• Friday, January 23, 2015RSS Feed

    6 in 10 Americans Willing to Participate in Online Physician Visits

    A new survey has found that a majority of Americans are not only receptive to the idea of an online physician visit, but that 7% would actually switch from their current doctors in order to have access to online services.

    According to a Harris poll sponsored by American Well, a privately held telehealth company, 64% of respondents answered that they would participate in a video visit with their physician, and 21% selected video technology as their first choice for "middle-of-the-night care," second only to a visit to an emergency department. The results were and reported recently in Mobihealth Newsand iHealthBeat.

    Enthusiasm for telehealth options tended to be stronger among younger individuals, with 11% of respondents 18-34 answering that they would switch physicians if online visits were available. That rate dropped to 8% in the 35-44 year age group, and was recorded at 5% for the next 2 age groups. Only 3% of respondents over 65 said they'd make the switch.

    While voicing support for the concept of online visits in a general sense, respondents were also very clear about a few particulars. Overall, 63% chose "HD video" as the preferred mode of delivery, 88% said that they would want to select their own doctors for the service, and 62% responded that they would expect online visits to be less expensive than in-person visits.

    In 2014, APTA's House of Delegates approved a resolution that supports the adoption of telehealth technologies in physical therapy as "an appropriate model of service delivery" when provided in ways that are "consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations."

    The survey did not address potential security concerns for patients and providers—a central concern for APTA as it continues to look at how physical therapists can use telehealth in their practice.

    APTA offers resources on telehealth in physical therapy—including a link to Board of Directors definition and guidelines--on its telehealth webpage.

    Friday, January 23, 2015RSS Feed

    Resistance Training Effective in Countering Bone Density Loss, but Only When Combined With High-Impact, Weight-Bearing Exercise

    Nondrug approaches to preserving bone mineral density (BMD) in women postmenopause can be effective—but only if the training includes high-impact or weight-bearing exercise in addition to progressive resistance training, according to a new meta-analysis of 24 studies.

    Researchers analyzed results from the studies—5 controlled trials and 19 randomized controlled trials involving 1,769 women who were postmenopausal—to determine the effects of physical training on bone density, particularly in the spine and hip. Participants were limited to women who did not engage in regular exercise prior to study enrollment, and who were not receiving hormone replacement therapy or antiresorptive treatment. BMD outcomes were measured by way of X-ray or photon absorptiometry.

    "Protocols that included only resistance training did not generate significant effects on BMD in older women," authors write. No studies were limited to high-impact or weight-bearing training alone—but significant improvements were found when these interventions were included as part of a "combined resistance training" approach.

    "It was estimated that the beneficial effects induced by combined resistance training could contribute to almost 1.8% and 2.4% BMD gains for the hip and spine in postmenopausal women," authors write. "The training-related increase in BMD effectively prevented bone loss and greatly benefited postmenopausal women at risk for fracture."

    Researchers included activities such as jumping, skipping, dancing, and hopping among the high-impact, weight-bearing activities that contributed to increases in BMD when combined with progressive resistance training.

    Authors acknowledge questions about the safety of combined resistance training for older women, but write that the incidence of injury in the studies they reviewed was "very low," possibly due to the fact that most of the training was supervised. And while they write that "caution is advised when resistance training is performed at home," they conclude that data support the idea that resistance training is "a feasible nonpharmacological strategy for preventing postmenopausal bone loss." The study appears in the January 21 online edition ofOsteoporosis International (abstract only available for free).

    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.

    Friday, January 23, 2015RSS Feed

    PTNow Blog: Orthopaedic Section CPGs Get High Marks

    New appraisals of 2 Orthopaedic Section clinical practice guidelines (CPGs) are in, and both support the guidelines' usefulness for physical therapists treating ankle sprain and adhesive capsulitis, according to the latest PTNow blog post.

    The post offers highlights of the CPG+ reviews, which assigned a 5.0 out of possible 7 to the guideline on ankle stability and movement coordination impairments related to ankle ligament sprains, and a 5.25 rating to the CPG on shoulder treatment of pain and mobility deficits for individuals with adhesive capsulitis.

    Links to both CPGs are available through the blog, as well as links to information on the AGREE II rating system used by the appraisers.

    The CPG+ process is based on input from physical therapist experts. Interested in becoming an appraiser? Email PTNow@apta.org with “CPG+” in the subject line.

    Thursday, January 22, 2015RSS Feed

    New APTA Policy Priorities Leverage the Power of Physical Therapy

    The vision is plugged in. Now it's time to turn on the power.

