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  • In Wake of Nassar Conviction, PT Points to Need for Patient Education on Legitimate Pelvic Physical Therapy

    The multiple sexual abuse convictions of former USA Gymnastics doctor Larry Nassar brought an end to Nassar's monstrous behavior, increased awareness about systemic problems that allowed the abuse to occur, and hopefully even provided a certain sense of closure to the more than 150 victims of his assaults. But in an article written for the HuffPost, APTA member Lora "Lori" Mize, PT, DPT, and certified clinical specialist in women's health physical therapy, raised concern that the Nassar case also may create a ripple effect that could discourage individuals from seeking legitimate and responsibly delivered pelvic physical therapy.

    In her opinion piece titled "Nassar's Atrocities Stigmatize A Legitimate Medical Treatment," Mize contrasts Nassar's horrific actions with the well-established, evidence-based pelvic physical therapist treatments "performed by a highly trained specialist [that] can have a positive impact on a woman's quality of life."

    "It is my duty to women [in need of pelvic physical therapy] to ensure Nassar's abuse does not, in addition to all the other damage it has done, prevent others from getting the care they need," Mize writes. "It is critically important for women's health professionals to ensure the horror of the Nassar case does not feed public fear and misconceptions about pelvic [physical therapy] or stop women who need health care from walking through our doors."

    "This is a powerful article," said Patricia Wolfe, PT, MS, president of APTA's Section on Women's Health. "Lori did an excellent job articulating the value of pelvic physical therapy and its significant impact on quality of life

    Mize delivers the pelvic physical therapy message not only through an explanation of the relationship between pelvic floor muscles and their role in health, but also by way of examples from her own practice. She also clarifies what patients should expect from legitimate pelvic physical therapy treatment.

    “As Lori pointed out, what’s needed is clear and accurate communication to the public to encourage and inform individuals about legitimate care," Wolfe said. "That includes care related to incontinence, sexual dysfunction, constipation, and abdominal and pelvic pain.”

    "For women with pelvic floor disorders, it is difficult enough to battle the stigma, shame and guilt often associated with these conditions," Mize writes." Those of us who care for and care about the health of women and girls must not allow predators like Nassar to further victimize women by making them fear the very interventions that can improve and enrich their lives."

    APTA-Hosted Panel Discussion on Opioid Epidemic and Pain to Be Broadcast Live Via Facebook

    The opioid crisis needs more action and attention. APTA continues to engage.

    Monday, February 5, APTA will convene a panel of experts to discuss how pain management in America can be transformed to move beyond opioids and improve the health of society. The discussion will be broadcast live from APTA’s Facebook page and will include the premiere of the association’s second public service announcement about the crisis.

    “Despite intensive media coverage over the past 2 years, there are aspects of the opioid epidemic that need significantly more discussion, understanding, and awareness,” said APTA President Sharon L. Dunn, PT, DPT, board-certified orthopaedic clinical specialist. “This crisis is not just about fentanyl, overdose, and addiction, it’s also about educating Americans so they know they have options in pain management and the prevention of chronic disease. We hope this event can advance the national conversation in a way that’s beneficial to both the public and health care providers.”

    The approximately 1-hour event, titled "Beyond Opioids: Transforming Pain Management to Improve Health," will be streamed live via APTA’s official Facebook page beginning at 8:00 pm ET. APTA encourages members to tune in and share the video via Facebook and Twitter using the #ChoosePT hashtag.

    Panelists for the discussion are:

    • Grant Baldwin, director of the division of unintentional injury prevention for the Centers for Disease Control and Prevention
    • Bill Hanlon, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, staff physical therapist working in addiction recovery at St Joseph Institute in Port Matilda, Pennsylvania
    • Joan Maxwell, patient and family advisor for John Muir Health, and patient-member of Patient & Family Centered Care Partners Inc
    • Tiffany L. McCaslin, senior policy analyst, public policy, for National Business Group on Health
    • Donald Norcross (D-NJ), US congressman, vice chair of the Bipartisan Task Force to Combat the Heroin Epidemic
    • Steven Stanos, DO, medical director, Swedish Pain Services; medical director, occupational medicine services, Swedish Medical Center; and president of the American Academy of Pain Medicine
    • Sarah Wenger, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy, associate clinical professor at Drexel University’s College of Nursing and Health Professions, and contributor to an upcoming issue of Physical Therapy (PTJ) devoted to pain management

    The public service announcement is part of the association's national public awareness campaign, #ChoosePT, which has won multiple national awards, including best video for the first public service announcement.

    That public service announcement reached more than 377 million Americans via television and radio in its first year of release, and APTA’s official consumer information website, MoveForwardPT.com, was visited by more than 3.2 million users in 2017.

    Monday’s panel discussion will be archived on Facebook and YouTube.

    Mid-Atlantic, Pacific States and Territories Will be First to See New Medicare Cards

    New Medicare cards are coming beginning this April, and, along with them, new beneficiary identifiers that don't rely on social security numbers (SSNs).

    According to recent information from the US Centers for Medicare and Medicaid Services (CMS), Medicare beneficiaries in 9 states, the District of Columbia, and 3 US territories will be the first to receive the new cards: Alaska, American Samoa, California, Delaware, District of Columbia, Guam, Hawaii, Maryland, Northern Mariana Islands, Oregon, Pennsylvania, Virginia, and West Virginia. CMS will begin mailing cards to those recipients in April. New cards in the remaining states and territories will be mailed beginning in June.

    The new cards will feature a unique Medicare identification number that will help CMS move away from health insurance claim numbers (HICNs) that contain the beneficiary's SSN and toward a CMS-generated Medicare beneficiary identifier (MBI). The change, intended to thwart fraud, was required by provisions in the Affordable Care Act and the Small Business Jobs Act. CMS offers a guidance resource with details on the change.

    According to CMS, providers can start using the MBI as soon as their patients receive the new cards and should have systems in place to accept the new number by April 2018. The changeover includes a transition period from October 2018 through December 2019, during which time CMS will accept claims using either the HICN or MBI. Once the mailings begin in April, Medicare beneficiaries will be able to check on the status of their cards on Medicare.gov.

    CDC: Most Middle and High School Students Don't Get Enough Sleep

    More than 2 out of 3 high school-aged adolescents aren't getting enough sleep, and the situation seems to be getting worse, according to the US Centers for Disease Control and Prevention (CDC). The agency, which found a similar trend among middle school-aged children, warns that insufficient sleep can increase the risk for a host of health problems including obesity, diabetes, and injury.

