• Tuesday, November 25, 2014RSS Feed

    No PT in Motion News Nov. 26, 27, 28

    PT in Motion News will not run on Nov. 26, 27, and 28. News stories will resume posting on Monday, Dec. 1. Additionally, there will be no weekly News e-mail blast on Nov. 28. The weekly e-mail blast will return on Dec. 5.

    PT in Motion News wishes you a safe and happy Thanksgiving!


    Tuesday, November 25, 2014RSS Feed

    Study Finds Significant Metabolic Energy Improvements for Older Runners Over Older Walkers

    A small study of adults in their late 60s has found that regular running can reduce the metabolic "cost" of walking in ways that a regular walking regimen can't, and may actually result in walking metabolic energy rates that are comparable to those found in young sedentary adults.

    Researchers write that the older adults who ran for at least 30 minutes 3 times a week demonstrated 7% to 10% better walking economy than study participants who walked at the same durations and rates. The results, they write, support the idea that "higher intensity aerobic activities may mitigate the typical age-related decrease in walking economy, and consequently, preserve mobility into older age."

    The study, published in the November 20 issue of PLoS One, involved 30 adults (14 males and 16 females) who ranged in age from 66 to 72 (average age of 69). Half of the participants were runners who self-reported engaging in that activity 30 minutes or more at least 3 times per week, and for at least 6 months prior to the study. The 15 "walkers" reported the same levels of participation in their activity.

    After evaluation by a physician and a treadmill familiarization session, participants were evaluated after walking on a dual-belt force-instrumented treadmill at 3 speeds—.75, 1.25, and 1.75 m/s—for at least 7 minutes at each speed. Areas evaluated by the researchers included oxygen consumption and carbon dioxide production, as well as ground reaction forces that were in turn used to determine gait cycle events and stride variables.

    Researchers found the runners' 7%-10% reduction in metabolic energy consumption occurred at all speeds tested. At the fastest walking speed, walkers increased gross metabolic power by 95%, while runners required an 86% increase in power.

    The "most striking" finding in the study, according to authors, occurred when researchers compared these data with younger and older sedentary adults who underwent the treadmill testing.

    "The results of this analysis showed that across the range of speeds, older walkers consume metabolic energy at a similar rate as sedentary older adults," authors write. "However, our most striking finding was that older runners consumed energy at a similar rate as young sedentary adults across the range or walking speeds."

    Authors of the study were somewhat surprised to find that the differences in metabolic cost could not be attributed to the actual mechanics of walking, which did not vary substantially between the walkers and runners.

    "Among spatio-temporal gait characteristics, we found no significant differences between older walkers and older runners in regards to stride time, stride frequency (p = .879), single leg stance time (p = .126) or duty factor (p = .126)," they write. The same was true with ground reaction forces relative to first and second peak vertical force, as well as anterior-posterior braking and propulsive reaction forces.

    Researchers are uncertain about the precise reason for the metabolic differences, but cite decreased muscle co-activation and increased muscle efficiency as possible contributors.

    Authors acknowledge the study's limitations, particularly around its small numbers and uneven distribution of males and females in the walker/runner groups (11 females and 4 males in the walking group; 5 females and 10 males in the running group). Still, they write, "while it would have been preferable to have a larger sample size with more similar sex and anthropometric matched cohorts, it would not have changed our overall conclusions."

    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.


    Tuesday, November 25, 2014RSS Feed

    PTNow Blog: COPD Resource Roundup

    The PTNow blog is serving as a temporary 1-stop shop for physical therapist (PT) and physical therapist assistant (PTA) resources on helping to manage chronic obstructive pulmonary disease (COPD). COPD is the third leading cause of death in the US.

    In recognition of November as COPD Awareness Month, the recent post gathers information on COPD from PTNow and offers it up in 1 convenient set of links. The partial listing includes a clinical summary, clinical practice guidelines, tests and measures, and clinical cases.

    Also included: patient education resources from APTA and the National Heart, Lung, and Blood Institute.


    Monday, November 24, 2014RSS Feed

    Washington Post: New Magnetic Stimulation Device Being Tested As a Way to 'Prep' Poststroke Brain for Physical Therapy

    A new transcranial magnetic stimulation (TMS) device is being tested as a possible aid to physical therapy for patients poststroke, according to a recent article in the Washington Post.

    In the November 24 article, Post reporter Amy Ellis Nutt describes early efforts at Ohio State Wexner Medical Center to use Nexstim, a technology that painlessly suppresses activity in the healthy parts of a patient's motor cortex. Researchers believe that after stroke, undamaged parts of the brain "[go] into overdrive in order to compensate," which "may actually slow recovery of the injured side," according to the article.

    The Post reports that the process involves using "a technology similar to a GPS" to pinpoint the areas of the motor cortex that have been injured. Researchers then apply low-frequency magnetic pulses to the corresponding healthy area to decrease activity. "This allows the injured side to make use of more energy during physical therapy, which immediately follows the [TMS]," Nutt writes.

