• Thursday, April 24, 2014RSS Feed

    FDA Issues Warning on Common Off-Label Neck, Back Pain Treatment

    The US Food and Drug Administration (FDA) has issued a warning (.pdf) about the dangers of administering epidural injections of corticosteroids to relieve neck and back pain. According to the FDA, the off-label use could result in blindness, stroke, paralysis, and death.

    The potential problems were characterized by the FDA as "rare but serious" for a treatment whose effectiveness "has not been established." The injectable corticosteroids include methylprednisolone, hydrocortisone, triamcinolone, betamethasone, and dexamethasone. Epidural injections of corticosteroids to treat neck and back pain, as well as radiating pain in the arms and legs, have been a "widespread practice for many decades," according to the FDA.

    Although many of the reported problems occurred within 48 hours after the injection and were temporary, some patients never recovered. The FDA is advising patients who receive the injections to be on the lookout for changes to vision, tingling in the arms and legs, dizziness, seizures, severe headaches, or sudden weakness or numbness in face, arms, or legs, or on one or both sides of the body.

    The FDA recommends that patients "discuss the benefits and risks of [the injections] with your health care professional, along with the benefits and risks associated with other possible treatments."

    APTA has a long history of involvement in the development of information and resources on neck and back pain. Some of the resources available to physical therapists (PTs) include a MoveForwardPT.com webpage on low back pain, the PT's Guide to Osteoarthritis, clinical practice guidelines on low back pain (.pdf) and hip osteoarthritis (.pdf), and a Learning Center presentation on manipulation for low back pain. PTNow provides full-text access to the latest clinical practice guidelines and Cochrane systematic reviews related to low back pain and neck pain.  


    Wednesday, April 23, 2014RSS Feed

    AHA/ASA Initiative Improves Outcomes for Patients With Stroke

    A multifaceted initiative from the American Heart Association (AHA) and the American Stroke Association (ASA) has generated marked improvements in the rate of patients suffering a stroke who receive a critical drug within an all-important treatment window. Those improved treatment rates have resulted in reduced in-hospital mortality, more frequent ambulation at discharge, and more frequent discharge to home, according to a study recently published in JAMA, the journal of the American Medical Association (AMA).

    The drug, tissue plasminogen activator (tPA),has been long known to significantly reduce long-term disability for patients with acute ischemic stroke; however, to work effectively it has to be administered early—within 60 minutes of patient arrival. The problem, according to study authors, is that less than one-third of patients who could receive the treatment have been getting it within the 60-minute "door-to-needle" timeframe.

    That low rate was the target of a treatment initiative called Target: Stroke created by the AHA and ASA in 2010. The goal was to get hospitals to employ combinations of 10 evidence-based strategies to increase door-to-needle rates. The strategies included prenotification of hospitals by emergency medical services personnel, the creation of a single call system that could activate an entire stroke team, premixing of tPA for likely candidates, and a faster process for getting and reading brain imaging, among other approaches.

    The initiative was accompanied by an extensive educational and public relations effort that included webinars, interactive video, case studies of successful approaches used by hospitals, and the publication of an "honor roll" of hospitals that raised door-to-needle rates to 50% or higher.

    Authors of the JAMA report analyzed 71,169 patients treated with tPA from 1,030 hospitals participating in the Target: Stroke program. Median age of the patient population was 72, with a median onset-to-arrival time of 51 minutes. Just over 50% of patients were women.

    The bottom line, according to authors, is that the initiative worked: the number of patients receiving tPA within the 60-minute door-to-needle time increased from 29.6% to 53.3%, with related decreases in hospital mortality, intracranial hemorrhages, and fewer overall tPA complications (an initial worry among some experts). The improved treatment times also resulted in more frequent ambulation at discharge and a greater number of patients being discharged to home. "These findings suggest that the 10 best practice strategies used with this initiative may have contributed to the benefits observed," the authors write.

    "There was a prompt improvement in the percentage of patients meeting guideline-recommended door-to-needle times once this quality improvement initiative was implemented," the report states. Authors attribute the effective strategies to the reductions but also acknowledge the importance of the hospital staff environment in making the initiative a success. "Prior experiences of hospitals successful in improving the quality of cardiovascular care suggest that improvement is most effective when integrated into an environment that includes explicit goals; collaborative, interdisciplinary teams; a patient-focused organizational culture; engaged clinical leaders and senior management; and detailed data feedback," they write.

    APTA offers resources to physical therapists including a podcast, around care of patients with limitations in functioning after a stroke, and has created a PT's "guide to stroke" and pocket guide to physical fitness for survivors of stroke at its Move Forward website. In addition, PTNow contains tests and measures used in the examination of patients with stroke and provides access to full text of relevant clinical practice guidelines and Cochrane systematic reviews. PTNow’s search engine searches across several stroke-related evidence sites, such as StrokEngine and Evidence-Based Review of Stroke Rehabilitation (EBRSR).