    APTA's public policy priorities for the next 2 years will bring new energy to some longstanding advocacy efforts, new focus on issues that are crucial to the profession, and new approaches to influencing decision-makers, all designed to advance the association's vision of "transforming society by optimizing movement to improve the human experience."

    The association will focus on 4 major objectives: the positioning of physical therapists (PTs) as integral to collaborative care; the ongoing support of integrity in practice through reduction of fraud, abuse, and waste, and creation of strong state regulatory frameworks; the promotion of the value of physical therapy through support for research, outcome measures, and effective payment models; and the continued effort to increase patient access to care from a PT.

    Within those objectives, APTA has identified "policy strategies"—goals it hopes to reach at the federal and state levels. The long list of strategies ranges from support for policies positioning PTs as key members of chronic care management teams to advocacy for rehabilitation research, and from the removal of restrictions in state and federal direct access policies to the promotion of PTs as an entry point to care. The priorities can be accessed through the APTA Federal Advocacy webpage.

    "It's always energizing to share the association's policy priorities every 2 years," said Justin Moore, PT, DPT, APTA executive vice president of public affairs. "This year, it's even more exciting because of the ways they tie in to APTA's vision of transformation. There's a lot of energy in the profession around this vision, and we can draw from that energy to make some real-world changes that will help the profession and the public."

    The association establishes new policy priorities every 2 years, to coincide with each new session of Congress. Priorities were determined through member input and review from the association's Public Policy and Advocacy Committee (PPAC). The priorities were considered and approved by the APTA Board of Directors during its November 2014 meeting.

    "The new priorities are really an ideal mix that play well to our strengths as an association," Moore said. "Our work on these priorities will support our ongoing initiatives around quality of care, integrity of the profession, innovative models of practice, access to care, and payment reform."

    The priorities aren't just about influencing policy on Capitol Hill and in federal agencies. Many of the strategies target changes at the state level, including reducing barriers to direct access, strengthening state term and title protection, modernizing practice acts, and improving appropriate coverage of physical therapy in state Medicaid plans.

    Justin Elliott, APTA director of state government affairs, sees the priorities as a natural extension of ongoing work with state chapters and legislatures.

    "The physical therapy profession enjoyed some hard-fought success last year when we reached the milestone of some form of direct access in all 50 states, DC, and the US Virgin Islands, but it's important to remember that for some states, more work needs to be done to eliminate unwarranted provisions tied to direct access laws," Elliott said. "We'll be working on that and several other issues that can make a difference in the profession's ability to better serve the public."

    APTA members can get more involved with the association's policy work through the APTA Legislative Action Center, and by joining PTeam, the association's email group that provides regular updates on legislative and regulatory issues affecting PTs. Also available: a free "APTA Action App" for mobile devices that includes an action center, congressional directory, talking points, and more.

    Thursday, January 22, 2015RSS Feed

    Health Care Hiring Will Increase Overall - For Hospitals, Not So Much

    After anemic growth over the past 5 years, hiring in health care is predicted to return to boom times in 2015 and beyond—but the future landscape could be very different, with hiring in outpatient facilities, skilled nursing facilities, and home health growing while hospital hiring rates slow.

    According to a recent article in Modern Healthcare (free registration may be required to access story), predicted increases in health care hiring will be "uneven," with the growth in hospital-based hiring anticipated to be "modest at best."

    The article describes US Bureau of Labor Statistics (BLS) data that project overall health care employment to grow by 29.4% over the next decade, but hospital employment growing at a 17% rate during the same period. BLS predicts that by 2022, hospital employment will represent 25.5% of health care jobs—down from its 28.2% share in 2012.

    So where will the hiring happen? According to the Modern Healthcare article, "postacute care companies, which continue to expand, will pick up the slack in healthcare hiring," with home health leading the way, followed by skilled nursing and residential care facilities. The story includes data from the American Health Care Association, which predicts the number of individuals receiving long-term care, including home health services, will increase from 6 million today to 27 million by 2022.

    Want to know where the jobs are? Check out APTA's Red Hot Jobs website for regularly updated opportunities.

    Wednesday, January 21, 2015RSS Feed

    Rise in Fall Prevalence 'Exceeds What Would be Expected'

    The prevalence of self-reported falls among adults 65 and older is on the rise, and it's not just because of an aging American population, according to researchers who analyzed data collected from 1998 to 2010.

