• Friday, July 31, 2015RSS Feed

    Oregon Medicaid Will Shift to Physical Therapy, Other Nonsurgical Approaches as First-Choice Treatments for Back Pain

    As part of a change aimed at improving what one state official described as a "really stupid" health care policy, Medicaid recipients in Oregon will be able to access physical therapy and other nonsurgical and nondrug approaches to back pain as the priority treatment beginning in 2016.

    The Bend, Oregon, Bulletin reports that the Oregon Health Plan (OHP)—the state's Medicaid program—will apply the change to all types of back conditions, and will restrict surgery to cases of spinal stenosis and "certain types of radiating pain."

    According to the Bulletin report, the impetus for the change was based in part on evidence that points to the efficacy of nonsurgical, nondrug approaches, and in part on troubling statistics that showed that of the 8% of OHP recipients who sought treatment for back pain, over half received prescriptions for narcotics.

    “We were hearing really loud and clear … our current state of affairs is really stupid,” said Ariel Smits, medical director for the Health Evidence Review Commission, in the Bulletin story. Backers of the new plan hope that a reduction in narcotic use will partly offset what they expect to be increased costs associated with the change.

    OHP members will be allowed to see 1 or more providers, in any combination, up to 30 times a year for back pain. Physical therapy, acupuncture, chiropractic, cognitive behavioral therapy, osteopathic manipulation, and occupational therapy are included in the list of priority treatments.

    Friday, July 31, 2015RSS Feed

    Get Inspired: PTs and PTAs Make a Difference at the Special Olympics

    We could write a bunch of words describing the volunteer efforts of physical therapists (PTs) and physical therapist assistants (PTAs) at the Special Olympics games now taking place in Los Angeles, but really, wouldn't you rather see for yourself?

    Take a few minutes to get a visual reminder of why you're a member of the profession, and how #PTTransforms—check out this Storify from the Special Olympics' FUNfitness tent, a popular screening service that is now a staple of the games' Healthy Athletes program.

    590 px Sliver for Storify

      Want to see more photos from the FUNfitness screening tent? Check out this special article from ESPN.

    Friday, July 31, 2015RSS Feed

    Voluntary Movement Restored to Individuals With Paralysis Through Noninvasive Electrical Stimulation

    In research that builds on previous breakthroughs in electrical stimulation of the spinal cord, researchers report that 5 additional individuals with complete lower extremity motor paralysis are now able to voluntarily generate movements by way of electrical stimulation—this time, through a noninvasive technique.

    The new approach, developed through research partially funded by the National Institutes of Health (NIH), uses the same concept of electrical stimulation to the spine, but does so through electrodes on the surface of the individual's skin, rather than through a surgically implanted device. The earlier study used surgically implanted devices to restore a degree of voluntary movement to 4 people with paralysis.

    The 5 men who participated in the most recent study had experienced total lower extremity paralysis for at least 2 years. Each individual participated in a series of 45-minute sessions once a week for 18 weeks. Those sessions also involved physical conditioning and the administration of buspirone during the final 4 weeks.

    By the end of the sessions, the men were able to "voluntarily generate step-like patterns" while their legs were suspended in braces that hung from the ceiling, according to a news release from NIH. "Movement in this environment is not comparable to walking," NIH states. "Nevertheless, the results signal significant progress towards the eventual goal of developing a therapy for a wide range of individuals with spinal cord injury."

    Researchers believe the new approach may be useful for individuals with paralysis who have already undergone extensive surgeries and may not be ready for or capable of more.

    Another significant factor: cost. If the technology can be refined, the noninvasive approach could be one tenth as expensive as the surgically implanted device.

    Lead researcher V. Reggie Edgerton, PhD, who participated in the earlier study with implants, believes that both the invasive and noninvasive approaches need to be pursued, according to NIH. Edgerton is hoping to expand research to find out whether the noninvasive stimulation can also help individuals with paralysis regain autonomic functions they may have lost, according to NIH.

    Thursday, July 30, 2015RSS Feed

    50 Years In, Medicare Experiences 'Jaw Dropping' Drop in Mortality, Hospitalizations, and Expenditures

    Nothing eases the sting of turning 50 like knowing you're in better shape now than you were at 34.

    Just in time for the 50th anniversary of Medicare, a new study published in JAMA (abstract only available for free) is making headlines for its findings that Medicare beneficiaries' mortality and hospitalization rates declined between 1999 and 2013, as did overall expenditures per beneficiary. The rate of decline was described as "jaw-dropping" by lead researcher Harlan Krumholz, MD, SM, in an article in USA Today.