    Research-related stories featured in News Now 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, April 23, 2014RSS Feed

    PTs On Top of the World: Nepal Conference Set for November

    If you've ever felt like shouting the benefits of physical therapy from the highest mountain, now's your chance: the Nepal Physiotherapy Association (NPA) has opened registrations for its seventh international conference, to be held in Kathmandu, Nepal, in the Himalayan mountains, November 21-22, 2014.

    Clinical physical therapists (PTs), educators, and students are invited to submit abstracts on research for possible presentation at the conference, which will combine academic activities and social events. Featured speakers to date hail from the US, Norway, India, Australia, and Poland.

    Details on the conference, including registration information, can be found on the NPRA website. Like APTA, NPA is a member organization of the World Confederation for Physical Therapy (WCPT).


    Tuesday, April 22, 2014RSS Feed

    Blum Resigns From CMS

    Jonathan Blum, principal deputy administrator for the US Center for Medicare and Medicaid Services (CMS), has resigned his position effective May 16, according to an alert from Modern Healthcare (access via free signup).

    Blum was the Obama administration's first appointee to CMS, and he led the development of regulations for accountable care organizations (ACOs) as well as "developing many … value-based payment strategies," according to an e-mail from CMS Administrator Mary Tavenner announcing Blum's resignation. Most recently, Blum oversaw the release of extensive Medicare payment data for 880,000 health care providers.

    At the time of this writing, details behind Blum's resignation were not available. In her e-mail Tavenner cited "new opportunities" as the reason for his departure.


    Tuesday, April 22, 2014RSS Feed

    Tablets: The Future of Care Coordination in Home Health?

    It may not be a 1-size-fits-all solution, but least 1 fairly large home health care agency thinks it may have hit upon the technology that can best coordinate care, reduce costs, and minimize privacy concerns: the 7-inch mobile tablet.

    A recently published case study (.pdf) from the College of Healthcare Information Management Executives (CHiME) tells the story of Sutter Health at Home, a division of Northern California-based Sutter Health. With a program that employs about 1,300 caregivers who make home visits to nearly 100,000 patients across 23 counties, Sutter was on the lookout for technologies that could improve coordination of care and reduce costs.

    After experimenting with individual laptops (too big, too hard to learn, glitchy) and smartphones (too small, limited computing and document-handling capabilities, spotty connections), Sutter switched to 7-inch Android-based devices. The devices themselves are the same tablets commonly available to consumers, but these are equipped with electronic health records (EHR) software specially made for Sutter Health at Home. Caregivers are also supplied with a bluetooth-enabled keyboard and a stylus.

    According to the case study, the use of tablets dramatically reduced turnaround for patient documentation from 72 to 24 hours. "In the past, if 1 of the clinicians went to see the patient on Monday and the physical therapist would go on Tuesday, the therapist would not have the information about the Monday visit available," said the program's project manager. "This is better from a productivity perspective and better for the patient." Sutter Health at Home also estimates that it has reduced costs in a number of areas, including supply ordering, which is now done directly through the tablet rather than by calling a medical supply vendor.

    The home health agency is also pleased with improvements to privacy safeguards. Built-in cameras allow clinicians to send photos quickly and securely—an improvement over past practice of taking pictures with a separate digital camera (that could be lost) and uploading the photos later (a time-consuming process). Another significant benefit: greater IT control over security and the ability to remotely wipe a device clean if it is lost or stolen.

    The case study reports that the switch to tablets is not without challenges. Sutter Health at Home invests heavily in training, requiring 18 hours of education on the tablet for any new user. And while the fact that Sutter is using easily available devices makes purchasing easier, it also means that the devices are subject to the same kind of forced obsolescence that can frustrate individual consumers. The platform has also required the agency's IT department to relinquish control of when patches and updates are installed—for tablets a process typically managed by the communications carriers.

    APTA offers a variety of resources on home health and physical therapy, including a free video on the role of home health physical therapy in the continuum of care, and a webpage devoted to payment, coding, and billing for home health patients in the Medicare system. The association also offers resources on electronic health records at its EHR webpage.  


    Tuesday, April 22, 2014RSS Feed

    Interprofessionalism: Jargon vs Practice

    Peruse articles on the future of health care, and you're likely to read plenty of references to "interprofessionalism" and how it will become central to effective delivery.

    But have we agreed on what the word means? And if we can manage to agree on a definition, do we know how to apply it to real-world situations?

