortage of factors that could affect just how to fulfill that role. Fortunately, there's now an APTA webpage that helps PTs navigate the issues.

    New to the APTA website: "Nutrition and Physical Therapy," a webpage with a collection of resources that delivers context for APTA's position that it's the role of PTs to "screen for and provide information on diet and nutritional issues to patients, clients, and the community"—within the bounds of the PT's scope of practice. That means, among other things, that PTs wishing to provide information on nutrition need to be certain that they're doing so in ways that are consistent with state licensing laws for both physical therapy and nutrition services, and assess whether this ability is within their personal scope of practice.

    The webpage provides factors to consider related to the PT's role in nutrition and diet, including additional certifications that may be required, use of the designation "nutritionist," and when to refer a patient or client to a specialist for nutritional education. Other resources on the page include links to dietary recommendations, a registered dietician nutritionist lookup, and information on how to pursue additional certifications.

    Utilization Management Toolkit Helps PTs Navigate Difficult Landscape

    It looks as if utilization management (UM) will be sticking around for the foreseeable future, but that's not necessarily because it's working so well everywhere. In fact, it's the combination of prevalence and variability that prompted APTA to launch a new toolkit to help physical therapists (PTs) and physical therapist assistants (PTAs) understand—and be successful in—the UM environment.

    APTA's UM Toolkit offers members a range of information on UMs that includes everything from the history of the concept to strategies for working with UM vendors and tips for reducing authorization denials. The toolkit's resources can be used by individual PTs and PTAs as well as APTA chapters, and are offered through both a collection of webpages and a single downloadable pdf document.

    Although the concept of UM has been around since the 1950s, the real growth in use came after the adoption of the Affordable Care Act in 2010. With the ACA's expanded coverage, inclusion of "essential health benefits," and emphasis on improved patient experience and reduced costs, insurers felt pressure to more tightly control the kinds and duration of treatments being used by clinicians. The physical therapy profession's experience of this shift was intensified by the fact that the effectiveness of physical therapy is increasingly better understood by a public that now has greater access to PTs—an evolution that has made PTs a target for "cost containment" efforts, according to the toolkit.

    Making things even more difficult is the fact that UM—often conducted by third-party vendors on behalf of insurers—has developed in sometimes-haphazard ways, putting much of the onus for advocating for consistent, effective patient care on the clinicians themselves. That's why APTA's UM toolkit exists.

    "There are inherent conflicts and difficulties when balancing access, quality, and cost," APTA says in the UM overview section of the toolkit. "The ultimate goal is a UM program that facilitates effective use of limited resources, improves appropriateness of care, and imposes only reasonable burdens on patients and providers."

    APTA continues to engage with UM vendors and insurance companies to develop systems that are more responsive to PTs and their patients. The toolkit and other UM information is found on the APTA’s Third-Party Administrators (TPA): Utilization Management & Utilization Review webpage.