    CDC's findings are based on results from the Youth Risk Behavior Surveys (YRBS) administered in 2015 to high school students in 30 states and 16 large urban school districts, and to middle school students in 9 states and 7 large urban districts. Students were asked to estimate how many hours of sleep they got on an "average school night," with researchers looking for the prevalence of responses that fell below American Academy of Sleep Medicine recommendations for at least 9-12 hours per 24 hours for children aged 6-12, and 8-10 hours per 24 for children aged 13-18. Here's what they found:

    • Among middle school students, 57.8% reported insufficient sleep, with nearly 12% reporting sleeping fewer than 6 hours a night.
    • Among high school students, 72.7% reported insufficient sleep, with about 20% reporting sleeping fewer than 6 hours a night.
    • In both groups studied, females fared worse than males, with 59.6% of middle school females and 75.6% of high school females reporting insufficient sleep, compared with 56% of middle school males and 69.9% of high school males.
    • The percentage of high school students who reported getting sufficient sleep dropped from 30.9% to 27.3% between 2009 and 2015 (2015 was the first year the YRBS was administered to middle school children).
    • Among states, Connecticut recorded the highest prevalence of high school students reporting insufficient sleep, at 80.1%. At the middle school level, the highest prevalence was recorded in Kentucky, at 64.7%.

    Solving the problem won't be easy, according to the CDC, which recommends that parents support good sleep health by maintaining consistent schedules with their children and imposing "media curfews" for a certain period of time before bed, or by not allowing the use of screen technologies in the child's room. Schools can also play a role by providing sleep education programs, says the CDC, but studies have shown that a 1-time program isn't enough—students tend to slip back into their old sleep habits unless the education is repeated periodically.

    Another possible help: delayed school start times, a change recommended by the American Academy of Pediatrics, the American Medical Association, and the American Academy of Sleep Medicine, according to the CDC.

    APTA Issues a 'Call to Action' for Patient Videos on Therapy Cap

    After a brief shutdown, the federal government is up and running—but there's still no resolution to the hard cap still in place for therapy under Medicare. With lawmakers facing a February 8 deadline for coming up with a spending plan, now is the time to act to advocate for a bipartisan, bicameral deal to end the hard therapy once and for all.

    To that end, APTA launched a new call for grassroots advocacy—this time through videos of patients affected by the hard cap. Following is the email sent to all members that contains instructions for participating in the effort. Deadline for videos is February 2, 5:00 pm ET.

    Submit Your Patient Story
    We are at a critical point in the legislative process involving the Therapy Cap. It is more important now than ever that we keep our voices loud and strong so that we are heard by our representatives. To do that we’d like to enlist our member’s help in gathering very brief video testimonials from their patients who are affected by the hard cap.

    What You Can Do

    • Select a patient who has been/will be affected by the cap.
    • Ask her/him if she/he would be willing to be filmed briefly and allow you to pass along to us to share on our website and promote via social media.
    • Film 20-30 seconds using below script.
    • Ask her/him to sign [a required] video/photo release form, granting us ownership and permission to share.
    • Send video and signed release form to Amelia Sullivan at ameliasullivan@apta.org with “Stop the Cap Patient Testimonial” in the subject line.

    Record a simple and quick video, no more than 30 seconds, by having your patient say the following:

    “Hi. I am [PATIENT FIRST NAME] and I have/had (a) [NAME OF CONDITION, (ie, stroke). Physical therapy helps me [describe]. Because of the therapy cap, I won't get the care that I need. Congress – you must Stop the Cap.”

    Note: It is important to be conscious of background, good lighting, and audio, so please take a moment to check each.

    Please submit your video and the signed release form via email to ameliasullivan@apta.org.

    Other Therapy Cap News

    Claims above the hard cap being held
    Recently, the US Centers for Medicare and Medicaid Services (CMS) reported that the agency has been holding all outpatient therapy claims since January 1 that go above the $2,010 cap. CMS is expected to begin processing those claims in the near future, but has not yet provided a time line.

    Use of KX modifier recommended
    CMS has stated that providers should continue to submit claims with the KX modifier, even though the exceptions process is not in place, under the assumption that Congress will retroactively apply a permanent therapy cap fix.

    APTA continues to push CMS to issue additional guidance on claims impacted by the hard cap, and shares information with members as it becomes available. Please see APTA’s revised FAQ document for more details.

    Study: Concussions Aren't the Link to CTE

    New research on chronic traumatic encephalopathy (CTE) concludes that it's not concussions that cause the condition, but repeated traumatic brain injuries (TBIs)—the kind experienced by more people than just those involved in contact sports. Authors of the study also call for more clarity when it comes to concussion—which they describe as a syndrome—versus TBI, a tissue-damaging event that can happen with or without concussion.

    The study, published in the journal Brain, is based on head trauma experiments on mice, as well as an analysis of several brains of teenagers who had experienced head injuries. Researchers were looking for the presence of CTE or an abnormal accumulation of tau protein, a marker for CTE and Alzheimer's disease. They found those indicators even in brains that had not experienced concussions, leading researchers to conclude that it is repeated TBIs that can cause CTE. The results grabbed the attention of national news outlets, including CNN, National Public Radio, and The Washington Post.

    "The results may explain why approximately 20% of athletes with CTE never suffered a diagnosed concussion," Lee Goldstein, MD, PhD, 1 of the study's authors, told The Washington Post.

    "There are many vulnerable populations at greatly increased risk of repetitive head injury," Goldstein said in the Post interview. "It's a big problem for the [National Football League], a bigger problem for amateur athletes, and even larger problem still for the public."

    The study also aims to separate the concept of concussion as a neurological syndrome from TBI as an event that causes damage to tissue. In his Post interview, Goldstein explained that "If you don't have a concussion, you can absolutely have brain injury and the reverse is true."

    "Collectively, these results raise concern that repetitive neurotrauma, independent of concussion, may induce early CTE brain pathologies, even in teenagers and young adults," authors write in the study. "Cumulative exposure to such injuries may also increase risk for other tau protein neurodegenerative diseases, including Alzheimer’s disease…. These considerations are important not only for understanding and differentiating concussion, TBI, and CTE, but also to inform clinical practice, return-to-play protocols, and public health policy."

    For more information on the role of the physical therapist and physical therapist assistant in TBI and concussion, visit APTA's Concussion and Traumatic Brain Injury webpage.

    New Data on Musculoskeletal Disease Highlight its Position as Major Contributor to Health Care Costs

    Musculoskeletal diseases aren't just widespread— they've also become a significant factor in the economy, with associated costs estimated at an amount equal to 5.76% of the US gross domestic product. That's just 1 of the insights offered in the latest edition of a detailed report on the impact of musculoskeletal conditions across the country.

    Advance-published sections of the US Bone and Joint Initiative's (USBJI) 4th edition of "The Burden of Musculoskeletal Diseases in the US" are now being rolled out at the USBJI website. The report compiles extensive data on a wide range of conditions, including low back pain, neck pain, arthritis, osteoporosis, and injuries both in aggregate and among special populations, and includes insight on economic impact. The latest edition also features a new section on neuromuscular diseases.

    According to USBJI, more than half of all adults in the US now report a chronic musculoskeletal condition—a rate that outpaces the prevalence of reported respiratory conditions (24%) and circulatory conditions including high blood pressure (42%). Chronic low back pain, joint pain, and disability make up 3 of the top 5 most commonly reported medical conditions, the report states.

