• Wednesday, May 27, 2015RSS Feed

    Postpartum Exercise, Concussion, Stroke, and More: Catch Up With Move Forward Radio

    The transformative power of physical therapy to treat diverse conditions is at the heart of recent Move Forward Radio episodes.

    A twice-monthly podcast, available for free download from iTunes or at MoveForwardPT.com, Move Forward Radio is a terrific resource to share with your patients. Recent episodes include:

    Pregnant and postpartum exercise
    During pregnancy and childbirth a woman’s body goes through profound changes in a relatively brief period of time. For women who exercise during or after pregnancy, failure to respect those changes has the potential to lead to problems. Christy Martin, PT, DPT, SCS, who specializes in sports physical therapy, and Vicki Lukert, PT, PRPC, who specializes in pelvic health, outline how pregnant and postpartum women can exercise safely and how to spot warning signs for problems that might require medical attention.

    Concussion and mild traumatic brain injury
    At Brooke Army Medical Center in Texas, Miriam Hammerle, PT, Cert SMT, often sees patients who have suffered a mild traumatic brain injury or concussion in the line of duty. One of her recent patients, Lt Col Tony Cromer Jr, suffered a concussion when his head was slammed by an opening door. The effects of that workplace accident, including headaches and dizziness, were the same as they often are for soldiers on the battlefield. Hammerle and Cromer discuss his injury and treatment.

    Autism spectrum disorder (ASD)
    ASD can be treated by a range of therapists who have individual specialties but overlapping goals. Christine Baksi talks about her 4-year-old son Sam, who was diagnosed with ASD at the age of 2, and is benefitting from a variety of therapies including physical therapy. Joining the discussion is Sam's physical therapist Lori Glumac, PT, DSc, PCS, who is a member of a collaborative care team that helps children with ASD develop physically and socially.

    Avoiding golf injuries
    Having a repeatable swing is key to having a good golf game. But with that repetition comes a risk for injury to backs, elbows, shoulders, and more. Michael Mulcahy, PT, discusses treatment for injured golfers, outlines typical golf-related injuries, and offers prevention tips that can help golfers strengthen themselves and their game.

    Stroke awareness, prevention, and recovery
    Those fortunate enough to survive a stroke often face problems with mobility, speech, balance, weakness, and memory loss, among other symptoms. Fortunately, depending on the severity of the stroke and the health of the individual, a physical therapist can effectively treat many of these side effects. Julia M. O. Castleberry, PT, DPT, MS, CLT, GCS, NCS, addresses all aspects of stroke, including describing what stroke rehabilitation looks like, how to spot a stroke, identifying who is at risk, and how to lower that risk.

    Spinal stenosis
    Spinal stenosis is a degenerative disease that causes a narrowing within vertebrae of the spinal column, resulting in pressure on the spinal cord. While it may sound like a serious problem in need of an invasive medical procedure (such as surgery), a recently published study in the Annals of Internal Medicine suggests that surgery should be considered only when other more conservative treatments, such as physical therapy, fail. Lead author Anthony Delitto, PT, PhD, FAPTA, discusses the study, treatment for lumbar spinal stenosis, and what patients need to know about options to avoid going under the knife.

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

    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 e-mailed to consumer@apta.org.

    Wednesday, May 27, 2015RSS Feed

    David Sackett, 'Father of EBM,' Dies

    David Sackett, MD, regarded as the "father of evidence-based medicine," died on May 13. He was 80.

    In a career—or as Sackett described, a series of careers—that included many achievements, Sackett is most often recognized by the public as the researcher who confirmed that aspirin helps to prevent heart attacks. Among health professionals, however, Sackett is recognized as the person who applied research evidence to clinical practice—an approach that may seem obvious today, but was radical in the late 1950s, when he first decided to consult clinical trials to determine treatment approaches.

    A lengthy obituary in the Globe and Mail states that Sackett's "methods and philosophy, now standard practice, have helped determine everything from what surgery is best after a heart attack to what type of hospital administration provides the best bang for the buck," and cites a BMJ article that ranks evidence-based medicine (EBM) as one of the most significant medical advancements in the past 150 years, "alongside the discovery of vaccines and antibiotics."