    Researchers analyzed data from 68,374,904 Medicare beneficiaries, both in fee-for-service and Medicare Advantage systems, and found that all-cause mortality dropped from 5.30% in 1999 to 4.45% in 2013. Among slightly more than 60,000 fee-for-service beneficiaries, the total number of hospitalizations per 100,000 person-years decreased from 35,274 to 26,930, while average inflation-adjusted per-beneficiary inpatient expenditure shrank from $3290 in 1999 to $2801 in 2013.

    In its coverage of the study's findings, National Public Radio turned to economist Craig Garthwaite at the Kellogg School of Management at Northwestern University, who acknowledged that Medicare has achieved cost-containment in part through tightening reimbursements to hospitals and health care providers.

    "That's an easy way to get control of medical spending in Medicare," Garthwaite says in the NPR article, adding that "it's just not something we can do in the private market, and we have to worry about how sustainable it is for the Medicare program overall."

    When interviewed by NPR, Krumholz pointed to better overall approaches to treatment and wellness as one reason for the savings, in addition to a shift in care from hospitals to outpatient clinics.

    Physical therapy has been a part of Medicare and Medicaid in 1 form or another since 1968. Track the development of the profession's relationship with the programs by checking out this new timeline from APTA (.pdf).

    Thursday, July 30, 2015RSS Feed

    New Course for Internationally Educated PTs the Result of Collaborative Effort

    Internationally educated physical therapists (PTs) will soon be able to get up to speed on crucial areas of the US health care system, thanks to a collaborative effort to develop an online course that aims to smooth the transition into practice as a licensed PT in the US.

    APTA, the Federation of State Boards of Physical Therapy (FSBPT), the Foreign Credentialing Commission on Physical Therapy (FCCPT), and APTA's Section on Health Policy and Administration (known as HPA: The Catalyst), recently announced that Duke University has been selected to develop, run, and administer an online course that covers the health care delivery system in the US. According to a news release from APTA and its project partners, the course is designed to help PTs educated and trained outside the US "overcome hurdles resulting from cultural differences and achieve a smoother and quicker transition" to stateside practice.

    The joint effort to establish the course began over a year ago, led by a multi-organization project team with members from each of the participating entities.

    Aspects of the American health care system that will be covered in the 10-module course will include the role of federal and state governments, Medicare and Medicaid basics, the private insurance system, proper use and supervision of support personnel, ethics and integrity in practice, cultural competence, billing, and direct access.

    The course will be made available online through Duke University. Participants will receive college credit for completing all 10 modules.

    Duke was selected from among 10 candidates that had submitted proposals.

    "This is a fantastic example of what can be achieved when leading groups in health care collaborate to achieve a common goal," said APTA President Sharon L. Dunn, PT, PhD, OCS, in the statement. "We are excited to get the ball rolling."

    Wednesday, July 29, 2015RSS Feed

    For Medicare and Medicaid's 50th, a Look at Physical Therapy's Role

    When it arrived as signed legislation 50 years ago, Medicare and Medicaid was far from the system we know today—especially when it comes to physical therapy. APTA is marking the program's half-century birthday by highlighting how its evolution affected the profession, and vice-versa.

    Just in time for the July 30 anniversary of Medicare and Medicaid, the association has released an infographic (.pdf) that lays out the timeline for physical therapy's involvement in a program that covers an estimated 124,000,000 people (55 million via Medicare and 69 million through Medicaid). The program, controversial at the time of its implementation, now is credited with increasing life expectancy and reducing poverty in the United States.

    Today's Medicare and Medicaid are significantly different from their original forms. Medicaid, for example, was tied to welfare, and Medicare didn't cover prescription drugs. Initially, private insurance played a far less prominent role than it does today, and hospitals and nursing homes were racially segregated (something Medicare and Medicaid helped to eliminate).

    The physical therapy profession became part of this evolution in 1968 and has remained integral to the program ever since. Like almost every other element connected to Medicare and Medicaid, however, the relationship between the programs and physical therapy has changed over time.

    It's a relationship that, judging from the APTA timeline, has had its share of ups and downs. But it generally has trended toward increased patient access to physical therapist services. Among the notable developments listed in the infographic:

    • Reimbursement for physical therapists became possible in 1968 when the definition of outpatient physical therapy services was added to the Social Security Act of 1967.
    • In 1983, the Centers for Medicare and Medicaid Services (CMS) fueled the rise in postacute care by enacting the prospective payment system based on diagnosis-related groups. Prospective payment systems for skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities were added in 1997.
    • The Balanced Budget Act implements a $1500 cap on outpatient therapy in all settings except hospitals beginning in 1999; APTA successfully lobbies Congress to impose a 2-year moratorium on the cap.
    • The number of physical therapist practices participating in Medicare and Medicaid grows rapidly after 2000, when CMS eliminates certain conditions of participation.