    In turn, musculoskeletal conditions have become a major factor in health care costs—an estimated $332 billion between 2012 and 2014, according to USBJI, with costs likely to increase with an aging US population.

    Three chapters of the latest edition are now available, with more to be released in the coming weeks. USBJI hopes that the resources will help to highlight the need for more resources devoted to addressing prevention and treatment of musculoskeletal disorders.

    "In spite of [the overall prevalence and significant costs], research funding for musculoskeletal-related conditions remains substantially below that of other major health conditions, such as cancer and respiratory and circulatory diseases," the report states. "If health care costs in the future are to be contained, musculoskeletal diseases must come to the forefront of research."

    APTA is a founding member of USBJI.

    Government Reopens Under Short-Term Deal That Leaves Medicare Patients in Limbo

    After an approximate 36-hour shutdown, the US government is back in business, which means the push is on to get a permanent repeal of the Medicare therapy cap over the finish line.

    On Monday, January 22, the US House and Senate agreed to fund the federal government through February 8. The deal fully funds the Children's Health Insurance Program (CHIP) for 6 years, and was accompanied by a compromise to bring a vote on the Deferred Action for Childhood Arrivals (DACA) legislation if a deal on immigration is not reached by February 8. What the deal does not include is a repeal of the hard cap on therapy services under Medicare, despite intense lobbying, grassroots, and social media efforts by APTA and members of the Repeal the Therapy Cap Coalition. Also missing from the deal: fixes to a host of Medicare-related critical issues affecting millions of Americans.

    Essentially, the short-term spending bill is intended to buy legislators time to agree on a longer-term funding plan—one that APTA is pushing to include a repeal of the hard Medicare therapy cap now in place. It's an idea supported by several legislators including Sen Ben Cardin (MD), who took to the Senate floor to call for action on the cap by the February 8 deadline.

    For the physical therapy profession, patients, and stakeholders, it's now time to work harder than ever before to make it clear to lawmakers that the hard cap must end.

    Although APTA's efforts to push for passage of a bicameral, bipartisan deal on the therapy cap never let up, the association plans to turn up the heat even more over the next few weeks. APTA is developing a special campaign that will involve physical therapists and patients across the country, and will contact members in the coming days about opportunities for participation. In the meantime, members and supporters are being urged to continue to contact members of Congress via email, phone, and social media, and tell them to pass the therapy cap permanent fix as soon as possible.

    "The time has come for resolution of this unacceptable situation," said Justin Elliott, APTA's vice president of government affairs."A person who is recovering from a stroke or other serious condition may be days away from hitting the hard cap and having Medicare no longer pay for essential physical and speech therapy. Therapy can’t wait—neither can Congress. There is a bipartisan solution to permanently address the hard cap, and Congress must act on it now."


    Visit APTA's Medicare Therapy Cap webpage for more information, download the APTA Action App to keep up-to-date on action alerts, and be sure to stay tuned for additional updates.

    Study Contradicts Popular 'Text Neck' Theory

    Is there a connection between "text neck" and neck pain in young adults? Researchers from Brazil don't think so.

    Authors of a new study of 150 18-21 year-olds in Rio de Janeiro claim they found no connection between handheld device use posture and the presence or frequency of neck pain—a conclusion that runs counter to popular media reports that "text neck" is contributing to increased rates of neck pain worldwide. Results were published in the European Spine Journal (abstract only available for free).

    To study the possible connection, researchers asked the participants about the amount of time they spent "reading, writing, or playing" on their mobile phones, and then asked them to identify what they believed their texting posture was based on a series of 4 drawings: 2 that were dubbed by researchers to be "no text neck" (phones held higher, farther away from the body, resulting in a less tilted head position), and 2 labeled as "text neck" positions (phones held lower and closer to the body, forcing a greater head drop).

    Next, participants were photographed in profile while texting to establish a more objective view of texting posture. The photographs were analyzed by 3 physiotherapists and individual texting postures rated as "normal," "acceptable," "inappropriate," or "excessively inappropriate." Finally, participants were asked about the occurrence and frequency of neck pain and the degree to which they worry about body posture.

    While the physiotherapists identified 40% of the participants as demonstrating text neck, in the end, authors of the study found no association between reported neck pain and text neck—whether self-perceived or identified in photographs. "Unquestionably, there is an awkward neck position to be found in many mobile phone users but this does not, according to our results, imply an association with neck pain," authors write.

    That's not to say that handheld device use is harmless—or even that the use is not linked in some way to neck pain, researchers say. With 76.6% of participants reporting that they spend 5 hours or more day "reading, texting, and playing" on their mobile phones, authors believe it's entirely possible for problems to develop, even if they're not directly related to posture.

    "The high percentage of participants who use a mobile phone more than 4 hours per day…is a concern, since the time spent with this device seems to be a risk factor for hand/finger symptoms," authors write. "Furthermore, an excess of screen time could lead to physical inactivity which is associated with neck and back pain in young adults."

    Just don't pin that pain on posture, according to the study's authors, who write that the findings of their admittedly limited study "challenge the belief that inappropriate neck posture during mobile phone texting is the leading cause of the growing prevalence of neck pain."

    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.

    Major Health Industry Groups Look to Streamline Prior Authorization

    While prior insurance authorization may be right up there with death and taxes when it comes to life's certainties, 6 major health industry groups believe the process could be much improved.

    The American Hospital Association, America's Health Insurance Plans, the American Medical Association, the American Pharmacists Association, BlueCross/BlueShield, and the Medical Group Management Association issued a consensus statement outlining 5 ways the health care system could "improve the [prior authorization] process, promote quality and affordable health care, and reduce unnecessary burdens." Those 5 areas are:

    Selective application of prior authorization. The consensus letter argues for basing application of prior authorization on "provider performance on quality measures and adherence to evidence-based medicine or other contractual agreements."

    Regular reviews of prior authorization and adjustments for volume. "Regular review of the list of medical services and prescription drugs that are subject to prior authorization requirements can help identify therapies that no longer warrant prior authorization due to, for example, low variation in utilization or low prior authorization denial rates," according to the statement.

    Better communication and transparency. The group calls for improved communication between health plans, providers, and patients "to minimize care delays and clearly articulate prior authorization requirements, criteria, rationale, and program changes."

    Attention to continuity of care. The statement identifies continuity of care as "vitally important" and urges "additional efforts to minimize the burdens and patient care disruptions associated with prior authorization."

    More automation. "Moving toward industry-wide adoption of electronic prior authorization transactions based on existing national standards has the potential to streamline and improve the process for all stakeholders," the group states in the letter.

    "This consensus statement is a step in the right direction," said Elise Latawiec, PT, MPH, APTA staff lead for practice management. "The areas noted in the statement align very closely with APTA's positions on relieving administrative burdens and its efforts to explore potential solutions, and we are looking at ways to support and collaborate on this important effort."

    Study: To Avoid LBP, Runners Should Think Deep

    Even though they are keeping fit, up to 14% of American runners experience low back pain (LBP) each year. But runners can reduce their risk by developing their deep core muscles, say authors of a recent study in the Journal of Biomechanics (abstract only available for free).