    In addition to his direct clinical practice, Sackett founded the journal Evidence-Based Medicine, and became the first chair of the Cochrane Collaboration. A self-published autobiography (.pdf) in question-and-answer form is available online, as well as an oral history of EBM that features Sackett and other leaders.

    Look for a tribute to Sackett and his impact on physical therapy and rehabilitation in an upcoming issue of PTJ.

    Tuesday, May 26, 2015RSS Feed

    Legislation Would Expand PT Workforce in Underserved Areas, Extend Student Loan Repayment Program to PTs

    Legislation that would include physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in underserved areas was introduced in both the US House of Representatives and Senate, just in time to be included in the grassroots advocacy efforts taking place during PT Day on Capitol Hill June 3-4.

    The Physical Therapist Workforce and Patient Access Act (H.R. 2342/S. 1426) was reintroduced late last week and, if passed, 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).

    The bill was introduced in the House by John Shimkus (R-IL) and Diana DeGette (D-CO), and in the US Senate by John Tester (D-MT) and Roger Wicker (R-MS). The timing of the reintroduction couldn't be better, as an estimated 1,000 PTs, physical therapist assistants (PTAs), and students from PT and PTA programs descend on Washington, DC, to join in PT Day on Capitol Hill on June 4. Events will begin with a rally before participants fan out across the halls of Congress to advocate for increased patient access to PTs, loan forgiveness, the Medicare therapy cap, and other issues.

    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.

    "Based on current trends in the physical therapist workforce, the shortage of physical therapists could potentially reach over 27,000 in the United States by 2020, greater than other primary care disciplines recognized by the [NHSC]," APTA notes in a position paper on the legislation (.pdf). "The inclusion of physical therapists in the NHSC Loan Repayment Program will help to ensure that rehabilitation services are available to underserved communities."

    Find out more about PT workforce legislation—including details about the NHSC loan repayment program and what you can do to advocate for the profession—at APTA's Education and Workforce Legislation webpage.

    Tuesday, May 26, 2015RSS Feed

    Foundation Opens Call for Scientific Review Committee Members

    The Foundation for Physical Therapy (Foundation) is accepting nominations and CVs from physical therapists (PTs) interested in serving on the Foundation's Scientific Review Committee (SRC). This elite group of professionals is the peer review arm of the Foundation’s scholarship, fellowship, and grants programs.

    Members selected to serve on the SRC have significant practice in training pre- and postdoctoral students and mentoring emerging investigators, as well as a strong track record of extramural funding and peer review experience at the federal level. Terms are for 3 years beginning January, 2016.

    For more information, including a full list of qualifications to serve on the SRC and instructions on submitting a CV, please visit the SRC webpage or email rachaelcrockett@apta.org.

    CVs must be received by August 1, 2015.

    Friday, May 22, 2015RSS Feed

    Meniscus Surgery All in Your Head, Says One Psychiatrist

    Apparently, even psychiatrists have issues—and sometimes these issues include feelings about the validity of arthroscopic surgery for meniscus tears.

    In an opinion piece for Psychiatric Times titled "Knee Surgery? Think Twice," psychiatrist Allen Frances, MD, explores not just the power of the placebo effect, but the role of exercise and physical therapy to lessen the pain associated with meniscus tears.

    To make his point, Frances mostly turns over the commentary to Teppo Jarvinen, the orthopedic surgeon who was the lead author a study that compared outcomes of patients who received arthroscopic surgery for a meniscus tear with patients who were provided sham surgery. The results showed that the sham surgery patients reported outcomes just as good as or better than their real-surgery counterparts. Findings of the study were reported in a January 2014 PT in Motion News article.

    In the Psychiatric Times article, Jarvinen says that knee surgery is sometimes recommended but that "without a true traumatic event … resulting in your knee filling up with blood ... if you're able to move your knee freely (even with some possible pain), there is no urgent need to have your knee 'scoped.'"

    "Rather, go and see your physiotherapist, start a good rehab program, and give it some 3-4 months to let nature take its course," Jarvinen says.

    Allen writes that Jarvinen's research "is one of those landmark studies that should change the world."

    "Patients beware before accepting the knife," Allen writes. "Insurance companies take note in establishing standards for reimbursement. Guideline makers insert watchful waiting and rehab before recommending surgery."