    Researchers anticipated that if increases in falls prevalence were found, they would be largely due to "changes in age structure of the population"—that is, more and more people getting older and older. What they found surprised them: while prevalence did increase across the board for adults 65 and older from 1998 to 2010, from 28.2% to 36.3%, the largest jumps in prevalence occurred in the lower age brackets.

    For adults age 65 to 69, falls prevalence increased by nearly 10 percentage points from 1998 to 2010, from 22.3% to 32%. The cohort of ages 70–74 experienced a similar increase, from 25.3% to 34.5%, as did the group aged 75–79, from 30.5% to 38.4%.

    After that however, the rates of increase start dropping off. For adults 80–84 years old, prevalence increased from 37.6% to 44.3%, while the 2 highest age groupings reported less than a single percentage point increase in prevalence. Researchers based their analysis on data obtained from the Health and Retirement Study sponsored by the National Institute on Aging, which collects health information from more than 10,000 adults 65 and older every 2 years. The results were shared in a letter published online in the January 19 edition of JAMA Internal Medicine.

    "Contrary to our hypothesis, we observed an increase in fall prevalence among older adults that exceeds what would be expected owing to the increasing age of the population," authors write.

    One possible explanation for the increased prevalence: better reporting, according to the authors. However, they write, "if a true increase in falling is occurring, then further research is needed to identify possible reasons, such as an increase in fall risk factors (eg, cardiovascular and psychiatric medications) or an increase in fall risk behavior."

    APTA provides education on exercise prescriptions for balance improvement and falls prevention, and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, and information on evidence-based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf).

    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.

    Wednesday, January 21, 2015RSS Feed

    Pick the Next PT in Motion Cover

    It's time once again for members to help PT in Motion magazine decide the design to be used on the cover of the upcoming issue. For March, editorial staff is proposing 3 designs and asking members to vote on their favorite cover to illustrate the concept of "creative components: innovating to benefit PTs and patients." The design that receives the most votes will be the next cover.

    Take the quick and simple survey by January 26. Just pick the design you think is likely to get you to open up the magazine, and then check out the March issue to see which cover was most popular.

    Tuesday, January 20, 2015RSS Feed

    APTA: To Transform Health Care, Insurance Must Empower Consumers, Increase Access to Physical Therapy, Other Needed Services

    With the health care landscape evolving into a system built around patient-centered, coordinated care, APTA believes it's time that insurance laws catch up to ensure that networks provide the kind of coverage that will make this transformation possible.

    The association delivered this message by way of comments to a draft managed care plan network adequacy model act (.pdf) developed by the National Association of Insurance Commissioners (NAIC). The model will be a template to help federal and state lawmakers and regulators develop changes to actual laws and regulations.

    APTA's recommendations for the draft focus on real changes that counter some insurance company trends toward more narrow networks that make it difficult for consumers and patients to get the services they need. The APTA recommendations include:

    • Establishing geographic proximity and waiting time standards that better serve patients
    • Ensuring that patients covered in a plan have access to out-of-network providers when the network doesn't offer the specific type of provider a patient needs, or when access can't be provided by the network—all available at no additional cost
    • Requiring that health carriers/insurance companies offer monthly updated, accurate provider directories
    • Creating an oversight system that allows patients and providers to provide feedback on network adequacy and access

    The decision to revise the model—a document that hasn't changed since 1996—was driven by the Patient Protection and Affordable Care Act (ACA), which is built around care systems that are at odds with a growing number of narrow provider networks. The overhaul even extends to the name of the model, which will be released as the "Health Benefit Plan Network Access and Adequacy Model Act."

    "The health care world is changing in ways that demand better patient access to a wide range of effective care, which clearly includes access to physical therapy," said Carmen Elliott, senior director of payment and practice management at APTA. "APTA's work with NAIC is aimed at helping to make this access not just possible, but a part of baseline standards for all consumers covered under insurance."

    The association voiced the same network adequacy concerns to the US Centers for Medicare and Medicaid Services (CMS) in response to a proposed rule on payment parameters. That rule specifically stated that CMS was waiting to implement certain changes until after the final NAIC model was released.

    The final NAIC model act is expected to be released later this year. APTA will continue to work with NAIC through the development process.

    A true transformation of health care through reform can only occur if insurance networks provide adequate coverage—for more information on this issue, visit the webpage of APTA's Making Sense of Health Care Reform Series.