    While many fitness enthusiasts focus on their abs, they may neglect the trunk muscles they can’t see. “Improper function of this musculature may lead to abnormal spinal loading, muscle strain, or injury to spinal structures, all of which have been associated with increased low back pain risk,” say researchers.

    To test this idea, authors used motion capture technology to collect kinematic data from 8 participants with no history of back pain and no recent injuries. The data, gathered while the participants ran, was used to create simulated full-body models in OpenSim, a software tool for modeling movement.

    In the simulations, researchers gradually weakened the models’ deep core muscles, both individually and together. They found that when deep core muscles are weak, superficial core muscles, particularly the superficial longissimus thoracis (LT), tend to overcompensate, which may result in muscle injury or fatigue. And since the superficial LT was most often the muscle overcompensating for weak deep core muscles, it may be “most at risk for fatigue or injury” if deep core muscles are not functioning properly.

    The authors believe that certain deep core muscles appear to be more important than others in runners. “The deep erector spinae required the largest compensations when weakened individually,” note authors, who conclude that “it may contribute most to controlling running kinematics.”

    When all deep core muscles were weak, or when only the deep erector spinae was weakened, there was a significant increase in both compressive and shear spinal loading in the upper back, with a decrease in the lower back. Over time, this could result in damage to the spine and increase the risk of injury, authors warn.

    Authors suggest further research using simulated models to examine core function in running. The study, researchers observe, “is the first step in providing evidence to support the common notion that poor core strength and stability may influence a runner’s risk of developing injuries such as LBP.”

    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.

    The Good Stuff: Members and the Profession in Local News, January 2018

    "The Good Stuff" is an occasional series that highlights recent, mostly local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    "The Air Force expelled her in 1955 for being a lesbian. Now, at 90, she is fighting back." –The Washington Post tells the story of Helen Grace James, PT, who has filed a federal lawsuit to upgrade her discharge status and restore her rights as a veteran. (The Washington Post)

    Youngstown State University's physical therapy department is sponsoring a "Walk with a Doc" program that helps promote physical activity. (WKBN 17 News)

    Meredith Harris, PT, DPT, EdD, provides pointers on how adults who are older can stay safe in winter weather. (Caring.com)

    Alicia Willoughby, PT, and Brandi Dawn Kirk, PT, who's also a pelvic rehabilitation practitioner and certified visceral techniques practitioner, talk about the complexities of diastasis recti. (Vox)

    “Alex is among one of the best kids I’ve had a chance to work with. His attitude is terrific. He’s trying to find the bright spot in a pretty bleak situation.” –John Waite, PT, DPT, board-certified orthopaedic clinical specialist, is helping patient Alex Ruiz, a high school football star whose career ended in injury. Now Alex is facing the possibility of amputation. (Temecula, California Press-Enterprise)

    Ryan Balmes, PT, DPT, offers advice to stay safe on a ski trip. (US News and World Report)

    Kids' Anatomy 101? James Randolph, PT, and wife Amy Randolph, PT, have written a new children's book, B is for Biceps: Anatomy for Children. (A.T. Still University "Alumni Headlines")

    Biagio Mazza PT, DPT, shares tips on avoiding falls when sidewalks get icy. (Fox 4KC News, Kansas City, Missouri)

    Richard Willy, PT, PhD, explains how runners can spare knees and joints from injury. (News 24 "Health 24," Cape Town, South Africa)

    “Listen-to-your body apps are good for guidance, but your body is always right." –Shondell Jones, PT, DPT, board-certified orthopaedic clinical specialist, certified strength conditioning specialist, and certified orthopaedic manual therapist, discusses the limits of fitness apps. (WNCT 9 News, Greenville, North Carolina)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    Film Star Kathy Bates Helps to Spread the Word on Lymphedema Management in APTA Oncology Section's Journal

    Health care providers are increasing their knowledge of lymphedema management, but there's still much work to be done. Just ask film and television star Kathy Bates, author of a letter to the editor in a special issue of Rehabilitation Oncology (RO) entirely devoted to the disease. RO is the science journal of the APTA Oncology Section.

    Bates' letter, available for free, not only gives an account of her experience with lymphedema after a bilateral mastectomy but also provides insight into how much the patient experience has changed over the decades. Bates explains that her mother experienced lymphedema after cancer surgery in the 1970s, and that, "with no treatment in those days, I watched her spirit defeated as she realized she would have to live with the pain and heartache for the rest of her life."

    Given the experience with her mother and another individual she knew who lived with lymphedema after surviving stage 4 melanoma, Bates was well aware of the effects of lymphedema and pleaded with her surgeon to leave as many lymph nodes intact as possible. Bates writes that when her surgeon later told her that he felt it necessary to remove 19 lymph nodes from her right armpit and 3 from her right, she was "devastated" and experienced what she describes as an "emotionally draining" recovery.

    Eventually Bates came to terms with the necessity of the node removal, but she now lives with the reality of lymphedema. In the editorial, she writes of her treatment and management of ongoing symptoms, and her more recent work with the Lymphatic Education and Research Network (LEARN), where she now serves as spokesperson.

    Bates writes that with an estimated 140 million individuals with lymphedema—some undiagnosed—it's imperative that efforts to educate both patients and providers continue.

    "Lymphedema needs to be recognized as a disease that deserves money for research," Bates writes. "We need awareness. …Please help me spread the word."

    In an accompanying open-access editorial, guest editor Nicole Stout, PT, DPT, FAPTA, and certified lymphedema therapist from the Lymphology Association of North America, describes the advancements that have been made in both lymphedema management and clinical knowledge among health care providers, but she adds that more needs to be done.

    "The true measure of our advancement is in how our patients are impacted by the evolution in the field," Stout writes. "Decreased wait times to access therapy, more knowledgeable therapists, and better and higher-quality materials and treatment devices have emerged in the last decade. However, there are still significant barriers to care and clinical questions that we must set our sights on solving in the next decade," including payment, access to specialty care, and the slow growth of telehealth services.

    Still, Stout believes that continued technological breakthroughs and increased clinician understanding could pave the way for significant positive change, writing that "the future is bright, the future is smart, and we must continue to seize on opportunities to advance novel approaches to lymphedema management."

    This year, APTA's American Board of Physical Therapy Specialties will begin offering its first-ever specialist certification in oncology physical therapy. Deadline for applications is July 31, 2018.

    Ohio Workers' Comp Program Requires Nonsurgical, Nonopioid Treatment of LBP as a First Step

    In what the Associated Press (AP) describes as "a groundbreaking guideline," the Ohio agency that oversees that state's workers' compensation program has rejected spinal fusion surgery and opioid prescriptions as an early response to back pain. Instead, the state now requires that all workers with work-related back injuries undergo at least 60 days of nonsurgical care, including physical therapy, while avoiding opioids, before pursuing other treatments.