    Nexstim is planning on conducting an 8-month double-blind randomized clinical trial with 200 individuals who have suffered a stroke in the past 3-12 months and have weakness in the arm and hand on only one side. According to the Post report, the trial will involve up to 29 visits for each participant.


    Monday, November 24, 2014RSS Feed

    Free Webinar, Audio Course Offer Ends Nov 30

    Never mind how many shopping days are left until Christmas—you have a more immediate deadline to think about.

    November 30 is the last day APTA members can enjoy a prerecorded webinar or audio conference, courtesy of APTA. The limited-time offer is the association's way of saying thank you for your membership.

    Choose from programs on audits and appeals, how to overturn denials and get visits approved, the role of the PT in hospice and palliative care, and more.

    To redeem your complimentary recorded webinar or audio conference course:

    1. Check out the recorded webinar or audio conference options and select 1 course.
    2. Click the "Purchase Now" link and complete the online store transaction (login required).
    3. At the "View Shopping Chart" phase, click "Enter Vouchers," then enter promotion code CEUMBR1114. The member price for the program will be zero.

    Once you receive your order confirmation number, go to "My Courses" to launch the course. This offer is nontransferable and expires November 30, 2014.

    Questions? Contact Member Services or call 800/999-2782, ext 3395, M-F, 8:30 am to 6:00 pm, ET.


    Monday, November 24, 2014RSS Feed

    RockTape Named APTA Strategic Business Partner

    RockTape Inc, a leading provider of sports medicine products, has been named a Strategic Business Partner of APTA. Its flagship product, RockTape kinesiology tape, is used by more than 8,000 medical professionals worldwide to treat and prevent common sports injuries.

    "We are pleased to welcome RockTape to APTA's Strategic Business Partners family," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in an association news release. "It is important to APTA to enhance our business relationships and develop meaningful partnerships with for-profit companies. We are pleased that our services and marketing opportunities provide mutual benefits to our partners and APTA."

    "We knew that to best leverage all of our great relationships in the physical therapy profession, we needed to partner with and support the profession through the APTA Strategic Business Partners Program," said Alyson Evans, director of US sales.

    In 2015 RockTape will exhibit at APTA's Combined Sections Meeting, the NEXT Conference, and National Student Conclave.

    The APTA Strategic Business Partners program seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA. For further information on the program, visit the Strategic Business Partners webpage.


    Friday, November 21, 2014RSS Feed

    IOM: Physical Activity Measures Should Be Among Standard 'Social and Behavioral' Domains Tracked on EHRs

    The Institute of Medicine (IOM) is recommending that future electronic health records (EHRs) include patient "social and behavioral data"—including data on physical activity—acquired through a set of 12 measures.

    The 300-plus page report, "Capturing Social and Behavioral Domains and Measures in Electronic Health Records," makes the case for the Centers for Medicare and Medicaid Services (CMS) to include the measures as part of the EHR certification and meaningful use regulations.

    Data on 4 of the domains—alcohol use, tobacco use and exposure, race/ethnicity, and residential address—are already being widely collected, the report states. But additional domains should be included, each with its own measures—education, financial resource strain, stress, depression, physical activity, social connections/isolation, exposure to violence/intimate partner violence, and neighborhood compositional characteristics.

    The IOM report describes "a large body of empirical evidence" around the dose-response relationship between physical activity and improved physical and mental health throughout the lifespan, with "little evidence that an upper threshold exists." Authors write that not only is the relationship strong enough to be worth collecting data, the very act of obtaining this information from patients at outpatient visits is associated with "significant, yet small, changes in patient weight loss and [plasma glucose concentration] levels compared [with] those who were not asked about their physical activity levels."

    Authors of the report recommend that 2 "Exercise Vital Signs" questions from the US Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System be used as the standard measures for physical activity in EHRs. The 2 questions are:

    • On average, how many days per week do you engage in moderate to strenuous exercise (like walking fast, running, jogging, dancing, swimming, biking, or other activities that cause a heavy sweat)?
    • On average, how many minutes to you engage in exercise at this level?

    Authors also reviewed the International Physical Activity Questionnaire, a 9-question form, finding it "acceptable" but "more time consuming" than the 2-question measure.

    The report noted that the additional domains would likely add to costs, and that these costs would largely fall to providers. However, the report asserts, the long-term benefits would be significant.

    "The US health system has achieved technological advances but lags behind other countries in population health outcomes," write the report's authors. "Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research."

    APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs. Additionally, APTA has long supported the promotion of physical activity and the value of physical fitness, and is involved with the National Physical Activity Plan (NPAP), where the association has a seat on the NPAP Alliance board. The association also offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.


    Friday, November 21, 2014RSS Feed

    'Text Neck' the Focus of Upcoming Study

    The reasons for a person's neck pain could be as close as his or her phone.

