For many children in the United States, the battle against childhood obesity may be in part a battle of perception: according to a new report, nearly a third of children don't have an accurate view of their own weight status, with 81% of overweight boys and 71% of overweight girls describing themselves as "about the right weight."
The report (.pdf), issued this week from the US Centers for Disease Control and Prevention (CDC), says that from 2005 to 2012, 30.2% of children and adolescents aged 8–15 misperceived their weight status. Out of an estimated 9.1 million children and adolescents, 78% characterized themselves as "about the right weight" when they were in fact over or underweight. The remaining 22%, about 2 million of the 9.1 million, were of healthy weight but perceived themselves as too fat or too thin. The findings were based on an analysis of the National Health and Nutrition Examination Survey (NHANES).
The misperception problem was most prevalent among overweight boys and girls, and varied somewhat according to demographics. Among the findings:
"Accurate self-perception of weight status has been linked to appropriate weight control behaviors in youth," write the report's authors. "Understanding the prevalence of weight status misperception among US children and adolescents may help inform public health interventions."
PTs can provide crucial tests and can assist patients and clients in pursuing the behavioral changes to support achieving a healthy weight, according to Lisa Culver, PT, DPT, MBA, senior specialist for clinical practice at APTA. "Testing for body mass, which includes BMI, is a routine test for physical therapists to perform.” she said. "If we've established that body mass indicates overweight or obesity, we can play an important role in addressing healthy lifestyles, especially getting kids to be more physically active. Physical activity not only assists with loss of and maintenance of the loss of excess body mass, but an individual's level of physical fitness itself is an important and independent indicator of health, in addition to excess body mass."
APTA offers extensive resources on the PT's role in prevention and wellness, as well as on behavior change in the patient and client.
A sweeping multiorganizational effort to create a shared vision for physical therapist clinical education continues to advance, and now needs stakeholders to participate in webinars focused on partnerships.
The webinars are the latest in a series of open forums that allow participants to engage in discussions around position papers that were published in a special issue of the Journal of Physical Therapy Education (JOPTE). The next 2 webinars will focus on the papers by McCallum, et al, and Applebaum, et al. The first will be held on Wednesday, July 23, 8:00 pm–9:15 pm ET, and the second is scheduled for Tuesday, July 29, 4:00 pm–5:15 pm ET. Webinar facilitators will be Peggy Gleeson, PT, PhD, Scott Euype, PT, DPT, MHS, OCS, and Stephanie Piper Kelly, PT, PhD.
Instructions for joining the webinars can be found here. Participants are strongly urged to read the position papers before the online sessions.
Discussions from the webinars will inform the creation of a shared vision at the Clinical Education Summit planned for October 12–13 in Kansas City, Missouri, where participants will use the positions from the JOPTE papers as they have been shaped through discussions to reach agreement on best practices. The effort is being led by the American Council of Academic Physical Therapy (ACAPT), APTA, the Education Section of APTA, and the Federation of State Boards of Physical Therapy (FSBT).
A Centers for Medicare and Medicaid (CMS) proposed rule (.pdf) could reduce reimbursement for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) by more than $7 billion from 2016 through 2020, largely through applying payment rates from the DMEPOS competitive bidding program in noncompetitive bidding areas. APTA has published a detailed "highlights" summary of the rule on the DMEPOS webpage, part of a suite of APTA resources on Medicare payment.
Additional proposed policies that would impact physical therapists (PTs) include:
The public will have until September 2, 2014, to submit comments on the rule, and APTA will submit comments on behalf of its members.
Bad posture? There's a shirt for that. Well, maybe.
A July 21 Wall Street Journal article reports on preliminary studies of "posture" shirts—essentially shirts with built-in elastic bands that work with muscle groups to correct slumping shoulders and drooping heads—that show improvements in neck and back pain, and some increase in sports performance.
The WSJ article points out that even if the shirts do alter posture while they're worn, the issues behind the posture problem may not be properly addressed—an idea attributed to Timothy Sell, PT, who was interviewed for the piece. Sell points out that underlying problems, such as an imbalance between pectoral and back muscles, need to be corrected to truly address poor posture.
Recommendations around falls prevention, physical activity, and obesity prevention are among the topics covered in the latest edition of the US Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services, which grades preventive services based on the "net benefit" to the patient.
The new guide contains USPSTF recommendations released over the past 10 years on screenings for conditions such as breast cancer, cognitive impairments, osteoporosis, and carotid artery stenosis, but also includes recommendations around interventions and counseling on falls in community-dwelling older adults, diet and physical activity in adults and children, and obesity in all age groups. According to USPSTF, the recommendations are intended to be the result of evaluations "free from the influence of politics, special interests, and advocacy."
While none of the preventive services most strongly related to physical therapy received an A grade, falls prevention in community-dwelling older adults (65 and older) is most strongly supported, with the recommended intervention of "exercise or physical therapy and/or vitamin D supplementation" receiving a B, indicating "high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial."
