Colorado health officials now report that 10 children are experiencing paralysis and muscle weakness that may or may not be linked to Enterovirus D-68 (EV-D68), a respiratory infection that has now spread to 40 states.
According to a report in the Denver Post, 8 of 9 children originally diagnosed with myelitis were tested for viral outbreaks, with 4 testing positive for EV-D68, and 4 testing positive for rhinovirus or another enterovirus. At the time the Denver Post report was written, officials had not provided testing information on the 10th child.
No definitive connection between EV-D68 and the paralysis and weakness has been established. The Denver Post reports that "there are no cases where the children are completely unable to move, just varying degrees of muscle weakness, difficulty swallowing, difficulty breathing, weakness in the neck and trunk, and difficulty walking."
According to the Centers for Disease Control and prevention, the children tested negative for West Nile virus and polio.
In response to the reports, the CDC has issued a health advisory asking that health departments inform the CDC of any patients under 21 who have experienced acute onset of focal limb weakness on or after August 1, and who have an MRI showing a spinal cord lesion largely restricted to gray matter.
While researchers look to establish or eliminate EV-D68's role in the paralysis and weakness, the Washington Post reports that the virus has been found in 40 states and the District of Columbia. Children with asthma or other preexisting respiratory problems tend to be especially hard-hit by EV-D68. According to the Washington Post article, 277 cases have been reported to date.
Earlier this year, 20 children in California were reported to be experiencing similar neurological symptoms, with 2 testing positive for EV-D68. According to a story from the Associated Press, the CDC is still unsure if there is a connection between the virus and the paralysis and weakness in the California cases.
APTA has joined a national campaign to help raise awareness about safe needle practices and injections in health care.
Led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), the One and Only Campaign brings together professional organizations, health care certification groups, health care systems, private companies, educational institutions, state and local health departments, and others to support the dissemination of safe injection messages using social media, electronic continuing medical education, advertising, and print materials for health care providers and patients.
In addition to APTA, campaign members include the Ambulatory Surgery Center Association, the American Podiatric Surgery Association, and the Association of Occupational Health Professionals in Healthcare.
Resources available from the One and Only website include a patient brochure (.pdf), patient frequently asked questions, and a provider training unit on bloodborne pathogens. The campaign also offers a YouTube channel with provider-focused informational videos.
Safe conduct of any invasive procedure such as dry needling, some forms of wound care, and electromyography are important components of physical therapist practice. In addition the resources now available to members through APTA's partnership with the One and Only Campaign, the association has developed a paper outlining the safe and effective performance of dry needling (.pdf).
There is a need for more definitive and rigorous studies, say researchers, but a new systematic review of the effects of exercise programs on gait performance in people with lower limb amputations points to some positive connections—even if specifics were hard to come by.
The review, published in the September 28 issue of Prosthetics and Orthotics International (abstract only available for free), found 623 article citations for studies of gait among people with lower limb amputations and eventually whittled acceptable research down to 8 studies involving 199 participants. These studies allowed researchers to compare self-selected gait speed among patients who received specific functional exercise programs, but in the end they did not reveal a single exercise program or combination that could be deemed most effective.
Authors focused on self-selected gait speed as "the only consistent measure of gait performance" among the studies.
The actual degree of improvement difference was difficult to pin down, authors write, based in part on inconsistencies in the studies, and wide variation of exercise programs used. Still, they write, "The combined evidence suggests that a variety of different types of exercise can improve self-selected gait speed," and that "improvement in gait performance was seen throughout whether participants were in their third or seventh decade, and whether only men or men and women were combined." No study focused on women only.
The range of exercises in the studies included activities targeted at supervised walking, specific muscle strengthening, balance, gait training exercise, and functional training focusing on coordination exercises "beyond walking and stair negotiation." Exercise treatment duration ranged from 3 days to 14 months, and from 2 to 40 individual sessions of 30 to 90 minutes. Physical therapists were identified as treatment providers in all but 1 study, which did not specify who provided treatment.
"Little evidence consistently differentiated which type of exercise was most beneficial," authors write, although improvement occurred "whether most exercise was performed as an unsupervised home exercise program, in focused daily treatments provided within a single week, or in regular sessions spanning months."
Overall, authors write, the evidence reviewed is only sufficient for a "Grade B" recommendation to support the use of exercise programs that use a range of methods, meaning that more research work needs to be done before a solid analysis can be conducted. "No consensus on a best approach emerged," they write. "This review underscores the need for more and higher quality research into the clinical benefits of specific exercise programs in lower limb amputation rehabilitation."
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.
Until you receive further notice, keep on using the 59 modifier in reimbursement claims to indicate that a health care common procedural code (HCPCS) represents a service that is separate and distinct from another service to which it is paired under the Correct Coding Initiative (CCI) program—that's the bottom line from the Centers for Medicare and Medicaid Services (CMS), which recently responded to an inquiry from APTA as to when—and whether—physical therapists should use a set of new modifiers announced by CMS in August.
The clarification was forwarded to APTA by CMS after some physical therapists questioned whether they should begin using the new modifiers. The CMS answer: not yet.
In August, CMS issued a transmittal describing new modifiers—XE, XS, XP, and XU—intended to be used to define subsets of the 59 modifier. The new modifier codes have not been implemented, and CMS has advised that PTs should not use the modifiers until they receive further notice.