    A recent story in the Washington Post describes the upcoming publication of a study that analyzed the burden placed on the cervical spine through the typical posture of people looking at their smartphones—head tilted down at angles as severe as 60 degrees. At that angle, researchers determined that weight on the cervical spine increases to about 60 pounds.

    According to the Post report, the "text neck" posture seen just about everywhere is like "carrying an 8-year-old around your neck several hours per day," at the rate of between 700 to 1,400 hours a year. For adolescents, that number could be 5,000 hours higher. The poor posture can lead to degeneration of the spine.

    The Post reports that the problems associated with text neck have been known for some time, and borrows quotes from a 2013 CNN interview with APTA Private Practice Section President Tom DiAngelis PT, DPT, in which he describes the dangers of the posture over time.

    The article offers suggestions from Kenneth Hansraj, lead author of the upcoming study, on how to counteract text neck. His biggest piece of advice: look down with your eyes—no need to bend your head. Second, he suggests specific exercises to improve mobility and posture.


    Friday, November 21, 2014RSS Feed

    USBJI Young Investigators Program Accepting Applications

    Physical therapist (PT) investigators have an opportunity to receive guidance in getting their research funded and "other survival skills required for pursuing an academic career" through a program that connects them with experienced researcher-mentors.

    The United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada announced that they are now accepting applications for the Young Investigator Initiative, a career development and grant mentoring program. Investigators chosen to participate in the program will attend 2 workshops 12-18 months apart and work with faculty between workshops to develop grant applications.

    This grant mentoring workshop series is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed and have a commitment to protected time for research. Basic and clinical investigators, with or without training awards (including K awards), are invited to apply.

    Application requirements and more details can be found at the USBJI website. Deadline is January 15, 2015, to participate in the next workshop, April 24-26.

    According to an announcement from USJBI, 140 program participants have obtained more than $130 million in research grants. APTA is a founding member of USBJI.


    Thursday, November 20, 2014RSS Feed

    Nurses' 'Choosing Wisely' List Should Resonate With PTS, PTAs

    A recently released list of practices nurses and patients should question will likely get nods of agreement from physical therapists (PTs) and physical therapist assistants (PTAs) for the ways the recommendations promote early mobility in hospital settings.

    The American Academy of Nursing (AAN) became the most recent nonphysician profession to add to the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely® campaign aimed at educating consumers and health care professionals on health care-related tests, procedures, and practices that may not be necessary or appropriate under certain circumstances. In September, APTA became the first nonphysician group to join the campaign when it unveiled its list of "5 Things Physical Therapists and Patients Should Question."

    Of particular interest to PTs and PTAs in the AAN list of "5 Things Nurses and Patients Should Question" (.pdf) are recommendations that nurses should not let older adults lie in bed or only get up to a chair during their hospital stay, that physical restraints should not be used with patients who are older and in the hospital, and that urinary catheters should not be placed or maintained in a patient "unless there is a specific indication to do so."

    "PTs know that an important contributor to hospital-associated disability is immobility during hospitalization, which leads to decreased function, increased fall risk, and increased length of stay—especially in older adults," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "The AAN Choosing Wisely list is an excellent addition to the support for greater mobility in hospitalized patients."

    Bemis-Dougherty noted that the AAN recommendations around restraints are consistent with The Joint Commission (TJC) restraint standards. In addition, she said, the AAN list correlates strongly with APTA's Choosing Wisely recommendations against using continuous passive motion machines after uncomplicated total knee replacement, and against bed rest following diagnosis of acute deep vein thrombosis after anti-coagulation therapy, unless significant medical concerns are present.

    "Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls," noted Bemis-Dougherty. "If the patient is restrained, the immobility could lead to poor outcomes."

    APTA Senior Director of Practice and Research Nancy White, PT, DPT, OCS, was involved in the development of the APTA Choosing Wisely list, and thinks that the AAN recommendations add to the reach of a campaign that's making a difference.

    "Choosing Wisely is recognized as a great way to improve outcomes of care and reduce the use of treatment approaches that are either not effective or that may even be harmful," White said. "AAN has identified several practices that are common in many hospital settings that result in prolonged and unnecessary bed rest—something that PTs know leads to poorer outcomes and prolonged hospital stays."

    Bemis-Dougherty believes that the AAN list can help APTA in its efforts "to change the culture of immobility in the hospital to one of mobility."

    "Creating that kind of change is a daunting task and can't be accomplished by PTs alone," Bemis-Dougherty said. "To have nursing recognize the problem caused by immobility is huge and hopefully can contribute to a more widespread culture of mobility that involves all health care professionals within hospital settings."

    APTA's Choosing Wisely list is offered in several forms, including consumer-focused versions in English and Spanish, and an expanded version containing citations on the association's Center for Integrity in Practice website. Resources on that site also include a ProfessionWatch paper from Physical Therapy that details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation.


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