    Many more details appear on the timeline, including more recent developments such as the repeal of the flawed sustainable growth rate formula and the signing into law of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.

    "It's nearly impossible to underestimate the effects Medicare and Medicaid have had on the overall population health of the United States," said APTA President Sharon L. Dunn, PT, PhD, OCS. "The physical therapy profession has had a relationship with these programs for nearly as long as they've existed. We should take pride in the ways our commitment to patient health and transformation has, in turn, helped Medicare and Medicaid evolve."

    Interested in more history and real-world accounts of the ways in which Medicare and Medicaid have made a difference in people's lives? Check out the CMS webpage devoted to the anniversary.

    Tuesday, July 28, 2015RSS Feed

    Evidence on Hamstring Rehab Supports Exercise; Platelet-Rich Plasma Found Ineffective

    Results of a new systematic review and meta-analysis point to stronger evidence that when it comes to acute hamstring injuries, rehabilitation exercises work—and platelet-rich plasma (PRP) injections don't.

    The study, which updated an earlier review published in 2012, analyzed 10 randomized clinical trials—6 of which were new since the previous publication—that focused on conservative interventions for acute hamstring injuries. A total of 526 participants were included in the trials (mean of 65 per study) with an average age of 20. All participants had some connection to sports, and most (86%) were male.

    The interventions used in the trials included lengthening and loading exercises, stretching and strengthening (STST) exercises, progressive agility and trunk stabilization (PATS), and PRP injections. Authors of the systematic review compared the interventions by way of return-to-play (RTP) times and re-injury rates. Results were e-published ahead of print in July 21 online edition of the British Journal of Sports Medicine (abstract only available for free).

    The analysis showed that in terms of reducing RTP times, evidence supports the addition of lengthening exercises. Authors also found a link between PATS exercises and reduced re-injury rates, although evidence supporting that relationship was described as "limited." Researchers weren't able to identify any evidence that supported PATS as a way to speed up RTP, nor were they able to point to evidence that lengthening exercises reduced re-injury rates. Studies of STST exercises did not produce evidence supporting their effectiveness in RTP, and showed what authors described as a "remarkably high" re-injury rate, at 70%.

    What the evidence definitely doesn't support, according to the authors, is the use of PRP injections.

    "Our meta-analysis and descriptive synthesis show that there is no superior efficacy for PRP injections," authors write. "Considering our quantitative and qualitative findings, higher levels of evidence are now available to discourage the use of PRP injections in the rehabilitation of hamstring injuries."

    While authors believe that their new review helps to create a clearer intervention path, they cite the need for more studies or higher quality. Most current studies, they write, are weakened by a lack of blinding among patients and therapists, and poor comparability between trials (mostly due to variation in what was used as the "standard therapy" control). Another issue: RTP measures "varied greatly" between studies.

    Still, they write, evidence is sufficient to point to the positive role of both lengthening exercises and PATS "for daily practice" to treat acute hamstring injuries.

    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.

    Monday, July 27, 2015RSS Feed

    Rapid—and Recent—Developments in Robot-Assisted Rehab Point to Burgeoning Industry

    We're not quite in Iron Man territory yet, but new developments in mobility assistance through robotics have been occurring at a fairly fast clip over the spring and summer of 2015, and financial forecasters expect the rehabilitation technology market to take off over the next 5 years.

    A few of the latest developments:

    A Lego-friendly prosthetic arm. Developers in Colombia have created a prototype prosthesis that can accommodate creations made from the popular interlocking plastic building system. The device reacts to movements from muscles at the arm stump and delivers signals to a motor that accepts standard prosthetic attachments and Lego-based creations. It's a project they hope will help break down barriers for children with disabilities. "The idea erases that line between disability and ability," says Carlos Torres, developer of the IKEO Prosthetic System.

    The first-ever US commercial insurance reimbursement for a ReWalk exoskeleton. The first company to receive US Food and Drug Administration approval for a robotic exoskeleton reached a milestone when an unnamed commercial insurance company approved reimbursement for the device, which has a retail price of $71,000.

    A lightweight walking assistance device from Honda. The Walk Assist system built by the car manufacturer is worn like a belt, with attachments that can be strapped on to the thighs of the wearer. Walk Assist weighs about 6 pounds and has a 60-minute battery life. Honda says the device is based on "the inverted pendulum model" and is intended to be used under the guidance of a physician or therapist. Leasing begins in Japan in November.