The Medicare "Pioneer" program that targets more sophisticated health systems to foster the development of accountable care organizations (ACOs) has now lost about 40% of the systems that signed on initially. According to an article in Modern Healthcare (access available via free one-time registration) the most recent withdrawals "suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models."
The most recent exits—Franciscan Alliance, Genesys PHO, and Renaissance Health Network—bring the Pioneer list from its original 32 members to 19. The Modern Healthcare article reports that 9 of the 13 ACOs that dropped out did so within the first year of the program's launch in 2012, opting instead to join the "less risky" shared savings program, the traditional Medicare program that allows other entities to form ACO. Unlike the Pioneer program, the number of entities joining the shared savings program has been steadily increasing.
The Pioneer program was designed to help ACOs transition from a fee-for-service payment structure to improve patient care, increase Medicare savings, lower costs, and to test alternative program designs to inform future rulemaking for the Medicare Shared Savings Program. The ACOs in the Pioneer program were generally considered ones that were willing to withstand potential losses in hopes of achieving bonuses for meeting various quality and spending metrics.
Modern Healthcare reports that while the ACO program is generally helping to set the stage for more widespread use, critics of the Pioneer program contend that Medicare's bonus formulas are "skewed in favor of [ACOs] that operate in markets that have above-average health spending, where hospitals and doctors have more opportunities for savings." The article describes how Medicare announced that its ACO initiatives saved $817 million through 2013, and how "dozens" of program participants shared in $445 million in bonuses, "but three-quarters saw nothing after failing to do sufficiently well against the financial benchmarks."
APTA members can learn more about a physical therapist's role in an ACO by visiting APTA's webpage, FAQ: Accountable Care Organizations (ACOs): Medicare Shared Savings Program and Pioneer Models.
When it comes to deciding on art for PT in Motion magazine, APTA members have it covered.
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 November, editorial staff is proposing 2 designs and asking members to vote on their favorite cover to illustrate the concept of physical therapy across the lifespan The design that receives the most votes will be the next cover.
Take the quick and simple survey by October 1. Just pick the design you think is likely to get you to open up the magazine, and then check out the November issue to see which cover was most popular.
As APTA continues to grow, so does its need for exceptional leaders. Anyone come to mind? Maybe you?
The APTA Nominating Committee is seeking recommendations for the 2015 slate of candidates for elected positions. Positions open for election are Board of Directors president, vice president, and 3 directors; and 1 Nominating Committee member.
Use the online nomination form to submit the names of qualified members who would be willing to be considered for the upcoming election cycle. Deadline is November 3.
Now's the time. Reach out to a leader you think should take those talents to a national level for APTA, and who's ready to guide the association through some exciting years ahead.
Physical therapists have long been aware of the importance of early mobilization and rehabilitation for patients in a hospital intensive care unit (ICU). Now a new program is recruiting hospitals to participate in a project to spread that understanding by facilitating practices that can more quickly liberate patients from mechanical ventilation and move them out of the ICU.
The Comprehensive Unit-Based Safety Program (CUSP) for Mechanically Ventilated Patients (MVP) and Ventilator Associated Pneumonia (VAP) is seeking so-called "coordinating entities" interested in participating in a 2-year program to prevent ventilator-associated events including VAP. A free 90-minute informational webinar on the program will be held on Monday, September 29, at 1:00 pm ET.
The program focuses on improvement in staff teamwork and communication, analysis of daily process measures, efforts to mobilize patients earlier, and employment of low tidal volume ventilation strategies. Project content will be delivered through webinars, e-mail, and as online resources, and all materials are available on the CUSP 4MVP VAP project website.
The initiative is funded by the Agency for Healthcare Research and Quality, and is being delivered in partnership with the Johns Hopkins Institute for Patient Safety and Quality, the Michigan Health and Hospital Association, the Department of Population Medicine at Harvard Medical School, and the Harvard Pilgrim Health Care Institute. APTA and its Acute Care Section provided consultation on the development of this program.
For more information, contact the project helpdesk at email@example.com.
With National Physical Therapy Month (NPTM) coming in October, now's a perfect time to begin making plans to celebrate the profession and increase understanding of how physical therapy can transform society.
Visit the APTA NPTM webpage for everything you need to create your own NPTM activities. Resources include the 2014 NPTM logo, fact sheet, event planning guide, sample news releases and proclamations, and much more. Even more resources can be found at MoveForwardPT.com, APTA’s official consumer information website.
NPTM is a great opportunity to give communities a "hands on" experience of physical therapy by demonstrating what physical therapists and physical therapist assistants really do, and how the profession keeps people fit, active, healthy, and mobile.
This year's APTA focus: a public education campaign to debunk 7 of the most common myths about physical therapy, set to launch during the second week of October. Stay tuned to learn how you can participate!
APTA members have an opportunity to contribute to the first-ever revision of the National Physical Activity Plan (NPAP), 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.
The NPAP Alliance has released an online survey that it will use to guide changes to the plan, which was released in 2010. The Alliance is particularly interested in views on how Americans' physical activity levels can be increased, what strategies could be effective in this promotion, and how the success of the NPAP can be ensured. Deadline for responses is October 31.
Respondents can comment on and rate strategies in 8 areas: business; education; health care; mass media; parks, recreation, fitness, and sports; public health; transportation, land use, and community design; and volunteers and nonprofits.
APTA is a member of the NPAP Alliance board of directors.
Survey tip: the survey form includes many optional "free text" opportunities—if you prefer you can leave any or all free text areas blank.
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