Also receiving a B grade were screening and management of obesity in adults and children. The guide gave "healthful diet and physical activity" a C rating, but limited its discussion to the effectiveness of behavioral counseling interventions at the primary care level, and not through referral or linkages with community-based programs. The guide notes that "the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease is strong."
According to USPSTF, the guide and grading system evolved "as it has become widely recognized that some 'preventive' services were not actually beneficial. Individual health care providers, professional organizations, [and other health care stakeholder groups] … have recognized the need to carefully balance potential benefits and harms using the highest quality evidence."
Prevention, wellness, and disease management figure heavily into APTA's priorities for physical therapy. As part of its effort to highlight the ways in which physical therapists (PTs) can have a positive impact on these issues, the APTA Board of Directors recently identified specific health priorities that are consistent with the United States National Prevention Strategy. These priorities include active living, injury prevention, and secondary prevention in chronic disease management. The association also provides extensive resources on these topics at its prevention, wellness, and disease management webpage, and has representatives on the board of the National Physical Activity Plan Alliance.
Choosing appropriate tests and measures is a crucial component of evidence-based practice. But not all measurements are reliable—and even when they are, the test or measure might not have validity for certain uses or types of patients.
Reliable? Valid? That's where psychometrics come in, via the PTNow blog.
The latest PTNow blog takes readers through the third installment of its primer to understanding how tests and measures are tested and measured by tackling validity, a multifaceted concept that aims to find out if a given measure is measuring what it's supposed to, how well, and for which populations.
Too complicated, you say? Nope. The blog is written with the uninitiated in mind as well as for those who could use a brush-up, and uses real-life examples to illustrate major points. Check it out—it's a validating experience.
A recent Boston Globe article explores some critics' claims that a government-incentivized "rush" to the adoption of electronic health records (EHRs) has created a new kind of patient safety issue with little oversight in place.
In the July 20 issue of the Globe, reporter Christopher Rowland writes that "the explosion in the use of the electronic records has created the potential for efficiencies and safety benefits but also new risks for patients, the scope of which is still not fully understood." Rowland's lengthy article describes how $30 billion in federal subsidies aimed at encouraging these technologies "has thrust balky, unwieldy, and error-prone computer systems into highly sensitive clinical settings at a record pace."
Rowland interviews proponents and detractors of EHRs—and a few professionals who are somewhere in the middle—and recounts findings from CRICO, "a Harvard-affiliated malpractice insurance group" that tallied rarely-reported cases in which the use or misuse of EHRs was thought to have caused harm.
According to the Globe article, the CRICO study looked at a pool of approximately 5,700 cases cited in malpractice claims, and found 147 instances in which EHR problems resulted in adverse events. Of those 147 cases, 46 resulted in patient death. The article also describes 2 Boston-area cases in which some claim EHR-related problems contributed to the deaths of patients.
The article does not include information on error rates or other problems linked to paper records.
The Globe article follows a report in the June 20 issue of JAMIA, covered in APTA's PT in Motion News, that looked at the nature of problems related to use of EHRs in the Department of Veterans Affairs (VA) hospital system.
APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs.
APTA is urging that UnitedHealthcare (UHC) stop its plan to implement Medicare outpatient therapy functional reporting code requirements in its Medicare Advantage plans.
UHC announced its decision to implement functional limitation reporting in their May bulletin (.pdf, p.46). The company plans to require G-codes and severity/complexity modifiers on contracted physical therapist (PT) claims with dates of service on or after August 1, 2014. Claims that do not include the appropriate G-code and modifiers will be rejected.
In its letter to UHC, APTA argues that the difficulties experienced by PTs during Medicare's changeover to the requirements, as well as limitations in data, make UHC's planned August 1 move ill-advised.
APTA has its own functional limitation reporting webpage that provides resources to help members meet this reporting requirement.
A new APTA summary focuses on proposed rules for the 2015 Medicare outpatient prospective payment system (OPPS).
The PDF document includes information on payment impacts, ambulatory payment classifications (APCs), packaging policies for ancillary services, and other issues. The summary is part of an extensive set of APTA resources on Medicare coding and billing.
Following a rigorous review that included a "Shark Tank"-like workshop and critique in May, APTA has announced the finalists in its Innovation 2.0 initiative. Through the program, APTA will provide funding and in-kind services over a 12-month period to help advance these innovative models of care delivery that highlight the value of physical therapist services.
In return, APTA will be able to access model data that potentially helps the association develop and disseminate templates and other resources that enable members throughout the country to promote the impact of physical therapy in the emerging health care environment—a strategic priority of the association.
"The health care environment is rapidly evolving with an emphasis being placed on collaborative care models that achieve the triple aim of improving health and outcomes and reducing costs," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "Our finalists have demonstrated success in using new and collaborative models to achieve these goals, and we are proud to support them in their pursuit."
The competition, which began with 60 applicants, included such models as accountable care organizations (ACOs), bundled payment, direct access, patient-centered medical homes, prevention and health promotion, and value-based purchasing. A group of member experts assessed the final 16 submissions to choose the winning 3:
APTA also gave "honorable recognition" to 2 additional models, which will receive a financial award:
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