    Panelists at this year's Rothstein Roundtable at the APTA NEXT Conference and Exposition will investigate some of the current thinking around interprofessionalism and its implementation in physical therapy in a session titled "Interprofessionalism: Is It Campfire Kumbaya, or the Means to the Triple Aim (Better Health, Better Care, Lower Cost)?" The conversation will focus on successful interprofessional models and how they might be generalized into physical therapist practice, and will address how interprofessionalism can be infused in education.

    The session will be held from 3:00pm – 4:30 pm Friday, June 13 as part of NEXT activities in Charlotte, North Carolina. Moderator is Anthony Delitto, PT, PhD, FAPTA, with panelists Aaron Friedman, MD, Mary Knab, PT, DPT, PhD, and Holly Wise, PT.

    NEXT evolved from the meeting formerly known as the Annual Conference and Exhibition. Though the focus and tone of NEXT will be on what's ahead for the profession, the event will also feature many of the popular elements of past annual conferences including the McMillan and Maley lectures and the Oxford Debate. As with past annual conferences, NEXT will occur immediately after APTA's House of Delegates. Registration and housing information can be found on the NEXT webpage along with a schedule of presentations and preconference sessions.


    Monday, April 21, 2014RSS Feed

    US Diabetes Rates Double in 20 Years, Diagnosis Rates Improve

    The "staggering" increase in obesity rates among Americans is the most likely reason behind a near-doubling in the prevalence of diabetes over the past 20 years, according to a new study, which also found "striking differences" in diabetes rates among minorities. On average, about 10% of the adult US population now suffers from the disease—up from 5.5% in 1994.

    The findings, which appear in the April 15 issue of Annals of Internal Medicine (abstract only available for free), point to general improvements in diagnosis rates, with the rate of undiagnosed diabetes estimated at about 11% of total confirmed cases. The study also reports that prevalence of treatment is also more widespread.

    Those were just about the limits of the good news, however. The study reviewed 43,439 participants in National Health and Nutrition Examination Surveys (NHANES) conducted in 1988–1994, 1999–2004, and 2005–2010 and found that rates of diabetes climbed as obesity rates rose. Obesity rates are now estimated at just over 32% of Americans without diagnosed diabetes, according to the report.

    The rise in diabetes rates was even more significant for certain ethnic groups. While whites reported an 8.6% diabetes rate, non-Hispanic blacks registered a 15.4% rate, while the rate of diabetes among Mexican Americans was estimated at 11.6%. The results are "particularly concerning because blacks and Mexican Americans are also at greater risk for complications from diabetes, particularly retinopathy and kidney disease," the authors write.

    APTA emphasizes the importance of prevention, wellness and disease management, and offers resources on diabetes for physical therapists and their patients through its Move Forward diabetes webpage and in a pocket guide to diabetes. The association also offers 21 clinical practice guidelines on care for patients with diabetes as well as 3 Cochrane reviews related to care for patients with diabetes-related foot ulcers through its PTNow evidence-based research tool.

    Research-related stories featured in News Now 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. Read APTA's full website disclaimer.


    Friday, April 18, 2014RSS Feed

    Professionalism Across Disciplines Subject of Panel Discussion

    What is professionalism, exactly? Part of a person's character? A set of learned behaviors? In a health care environment that demands increased levels of interprofessional collaboration, how important is it that individual providers understand professionalism across disciplines?

    APTA recently hosted a roundtable via Google+ Hangouts event that brought together representatives from physical therapy, nursing, dentistry, pharmacy, and osteopathic medicine to talk about professionalism—what it is, how it's incorporated into education programs, and the importance of understanding how professionalism is manifested in other health care professions. A recording of the session is free to view on the APTA Interprofessional Education and Collaborative Practice Resources webpage.

    Be sure to check out the other resources available on the Interprofessional Education and Collaborative Practice Resources webpage to get the latest information on how professions are learning to work together to provide patient- and client-centered care.


    Friday, April 18, 2014RSS Feed

    Foundation Now Accepting Grant and Scholarship Applications

    The Foundation for Physical Therapy now is accepting applications for the 2014 Florence P. Kendall Doctoral Scholarships and the 2014 Research Grants.

    The Kendall Post-Professional Doctoral Scholarships assist physical therapists and physical therapist assistants with outstanding potential within their first year of postprofessional doctoral degree studies. Research grant opportunities are being offered as up to 2 Foundation grants, a Magistro Family Foundation Grant, and a grant for orthopedic research.

    The deadline for all applications is Wednesday, August 6, 2014, noon ET—earlier than past years.

    Questions? E-mail the Foundation or call 800/875-1378.