    According to an AP article published in The New York Times, Ohio isn't the first state to restrict payments for surgery, but its approach includes a new twist: including a warning on the use of opioids. The Ohio rule stipulates that the 60 days of "alternative" treatment must be accomplished while avoiding opioid use if possible, an approach that NYT says is "more aggressive than other states that also decline to pay right away for the surgery."

    In the report, the Ohio Bureau of Workers' Compensation defended the move by citing research showing that spinal fusion surgery is "often ineffective," can lead to complications, and may result in increased opioid use postsurgery. The policy went into effect on January 1.

    APTA Physical Therapy Outcomes Registry Again Receives CMS Designation for MIPS Reporting

    APTA's Physical Therapy Outcomes Registry (Registry) has been approved again by the US Centers for Medicare and Medicaid Services (CMS) as a qualified clinical data registry (QCDR). The designation for 2018 means that physical therapists (PTs) who participate in the Merit-based Incentive Payment System (MIPS) program can submit their data directly from the Registry, but the CMS approval is also an acknowledgment that APTA offers a robust, reliable system for tracking and benchmarking patient outcomes.

    Although voluntary for now, PT participation in MIPS could be mandatory as early as 2019, making it important to become familiar with the system (APTA encourages eligible PTs to voluntarily participate in MIPS now).The Registry’s QCDR status will be particularly helpful for practices whose electronic health records (EHRs) do not have the capability to report directly to MIPS.

    According to Heather Smith, PT, MPH, APTA's director of quality, the value of the Registry goes well beyond MIPS data submission.

    "Registry data will allow physical therapists to understand their treatment patterns, interventions, and outcomes for specific patient populations," Smith said in an APTA news release. "In everyday practice, PTs then use the information objectively to evaluate how a patient, a group of patients, or a population of patients are cared for."

    Registry users can access nonproprietary outcomes measures supported by CMS, as well as measures specific to particular EHR systems. In addition, APTA has begun the process of developing its own quality measures. The Registry also will include region/disease-specific treatment and outcome modules to help PTs treat patients according to established clinical practice guidelines. The first such module, focused on congenital muscular torticollis, is now under development through a partnership between APTA and the Academy of Pediatric Physical Therapy.

    The Registry enables PTs to make improved, data-informed clinical decisions, track and benchmark outcomes against industry data, and demonstrate the value of physical therapist services to payers and fellow providers. It directly integrates with multiple third-party EHR systems. For more information about the Registry, visit www.ptoutcomes.com.

    Headed to the APTA Combined Sections Meeting in February? Check out the Registry booth at the APTA Pavilion, the Registry poster session on February 23, and 2 related presentations: "A Multi-Dimensional Data Collection System (#2145)" and "Balancing Inclusion and Use of Outcomes Instruments in the Registry (#2144)."

    From PTJ: Office Work Doesn't Have To Be a Pain in the Neck

    Office workers with neck pain may benefit from workplace-based strengthening exercises, especially those focused on the neck and shoulder, say authors of a recent systematic review.

    Among all occupations, office workers are at the highest risk for neck pain, with approximately half of all office workers experiencing neck pain each year. “Workplace-based interventions are becoming important to reduce the burden of neck pain,” researchers write, “due to the increasing responsibility of companies toward employee health, and the potential cost-savings and productivity gains associated with a healthy workforce.”

    The review of 27 randomized controlled trials (RCTs), published in the January issue of Physical Therapy (PTJ), focused specifically on office workers, whereas previous reviews of effectiveness of workplace interventions for neck pain have focused on workers in general. Authors also compared results between subgroups of office workers with and without neck pain. The included RCTs measured “neck and/or neck/shoulder pain intensity and incidence/prevalence” and used control groups for comparison.

    Among the findings:

    • Moderate-quality evidence suggested that workplace-based strengthening exercises reduced neck pain in office workers who were symptomatic, and the effect size was larger when those exercises focused on the neck and shoulder. Higher exercise participation rates resulted in greater benefits.
    • Neck/shoulder-specific strengthening exercises were not effective for a general population of office workers that included both those with and without neck pain.
    • Authors found “low-quality and conflicting evidence” for the effectiveness of ergonomic interventions among office workers in general (not specific to those with neck pain).
    • There was limited evidence for prevention of neck pain in office workers, but 1 trial suggested that “combined neck endurance and stretching exercises might be efficacious” for workers at risk for neck pain.
    • “Exercise interventions are best targeted toward symptomatic or ‘at risk’ office workers,” write authors, but “given that approximately half of office workers may suffer from neck pain within a 12-month period, it could be argued that interventions should be offered to all office workers” regardless of whether they have neck pain.

    Authors note that the studies included only self-reported pain measures, and suggest that future studies include functional outcomes, such as neck disability and sick leave. They also encourage future research to examine effectiveness of interventions for neck pain prevention among “symptomatic, asymptomatic, and possibly ‘at risk’” office workers.

    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

    Editor's note: Want more information on the physical therapist's role in employer-based health? Check out APTA's Working With Employers Toward Population-Based Health webpage. Resources include a blog post, magazine articles, and a recorded webinar titled "Direct-to-Employer Physical Therapy—Building Supply and Demand." Also worth checking out: this newly revised clinical practice guideline on neck pain, available at PTNow.

    Survey: HIIT Tops the List of Fitness Trends for 2018

    What's the future of fitness? According to an international survey of exercise professionals, high intensity interval training (HIIT) will be the strongest trend in 2018, outpacing wearable technologies, which held the number 1 position in 2017. Group training, body weight training, and strength training are also on the list of top 10 trends expected to be strong this year, while interest in Exercise is Medicine and exercise and weight loss is expected to drop off.

    The ratings are part of an annual review conducted by Health and Fitness Journal, published by the American College of Sports Medicine. Now in its 12th year, this year's survey included responses from 4,133 exercise professionals from around the world. "Medical professionals"—the category that includes physical therapists (PTs) and physical therapist assistants (PTAs) as well as physicians, nurses, and occupational therapists—made up 4% of the responses.

    The survey asks respondents to make a distinction between trends—changes in behavior over a period of time—from "fads," which tend be enthusiastically embraced for short periods of time. Consequently, the lists don't typically change dramatically from year to year. Still, the 2018 list includes some interesting differences from previous years. Here's a quick rundown of the top 10 trends for 2018:

    1.  HIIT (2017 position: #3)
    2.  Group training (2017 position: #6)
    3.  Wearable technology (2017 position: #1)
    4.  Body weight training (2017 position: #2)
    5.  Strength training (2017 position: #5)
    6.  Educated, certified, and experienced fitness professionals (2017 position: #4)
    7.  Yoga (2017 position: #8)
    8.  Personal training (2017 position: #9)
    9.  Fitness programs for older adults (2017 position: NA)
    10. Functional fitness (2017 position: #12)


    Rounding out the top 20 were, in order: exercise and weight loss, Exercise is Medicine, group personal training, outdoor activities, flexibility and mobility rollers, licensure for fitness professionals, circuit training, wellness coaching, core training, and sport-specific training.