    Thursday, May 21, 2015RSS Feed

    New Postacute Care Webpage Makes an IMPACT

    Work in a postacute care setting? Brace yourself for IMPACT.

    New to the APTA website: a webpage exclusively devoted to providing you with everything you need to know about postacute care reform in Medicare, including information on how the Improving Post-Acute Care Transformation (IMPACT) Act will change the types and quantity of data provided to the Centers for Medicare and Medicaid Services (CMS).

    The new webpage provides a basic outline of the principles behind postacute care reforms, resources from CMS, summaries of proposed rules, and highlights of APTA's involvement in the process.

    The reach of IMPACT and other postacute care reforms extends to skilled nursing facilities, home health, inpatient rehabilitation facilities, and long-term care hospitals. APTA is a strong supporter of the reform initiatives, including the provisions of the IMPACT Act.

    Thursday, May 21, 2015RSS Feed

    BMJ Study Links Regular Physical Activity to Longer Life in Elderly Men

    Older men have yet another incentive to be physically active—they can extend their lifespan. At least this was the case for elderly men in an observational study recently published in the British Medical Journal (BMJ) (free full-text download) that linked regular physical activity to a lower risk of death.

    Boosting physical activity levels in this age group seems to be as good for health as giving up smoking, the findings suggested.

    The 5,738 men under observation had taken part in the Oslo I study of 1972-1973, at which time they would have been aged 40-49, and again in Oslo II 28 years later. In Oslo II they were monitored for almost 12 years to see if physical activity level over time was associated with a lowered risk of death from cardiovascular disease, or from any cause.

    The men were surveyed on, among other things, their weekly leisure time physical activities. Activities were classified as sedentary (watching TV or reading); light (walking or cycling, including to and from work for at least 4 hours a week); moderate (formal exercise, sporting activities, or heavy gardening for at least 4 hours a week); and vigorous (hard training or competitive sports several times a week).

    The analysis indicated that more than an hour of light physical activity was linked to a 32% to 56% lower risk of death from any cause. Less than an hour of vigorous physical activity was linked to a reduction in risk of between 23% and 37% for cardiovascular disease and death from any cause. The more time spent doing vigorous exercise, the lower the risk seemed to be, falling by between 36% and 49%. Men who regularly engaged in moderate to vigorous physical activity during their leisure time lived 5 years longer, on average, than those who were classified as sedentary.

    Factoring in the rising risk with age of death from heart disease and stroke made only a slight difference to the results, researchers said. Overall, these showed that 30 minutes of physical activity—of light or vigorous intensity—6 days a week was associated with a 40% lower risk of death from any cause.

    Being an observational study, no definitive conclusions can be drawn about cause and effect, the researchers pointed out, adding that only the healthiest participants in the first wave of the study took part in the second wave, which may have lowered overall absolute risk. But the differences in risk of death between those who were inactive and active were striking, even at the age of 73, they suggest.

    More effort should go into encouraging elderly men to become more physically active, the researchers concluded, emphasizing the wide range of ill health that could be warded off as a result. PT in Motion News reported in 2014 on 2 other studies touting the benefits of physical activity for older adults: JAMA reported that a physical activity program can reduce the risk of losing the ability to walk without assistance; and the Journal of Physical Activity & Health reported that each hour of sedentary behavior increases the odds of disability in activities of daily living.

    APTA offers educational resources that address the role of the physical therapist in health and wellness in older adults and provide insight into older adults and exercise adherence. Additionally, APTA's consumer-focused MoveForwardPT.com website includes a webpage featuring videos addressing the importance of fitness across the lifespan. The association also offers a prevention and wellness webpage that includes videos, podcasts, and educational resources.

    Wednesday, May 20, 2015RSS Feed

    Last Chance to Test ICD-10 Reporting System

    With no further delays on the horizon, the shift to the new International Classification of Diseases, 10th Revision (ICD-10) is set for October 1. Physical therapists (PTs) have one more chance to capitalize on an opportunity to test the new system before actual implementation, but only if they act quickly.

    The last of 3 ICD-10 test programs that the Centers for Medicare and Medicaid Services (CMS) has conducted for health care providers is scheduled for July 20-24, and the deadline to apply is May 22. APTA is encouraging members to sign up for the program to gauge their own practice's readiness for the change.