    Be among the first to receive news about research, funding opportunities, and much more. Sign up today for the F4PT Alert mailing list by contacting Rachael Crockett.


    Thursday, April 17, 2014RSS Feed

    Study: Rethink Benefits of Antihypertensive Meds vs Risk of Serious Falls

    For adults over 70, could the risk of falls due to the effects of antihypertensive medications outweigh the risks of not taking those medications? According to a recent study of nearly 5,000 community-living adults over 70 with hypertension, it's a valid question that should be asked at the individual level.

    In an article e-published ahead of print (abstract only available for free) in the February 24 issue of JAMA Internal Medicine, researchers led by Mary Tinetti, MD,concluded that "antihypertensive medications were associated with an increased risk of serious fall injuries," with those taking antihypertensive medications who have already experienced a fall more than twice as likely to experience a subsequent serious fall than those who are not taking the drugs.

    "The morbid effects associated with serious fall injuries … which are comparable to those imposed by myocardial infarction and stroke, suggest that treatment decisions should be predicated on maximizing benefit and minimizing harm," the authors wrote.

    The study focused on participants in the Medicare Current Beneficiary Survey from 2004 – 2007 who were older than 70, in a community living environment, and were designated as a traditional Medicare beneficiaries (Medicare Advantage beneficiaries were excluded from the research). In all, 4961 participants with a claims-based diagnosis of hypertension were included with a mean age of 80.2 years. Just over 60% were female.

    The group was further divided into 3 subgroups, a no-hypertensive medication group (697 participants), a moderate-intensity medication group (2711 participants), and a high-intensity medication group (1553 participants). Researchers then tracked falls incidents for all participants, but limited their review to only serious falls, "which are more clinically equivalent to the cerebrovascular and cardiovascular events that antihypertensive medications are prescribed to prevent."

    According to the study, 446 of the 4961 participants experienced a serious fall injury, with 111 of those participants dying during the follow-up period (rates of death were higher for the medication groups, though it was unclear whether death was directly related to the fall). Broken down by subgroup, serious falls were experienced by 52 participants in the no-medication group, 267 in the moderate-intensity group, and 127 in the high-intensity group. When researchers looked further into the histories of the subgroups, they found that for those who had fallen in the year prior, risk of another fall more than doubled for the medication groups. They found no particular class of antihypertensive medication to be more strongly associated with falls risk than another.

    "This article highlights some important factors PTs know, but they're ones that bear repeating and should be on our collective radar," says Mindy Renfro, PT, PhD, GCS, research assistant professor at the University of Montana. "Fall risk is multifactorial, and polypharmacy use is high on the list of modifiable risk factors. Cardiovascular medications, including antihypertensive medications, are only surpassed by psychoactive medications in increased risk for falls in all adults—but even more so in older adults. As the profession of choice for falls prevention and management, we need to consider these risk factors."

    Authors acknowledged this risk and framed it in light of the relative benefits of antihypertensive medications. "Because most older hypertensive adults have had hypertension and been receiving treatment for many years," they write, "the clinical question is the likely benefit vs harm of continuing medications" at a time when serious falls risk has increased. Researchers wrote that because the morbidity and mortality associated with serious falls-related injuries such as hip fracture and head injury are comparable to morbidity and mortality associated with cardiovascular events, "It is important … to consider the effects of medications not only on the conditions for which the medications are indicated but on coexisting conditions, including fall injury risk."

    Renfro pointed out that while health care providers must always be aware of medication effects, particular attention needs to be paid to when a patient begins taking a drug. "PTs and other health professionals should understand that falls due to antihypertensive or psychoactive meds occur most often in the first 2 weeks after a prescription change," she said.

    “This research isn’t necessarily news for PTs, but it does point out how important it is for health professionals to recognize the effect that medications can have on a patient’s function, including the very serious risks associated with falls," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "Informing patients of the potential risks of medications and monitoring the effects of the medication on functioning—not just the effect of the medication on the condition being treated—must be considered, particularly in the older adult population."

    Authors acknowledged that "although cause and effect cannot be established" through the study, the nationally representative data on older adults suggests an association between the medicines and falls risk strong enough that it should be weighed against the benefits of the drugs on an individual level. "The potential trade-off between serious fall injury and cardiovascular events and mortality suggests that each older adult's prevention priority should drive decision making," they write.

    APTA provides continuing 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, information on evidence-based falls programs, and a clinical summary on falls risk in community-dwelling elderly. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as an online community where members can share information about falls prevention.

    Hypertension clinical practice guidelines and their lack of information on physical activity was the subject of a recent PTNow blog post. Check it out—and join the conversation!

      

    Research-related stories featured in News Now 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.

    Read APTA's full website disclaimer.


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