    Falling off the top 20 list for 2018 were worksite health promotion (#16 in 2017), smartphone exercise apps (#17 in 2017), and outcome measures (#18 in 2017). The biggest decrease was for exercise programs for children and weight loss, a trend that appeared in the top 5 lists every year from 2009 to 2013, but began to drop off in 2014. It's now ranked at #32.

    The report lists licensure for fitness professionals, core training, and sport-specific training as possible "emerging trends," but warns that "future surveys will either confirm these as new trends or they will fall short of making a sustaining impact on the health fitness industry and drop out of the survey "—a fate that has befallen indoor cycling, Pilates, and dance cardio.

    Far from being an exercise in crystal-ball-gazing, the survey has some very practical applications, according to ACSM.

    "The benefits [of the annual survey] to commercial health clubs…are for the establishment (or maybe the justification of) potential new markets…" the report states. "Community-based programs…can use these results to justify an investment in their own markets by providing expanded programs serving families and children. Corporate wellness programs and medical fitness centers may find these results useful through an increased service to their members and to their patients."

    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.

    CDC: 40% of Patients With Arthritis Don't Receive Exercise Counseling From Providers

    Better, but still plenty of room for improvement—that's the US Center for Disease Control and Prevention's (CDC's) take on a recent analysis of the rate at which health care providers are counseling patients with arthritis to engage in physical activity (PA). The good news: the percentage of individuals with arthritis who received provider counseling for exercise grew by 17.6% between 2002 and 2014. The bad news: even after that growth, nearly 4 in 10 patients with arthritis still aren't receiving any information from their providers on the benefits of PA.

    The CDC analysis, which appeared in a recent edition of its Morbidity and Mortality Weekly Report, uses data from the National Health Interview Survey gathered in 2002 and 2014. In those years, the survey included a question on whether respondents had been told they have "arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia," as well as a question asking whether "a doctor or other health professional [has] ever suggested physical activity or exercise to help your arthritis or joint symptoms?"

    According to the CDC, in 2002, 51.9% of individuals with arthritis reported receiving PA counseling from a provider; by 2014, that percentage had grown to 61%—a 17.6% increase.

    The overall percentage in 2014 pushes the percentage slightly above the US Department of Health and Human Services' "Healthy People 2020" target of 57.4%, but the growth isn't uniform across subgroups analyzed, according to CDC. Among differences revealed in the analysis:

    • While the overall rate of exercise counseling was 61%, the rate for underweight or normal-weight individuals with arthritis was only 50%. Other subgroups that registered averages below the overall rate were non-Hispanic other races (53.8%), current smokers (56.9%), persons with no primary care provider (50.7%), and individuals who reported being inactive (56.7%).
    • Among the subgroups that reported higher-than-average rates of PA counseling were individuals with obesity (70%), persons whose activities were limited by arthritis (67.7%), those with 3 or more additional chronic conditions (67.6%), black non-Hispanic (63%) races, and Hispanic races (64.7%).
    • All subgroups recorded improvements in the rate of PA counseling between 2002 and 2014, but the most significant gains were made for males (from 44.8% to 58.3%), individuals with no additional chronic conditions (from 46% to 63.3%), the unemployed (from 47% to 61%), individuals with less than a high school education (from 45.9% to 59%), and individuals who reported 1 to 3 primary care provider visits annually (from 45.2% to 56.4%).

    The CDC report acknowledges the positive trends but references other studies that may shed some light on reasons for the less-than-optimal rates of PA counseling by providers. Among the findings are a 2014 survey that found that fewer than one-third of primary care physicians said they provided exercise counseling for arthritis during office visits, and another survey of health care providers that found that 61% of respondents felt unsure of—or lacked—knowledge and skills to provide counseling on exercise to patients with osteoarthritis or rheumatoid arthritis.

    "Incorporating counseling into clinical training curriculum and continuing education programming…might encourage health care providers to provide exercise counseling," the CDC says in its report. Authors also suggest that providers who feel unsure about counseling should consider referring patients to "evidence-based, community programs" such as Enhance Fitness, Walk with Ease, and Active Daily Living Every Day.

    The bottom line, according to the CDC, is that it's not time to rest on any laurels.

    "Prevalence of health care provider counseling for exercise among adults with arthritis has increased significantly over more than a decade," the report states, "but the prevalence of counseling remains low for a self-managed behavior (exercise) with proven benefits and few risks, especially among those who are inactive."

    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.

    Editor's note: APTA offers resources on encouraging healthy, active lifestyles at APTA's Prevention, Wellness, and Disease Management webpage. Also available: an APTA webpage on arthritis management through community programs. January 2018 also marks the debut of APTA's newest council: The Council on Prevention, Health Promotion, and Wellness in Physical Therapy.

    The Hard Therapy Cap Is Here: Answers to Some Common Questions

    Because of inaction by Congress, the hard cap on outpatient therapy services under Medicare has been implemented. The cap, which began on January 1, 2018, includes no KX modifier exceptions and has created uncertainty for providers, patients, and their families.

    APTA has requested that the US Centers for Medicare and Medicaid Services (CMS) provide information and guidance for providers on how the (temporary, it is hoped) hard cap will be managed. While the association waits for that response, here are a few questions and answers that shed some light on where things stand.

    What is the therapy cap for calendar year 2018?
    The allowed dollar amount for 2018 for outpatient physical therapy and speech-language pathology combined is $2,010. For occupational therapy, the cap is set at $2,010.

    What Part B outpatient therapy settings and providers does the therapy cap apply to?

    • Physical therapists' (PTs') private practices
    • Offices of physicians and certain nonphysician practitioners
    • Part B skilled nursing facilities
    • Home health agencies (visits provided on an outpatient basis)
    • Rehabilitation agencies (also known as outpatient rehabilitation facilities)
    • Comprehensive outpatient rehabilitation facilities
    • Critical access hospitals (CAHs)

    What is the targeted medical review threshold for 2018?
    With the implementation of the hard therapy cap on January 1, 2018, there is no targeted medical review threshold. This is subject to change, pending congressional action.

    Does the 2018 hard therapy cap apply to hospital outpatients?
    No. Hospital outpatient departments or clinics (OPs) were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act in 1997. That exclusion was lifted when hospital OPs were added to the manual medical review process in 2012. Later, hospital OPs were regularly made subject to the cap as part of the stopgap exceptions routinely enacted by Congress. But in 2017, Congress not only failed to end the hard cap; it failed to create an exceptions process of any kind, meaning we're back to the hard cap as originally written, which doesn't include hospital OPs.

    Does the hard therapy cap apply to observation-status patients in hospital outpatient departments?
    No. The hospital setting is not included under the hard therapy cap that went into place on January 1, 2018 (see hospital outpatient question above). Hospital outpatients include those in observation status. Therapy services furnished to patients on observation status are billed as outpatient therapy services under Medicare Part B; however, because the hospital setting is not included under the hard cap, observation status patients are excluded.