    Bonus for any PTs who already participated in the January or April end-to-end tests: you can participate again in July without reapplying.

    The testing program will allow a sample group of providers to work with Medicare administrative contractors (MACs) and Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes, from submission to remittance advice. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.

    CMS is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by May 22. The MACs and CEDI will notify the volunteers selected by June 12 with information needed for the testing.

    More information on the testing process is available online (.pdf).

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.

    Wednesday, May 20, 2015RSS Feed

    Hospital 'Preferred Provider' Lists Put Pressure on SNFs

    A recent article in Modern Healthcare says that with increasing frequency skilled nursing facilities (SNFs) are being forced to compete for a coveted place on a hospital's list of "preferred facilities" that will receive the bulk of the hospital's referrals. According to the article, the results seem to be paying off—both in terms of improved patient outcomes and lower costs.

    Reporter Melanie Evans tracks trend by focusing on several hospitals that have adopted an "aggressive new strategy" of creating a shortlist of SNFs that will be recommended to patients after discharge. These preferred facilities are accepted based on a host of outcome data from state health reports and Medicare quality measures, including length of stay and readmission rates, in addition to questionnaires and interviews from the hospital.

    And those approval lists can be fairly exclusive. For example, Phoenix, Arizona-based Banner Health accepted 34 SNFs from among 90 applications; Partners Healthcare in Massachusetts included 47 of 140 potential SNFs in its preferred provider list.

    Evans writes that data gained since the switch to a preferred facilities system bears out the underlying assumptions—average lengths of stay are dropping, along with 30-day readmission rates. One Lincoln, Nebraska, hospital saw readmission rates drop from 15% to 11% in 7 months.

    While the SNFs that make the cut are experiencing increased business, the facilities that aren't on the lists may be in for tough times ahead, according to James Michel of the American Health Care Association. "For many providers, it could be life or death," he said in the article.

    Wednesday, May 20, 2015RSS Feed

    Patients With Colorectal Cancer Heed Physical Activity Advice – If They Get It

    The good news: a large-scale British study has found that individuals with colorectal cancer (CRC) who can recall a clinician giving them advice to stay as physically active as possible tend to do just that.

    The bad news: less than a third of CRC patients remember getting any such advice in the first place.

    In a study in the May issue of BMJ Open (.pdf), researchers presented findings based on a 2013 survey of 15,254 individuals in the United Kingdom who had received a CRC diagnosis in 2010-2011. The survey gathered demographic and other data—including rates of physical activity—and asked the question, "Did you receive any advice or information on physical activity or exercise?"

    Only 31% answered yes. And what makes this number particularly powerful is that receiving advice on physical activity (PA) seems to make a difference with patients.

    Researchers found that among the patients who recalled receiving PA advice, 51% were engaged in brisk physical activity for at least 30 minutes 1-4 days a week, with 25% participating in PA for at least 30 minutes 5-7 days a week. Those numbers dropped to 42% and 20%, respectively, among patients who didn't remember receiving PA advice.

    Authors write that while some clinicians may be waiting for the results of an ongoing clinical trial focused on the relationship of PA rates to CRC survival rates before considering giving PA advice, "in light of strong evidence for a number of other important outcomes, such as reductions in cancer-related fatigue and improved quality of life, it is important for clinicians to be advising their patients with CRC to be physically active."

    Other findings from the study:

    • Men (35%) were more likely than women (25%) to recall being given PA advice.
    • Patients 55 and younger recalled receiving advice more often than older patients (37% vs 20%).
    • Patients with higher socioeconomic status (SES) remembered getting advised on PA with more frequency than patients at lower SES levels (32% vs 28%).
    • Among patients in remission, 32% recalled receiving advice, compared with 27% of nonremission patients.

    Authors acknowledge that "giving PA advice may not always be easy for health care professionals" because of a "lack of appropriate support," uncertainty about what to recommend, or perceived time constraints.

    But these barriers must be overcome, they argue.

    "Our results strengthen the case for clinicians to recommend PA to their patients with cancer," authors write, citing the differences reported in the survey. "This difference is potential of real practical significance."

    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.