    Friday, January 16, 2015RSS Feed

    Direct Access Tops List of Physical Therapy-Related Stories From 2014

    Readers of PT in Motion News couldn't have made it any clearer: the achievement of some form of direct access to physical therapists (PTs) in all 50 states and DC in 2014 was something to remember.

    Last week, News asked readers to choose the top 3 physical therapy-related stories from 2014 from a list of 8 contenders. Among the options, "all states achieve some form of direct access to PTs" was selected by nearly 85% of respondents.

    The direct access story was the winner by a mile, in fact. Coming in a distant second was the news that legislation to end the therapy cap has now achieved majority support in the US House of Representatives (56.19%), followed closely by the increased attention on closing physician self-referral loopholes created when the American Association of Retired Persons (AARP) announced its support of making changes (53.33%).

    The direct access landmark was met in July 2014, when Michigan became the 51st US jurisdiction to adopt legislation allowing some form of direct access. Despite this milestone, achieving unrestricted direct access nationwide remains one of APTA’s policy priorities. This year, 4 APTA state chapters--Florida, Georgia, New Mexico and Virginia—will be pursuing this goal.

    APTA releases a new public policies priorities agenda every 2 years. The revised agenda will be released in the coming weeks.

    Friday, January 16, 2015RSS Feed

    Study: Physical Inactivity Responsible for Twice as Many Deaths as Obesity

    A study of 334,000 European men and women over 12 years concludes that physical inactivity is responsible for more than twice as many deaths as obesity, and that even small changes in activity levels can make a significant difference in life expectancy regardless of BMI.

    In an article e-published ahead of print in the American Journal of Clinical Nutrition (.pdf), researchers compared individual BMI, waist circumference (WC), and self-reported physical activity (PA) levels with all-cause mortality data for 116,980 men and 217,181 women in Sweden, Denmark, The Netherlands, United Kingdom, France, Germany, Spain, Italy, and Greece. Individuals with baseline heart disease, cancer, or stroke history were excluded from the analysis, as were individuals who were in the top or bottom .5th percentile of the energy intake-to-estimated basal metabolic ratio rate. Researchers then created a 4-level activity designation based on daily kilojoule-per-kilogram rates: inactive (36 kJ/kg), moderately inactive (41 kJ/kg), moderately active (46 kJ/kg), and active (51 kJ/kg).

    After adjusting for sex, educational level, and lifestyle (alcohol intake and smoking), researchers found that within all BMI groupings, mortality rates for moderately inactive individuals were 20%-30% lower than rates of inactive individuals. The reductions in mortality increased as activity levels increased, but only among normal and overweight individuals—rates for individuals with a BMI of 30 or higher did not drop when activity was recorded as more than "moderately inactive."

    Researchers found a similar relationship between physical activity and WC, with decreased mortality rates in the moderately inactive individuals across adiposity groupings, and little additional effect for abdominally obese individuals who had PA levels beyond "moderately inactive."

    According to the study's authors, the findings make a strong case for the effect of increased PA on mortality. "Physical inactivity may theoretically be responsible for twice as many deaths as high BMI … in this population, similar to the number of deaths averted if abdominal adiposity were eliminated," they write. "If all inactive individuals were at least moderately inactive, the number of deaths would theoretically be reduced by 7.5%." Authors estimate that in 2008, 676,000 deaths among Europeans may have been attributable to physical inactivity, compared with 337,000 deaths attributable to obesity.

    Authors of the study believe that achieving a level of moderate inactivity among those who are currently inactive may be more easily reached than one might imagine. "This amount of energy expenditure can be achieved by a [physical activity energy expenditure] equivalent to 20 minutes of brisk walking per day, which is lower than the current PA recommendations for public health," they write.

    "Our results suggest that the influence of physical inactivity on mortality appears to be greater than that of high BMI and similar to that of high [waist circumference] in European men and women," authors write. "From a public health perspective, it is therefore encouraging that our results suggest that small increases in PA in those who are currently categorized as inactive appear to be associated with significant reductions in all-case mortality at all levels of BMI and WC."

    APTA is a strong and vocal advocate for the ability of physical activity to transform society through its effects on public health. The association offers a prevention and wellness webpage with resources on how physical therapists and physical therapist assistants can help individuals become more physically active. Additionally, the association's MoveForwardPT.com website stresses the importance of physical activity in ways designed to be easily understood by the general public. The association is also on the board of the National Physical Activity Plan alliance, a high-profile effort to create a comprehensive set of policies, programs, and initiatives to increase physical activity in all segments of the American population.

    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.