    Does the hard cap apply to Critical Access Hospitals?
    Yes. Before October 1, 2012, the therapy caps applied to all outpatient therapy services except those furnished by outpatient hospitals and CAHs. Beginning January 1, 2014, the outpatient therapy caps, and related provisions, were applied to therapy services furnished by a CAH. Therapy services furnished by a CAH are counted toward the therapy caps as if the services were paid under the Medicare physician fee schedule.

    When are therapists required to issue the mandatory Advance Beneficiary Notice (ABN) for therapy services?
    Providing the patient with an ABN transfers liability and charge to the beneficiary, and becomes a crucial duty of the therapist now that the no-exceptions cap is in place. Providers must issue a valid, mandatory ABN to the beneficiary before providing services above the cap when there is no therapy coverage exceptions process. Therapists also are required to issue the ABN to original (fee-for–service) Medicare beneficiaries before providing therapy that is not medically reasonable and necessary.

    Wasn't Congress ready to permanently end the hard cap? What happened?
    It's true: over the fall, a bipartisan, bicameral deal was reached that would have permanently eliminated the hard cap on therapy services. That deal was part of a larger piece of legislation that included other changes to Medicare, such as payments for ground ambulances and reauthorization of special needs plans. This package of so-called "Medicare extenders" was supposed to be adopted in early December. Unfortunately, the debate over the tax reform legislation dominated Congress in the final weeks of session, pushing nearly all other issues to 2018.

    What happens next?
    The Senate returned to Washington on January 3, and the House will return on January 9. The first opportunity to address the hard cap will come when Congress takes up a spending bill that must pass in order to keep the government open after January 19. There are also opportunities for the cap repeal to be included in any of a number of other critical health care programs that expired on December 31, which Congress must act on immediately. Unfortunately, there are no sure bets: given the current political climate in Congress, including other unrelated, controversial issues in play, it is unclear if Congress will act quickly. APTA, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, and other allies in the Therapy Cap Coalition will continue to keep pressure on Congress to take quick action on the therapy cap in January.

    Will Congress retroactively apply any fix to the Therapy Cap back to January 1, 2018?
    Nothing is certain at this point. APTA and its partners are asking Congress to apply any fix retroactively to January 1, 2018.

    What can I do?
    It's important for the physical therapy profession to advocate for this critical permanent fix to the therapy cap. Contact your members of Congress today via email, phone, and social media, and urge them to pass the therapy cap permanent fix as soon as possible. Visit APTA's Medicare Therapy Cap webpage for more information, download the APTA Action App to keep up-to-date on action alerts, and be sure to stay tuned for additional updates.

    Most-Read Student Pulse Blog Posts of 2017 Point to a Bright Future for the Profession

    It doesn't matter whether you're a current student in a physical therapist (PT) or physical therapist assistant (PTA) program or a seasoned veteran of the profession: APTA's Student Assembly Pulse blog series is worth checking out.

    The posts, largely written by current students and new professionals, often touch on subjects that have broad interest, and many feature the kind of candor that speaks well of the next generation of PTs and PTAs. Authors are willing to put themselves "out there" for the sake of their fellow students and the profession; and even when they're providing practical tips on, for instance, useful apps for students, authors' excitement about physical therapy shines through.

    But don't take our word for it. Hare are links to some of the most-read Pulse blogs from 2017.

    Getting real: posts about common (if unspoken) feelings and lessons learned
    "My Biggest Challenge in Physical Therapy School? Imposter Syndrome"
    "Three Things I Wish I Knew Before I Started My Clinical Rotations"
    "Jealousy: A Well-Known But Unspoken Part of Physical Therapy School"
    "5 Lessons I Learned From My First Year in Physical Therapy School"
    "My Biggest Takeaways From Physical Therapy School"
    "Develop Your Patient Care, Not Your Social Network"
    "Failure is a bruise, not a tattoo. Keep going.”

    Getting practical: surviving PT/PTA school, and setting sights on the future
    "19 Study Tips From PT Students"
    "Apps to Help You Survive School"
    "Finding Your Niche"
    "How I Became a Private Practice Owner 3 Weeks Postgraduation"
    5 Tips To Help You Ace Your PT School Interviews

    Want to write something for the Pulse blog? Email the APTA Student Assembly.

    Get the Latest on the Future of Payment—And the Now of Home Health

    Are you ready for the future of payment—both near-term and down the road? APTA is ready to help you stay up to speed.

    The association offers 2 opportunities to learn about the payment landscape in 2018 and beyond: one focused on the bigger picture and another that zeroes in on changes to home health services.

    For the big picture, be sure to sign up for "The Shift to Value-Based Payment: What You Need to Know Now," a live webinar set for January 18, 1:00 pm–2:00 pm EST. The interactive session, led by APTA staff experts, will focus on participants' questions on what Medicare's shift toward value-based payment means for providers. The program is configured as a "flipped classroom"—participants need to register in advance, review a prerecorded presentation, and be ready for live interaction at the actual session. Best of all, it's free to APTA members.

    PTs and PTAs looking for more specific information on changes to home health rules can download an audio recording of a December 11, 2017, webinar focused on new home health conditions of participation set to go into effect January 13, 2018. The session, conducted by APTA staff and representatives from APTA's Home Health Section, sheds light on the practice implications of the new participation rules. And like the January 18 webinar, it's free. To download, visit APTA's Medicare Payment and Policies for Home Health webpage and click on the "Webinar Recording" link dated 12/11/17.

    Study: Referral to Physical Therapy for LBP Reduces Odds of Later Opioid Prescription—Even When Patients Don't Follow Up on the Referral

    There's solid evidence that physical therapy as a first-line approach for low back pain (LBP) improves outcomes, but not many studies have focused on the factors that are associated with referral to physical therapy in the first place, regardless of later participation in treatment. Now authors of a recent study believe they've found associations indicating that the very act of referral for physical therapy may point to the ways a primary care provider's approach to LBP can affect patient perceptions and reduce odds of later opioid use, even when the patient doesn't follow through with the referral.

    The study, published in the Journal of the American Board of Family Medicine (abstract only available for free) looked at data from 454 Medicaid enrollees who were initially treated by a primary care provider for LBP, of which 215 received a referral for physical therapy. While researchers were interested in differences between the referral and nonreferral groups, the target of their study was something they believe is missing in current research: an examination of the entire referral population, regardless of whether those patients followed up with actual physical therapy.

    "Identifying only patients who have participated in [physical therapy] fails to account for the impact of the referral itself," authors write. "The referral potentially represents a provider-patient interaction about the nature of the LBP and prognosis. Improved outcomes among [physical therapy] cohorts may represent a combination of patient compliance with the [physical therapy] recommendation and a provider's beliefs about the nature and severity of the LBP."