    A robotic assistant that senses small muscle contractions and interfaces with video games. The Luna rehabilitation robot uses electromyography to sense muscle movement at nearly undetectable levels, and then translates those into mechanically assisted arm movements that in turn interact with video games to make rehabilitation sessions more interactive and entertaining.

    An upper-body exoskeleton that feels "weightless" to wearers. Researchers at the University of Texas – Austin have developed HARMONY, an upper-body exoskeleton with extensive adjustment capabilities that works with the entire upper body, rather than a single arm at a time. "HARMONY’s shoulder mechanism assists in a range of motions that are very close to those required for daily activities, and the eventual incorporation of a screen or gaming environment to simulate such activities may lead to successful relearning," according to a UT-Austin news release.

    A rehabilitation robotics market poised to grow rapidly. A new financial analysis estimates that rehabilitation technology will grow from a $200 million global industry to a $1.1 billion one by 2021. According to a summary of the analysis from medGadget, "all the products that are now commercially viable are positioned to achieve significant staying power in the market long term, providing those companies that offer them with a possibility for long-term leadership position in the market."

    Check out APTA's resources on technology and patient care as well as an audio course on robotics and physical therapy.

    Monday, July 27, 2015RSS Feed

    PT Bainbridge Featured in ESPN Coverage of Special Olympics

    Many physical therapists (PTs) and physical therapist assistants (PTAs) have been involved with the Special Olympics over the years, but Donna Bainbridge, PT, EdD, ATC, has elevated that involvement in ways that stretch beyond the actual World Games now taking place in Los Angeles.

    As part of its coverage of the event, ESPN.com correspondent Stephania Bell, PT, OCS, CSCS, caught up with Bainbridge to find out more about FUNfitness, the screening program Bainbridge developed with APTA that is now a central part of the Special Olympics' Healthy Athletes Program.

    Bainbridge, former director of practice at APTA, explains how FUNfitness was developed and implemented at the 2001 games in Alaska, and how the program has grown from a 6-consultant program to a global operation that includes between 75 and 80 programs. This year, Bainbridge says in the interview, there could be as many as 200 volunteers at the games, working together to reach a goal of providing screenings to 60%-65% of all participating athletes.

    For Bainbridge, the benefits of the program stretch beyond the immediate needs of the athletes at the games, and reach physical therapists and their home communities.

    "I feel like we're changing the lives of the volunteers we train because even though all these physical therapists work with people with disabilities, this is not necessarily a group they would solicit," Bainbridge says. "I've heard many times that they go back much more aware and seek out working with these people in their practices and their communities."

    Friday, July 24, 2015RSS Feed

    Anthem's Acquisition of Cigna Continues Insurer Consolidation Trend

    Health insurer Anthem's recent announcement that it will acquire Cigna in a $54.2 billion deal is continuing a consolidation trend that could reduce the number of major insurance companies in the US from 5 to 3. And while the nuts and bolts of the deal are plain enough, when it comes to speculation on what it will mean for consumers and providers, there's less consensus.

    What's known is this: the multibillion dollar acquisition will make the Anthem-Cigna combination the country's largest private health insurer in terms of members, with an estimated 53 million people covered. Revenues for the new company are projected at $115 billion annually.

    Anthem's acquisition comes on the heels of a July 3 merger announcement from insurance giants Aetna and Humana, meaning that if federal regulators approve both deals, the country's 5 major private insurance companies will be reduced to 3, United Healthcare being the third. Pending regulatory approvals, the Anthem-Cigna deal will close in late 2016.

    Media coverage of the acquisition generally pointed to pressures applied to insurance companies from the Affordable Care Act (ACA), which put caps on profits that could be made by insurance companies, as the big motivator for the consolidations.

    Aside from that, reports on the deal highlighted different aspects of the acquisition and its possible effects. Here's a quick take on how the deal was reported in news media outlets:

    "The merger between Aetna and Humana was a major change for the Medicare Advantage marketplace, whereas the Cigna and Anthem merger will have the biggest ripple effects for the commercial insurance market." The Washington Post

    "Anthem's combination with Cigna will result in a company with a much broader base over which to spread costs and expenses, and it could make technology investments over the industry's biggest customer pool.." Associated Press

    "Health insurers are seeking to consolidate to gain greater scale to reduce costs and capitalize on growing opportunities in the government and individual markets." New York Times

    "Anthem said it expects the deal to close in the second half of 2016, indicating a long regulatory road ahead." Reuters

    "Bigger insurers with more clout could raise premiums and reduce the number of doctors and hospitals in network coverage plans. But health insurers have defended their position." CNN Money

    Visit APTA's webpage on private insurance to access information, tools, and resources that can help you navigate the physical therapist-insurance company relationship.