    To get at this issue, researchers divided patients who received a physical therapy referral into 2 groups—those who, after a physical therapy consultation, went on to participate in physical therapy, and those who didn't—and compared those groups with each other, as well as with the group that didn't receive any referral to physical therapy. Among the findings:

    • Patients receiving a physical therapy consult tended to be younger, and had received a radiograph and/or prescription for nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxers. Patients less likely to receive a consult were associated with tobacco use, chronic pain, depression, 2 or more comorbidities, and having received a referral for specialty care or advanced imaging.
    • The odds of a patient receiving a physical therapy consult were increased 1.8 times if the patient also received an NSAID prescription.
    • The odds of a patient receiving a physical therapy consult were decreased 25 times if the patient received specialty care or advanced imaging.
    • In terms of actual participation in physical therapy, patients who received multiple orders from the primary care provider (specialty referrals, advanced imaging, etc) in addition to a physical therapy referral were less likely to go to physical therapy, as were older patients and those with 2 or more comorbidities.
    • Opioid prescriptions were the most commonly used interventions during the year after the initial LPB visit. While the strongest predictor of a later opioid prescription was associated with whether an opioid prescription occurred at baseline, patients who received a physical therapy consult were 35% less likely to receive an opioid prescription, regardless of whether they participated in physical therapy after the consult.
    • Participation in physical therapy had a "mixed impact" on health care use and no difference on overall costs.

    "These results highlight the impact of the initial provider visit and provide a foundation for future work understanding patient and provider beliefs surrounding the initial primary care visit for LBP," authors write, adding that "providing a physical therapy consult in place of an opioid prescription is a reasonable alternate strategy for pain management and improved function, particularly in this population of Medicaid enrollees."

    Researchers acknowledge the limitations of their work, including its population of 70% women, its focus on association rather than causation, and a reliance on electronic medical records that can limit insight into clinical decision-making. Still, they assert, the data they were able to tease out from patients who were recommended physical therapy point to some promising possibilities.

    "Patients with a consult to [physical therapy] represent a unique and important subset as the consult may represent a reflection of a provider's values and subsequent communication with the patient," they write. "Recommending [physical therapy] provides reassurance to patients that their LBP is best managed with physical activity and is in line with advice to stay active. This in itself has potential to change cost and health care use."

    Authors of the study include APTA members Anne Thackeray, PT, PhD; and Julie Fritz, PT, PhD, FAPTA.

    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.

    Editor's note: Look for a special issue of Physical Therapy (PTJ) on nondrug management of pain coming in April.


    2017's Top Stories From PT in Motion News

    The past year was another eventful one for the physical therapy profession, and with more than 270 stories posted during 2017, readers of PT in Motion News were able to keep up with a wide range of developments, from payment to research to new APTA offerings. Here are 7 of the most-read stories from 2017.

    (Editor's note: Don't miss reader comments on the articles—often as interesting as the story itself.)

    A change in how CMS calculates reimbursement results in generally higher payments under the new CPT code set.
    January: When the 3-tiered current procedural terminology (CPT) code set launched in 2017, not much was known beforehand about its effects on payment. Early on, however, the Centers for Medicare and Medicaid Services (CMS) revealed that it had tweaked a formula in ways that would likely result in modest payment increases, depending on geographic region and other factors.

    A study underscores the importance of patient education and choice when it comes where to receive physical therapy soon after surgery for TKA.
    January: Authors of a retrospective cohort study found that patients who receive home-based physical therapy before entering an outpatient program do just about as well as those who receive immediate outpatient physical therapy—but it may take them longer to get there. The results, they say, point to the importance of shared decision-making between patient and the care team. PT in Motion News readers were eager to share their personal takes on both the research itself and the role of home-based physical therapy in general.

    The Physical Therapy Licensure Compact reaches a critical milestone.
    April: Washington became the 10th state to sign on to the Physical Therapy Licensure Compact (PTLC), allowing for official establishment of a system designed to allow PTs and PTAs to apply for privilege to practice in any participating PTLC state without having to be licensed in each one.

    A new guideline says no to arthroscopy for knee OA or meniscal tears.
    May: Delivered in the form of a clinical guideline, researchers said that short-term gains and function from arthroscopy are outweighed by the burden and risks of the procedure. Instead, the guideline recommends conservative treatment for "nearly all" patients with degenerative knee disease.

    A new APTA webpage focuses on the PT's role in nutrition.
    June: APTA unveiled a new "Nutrition and Physical Therapy" webpage with resources reflecting the association's position that it's appropriate for physical therapists (PTs) to "screen for and provide information on diet and nutritional issues to patients, clients, and the community." The story prompted a lively exchange of reader comments, both pro and con.

    PTAs are included as providers under TRICARE.
    December: In a big win for the profession, the new defense spending bill signed into law by President Donald Trump paves the way for physical therapist assistants (PTAs) to be recognized providers under the TRICARE payment program used throughout the Department of Defense health care system.

    Capitol Hill inaction triggers a no-exceptions therapy cap—at least until mid-January, 2018.
    December: The celebration of the news that PTAs would be included in TRICARE had hardly died down before the news hit that Congress was headed into recess without addressing the Medicare therapy cap in any way—including creating a stopgap exceptions process. The result? The $2,010 hard cap on therapy services is now in place until legislators decide to take up the issue once they return in January. The news was especially disappointing given that a bipartisan agreement to end the hard cap had been reached.

    Do-Over: Check Out PT in Motion Magazine's Most-Read Articles From 2017

    PT in Motion, APTA's award-winning member magazine, offered up another year of stellar articles relevant to the physical therapy profession in 2017. And it just so happens that January is when the magazine takes a 1-month break. So while PT in Motion gears up for 2018, why not catch up on what you may have missed from last year?

    Here are some of the year's most-read PT in Motion stories, arranged by shared themes.

    Explorations of the ways the physical therapy profession is expanding its reach
    In 2017, PT in Motion ran highly popular pieces on how physical therapists (PTs) are getting the word out on the profession's role in concussion management, as well as the ways PTs treat patients during and after pregnancy. The magazine also looked at opportunities for PTs in employer self-insurance programs and delivered a fascinating article on physical therapy and chronic fatigue syndrome that includes interviews with PTs who are themselves battling the condition.

    Features on PTs and PTAs letting their creativity shine
    Other popular articles looked at how PTs and physical therapist assistants (PTAs) created their own solutions, including within their own career paths. An August article on "inventional thinking" introduced readers to several PTs who became inventors to fill in gaps in rehabilitation, while "Physical Therapy by Design" in the October issue featured PTs who have redesigned their clinics, both big and small. Earlier in the year, PT in Motion looked at how creativity, passion, and bravery intersected to spur several individuals to make dramatic career changes to become a PTA.

    Perspectives on how to survive (and thrive) in the profession
    PT in Motion also regularly offers practical information that help readers navigate their day-to-day lives. In 2017, popular articles included a primer on the revised Current Procedural Terminology (CPT) code set, as well as insight on documentation in the new 3-tiered system. The magazine also looked at the importance of financial literacy for new DPT grads who often face significant education-related debt.

    Printed editions of PT in Motion magazine are mailed to all members who have not opted out; digital versions are available online to members.