Physical therapy and other nonoperative treatments are just as effective at reducing pain and disability as surgical spinal fusion for patients suffering from degenerative disc disease (DDD), according to a recently published study conducted at Thomas Jefferson University Hospital in Philadelphia.
Results of the study, which were published ahead of print in World Neurosurgery, show that among 96 patients treated for DDD, there were no significant differences in outcomes between the 53 who were treated with lumbar fusion and the 43 who chose to pursue nonoperative treatment. Measured outcomes included pain, health status, disability, and overall satisfaction. All patients were cared for by the same physiatrist.
All of the subjects in the study received a diagnostic lumbar discography procedure between 2003 and 2009, and were offered fusion surgery based on the discogram and magnetic resonance imaging (MRI) results. Researchers found that while all patients reported significantly lower pain scores, data for the 2 groups "do not demonstrate a significant difference for standardized outcomes measures of pain, generalized health status, satisfaction, or disability."
Results from an APTA survey found that 61% of Americans experience low back pain, but only 4 in 10 seek relief through movement. The APTA patient-focused Move Forward website offers a host of low back pain resources for physical therapists (PTs) and their patients, including audio presentations and an e-book on low back pain and how PTs can help. Treatment of low back pain was the subject of a 2-day series of presentations at the 2013 APTA Conference in Salt Lake City in June, as well as the focus of several CEU courses in APTA's Learning Center.
California residents will have improved access to physical therapist services due to a bill that was signed into law by Gov Jerry Brown on October 7. The signing of the bill, known as Assembly Bill 1000, marks the end of a challenging legislative journey for physical therapists in the state in 2013.
Under the previous law, patients could only be seen for an evaluation, fitness and wellness services, and treatment for a condition that had been the subject of a medical diagnosis. AB 1000, which goes into effect on January 1, 2014, expands patient access to physical therapist services for immediate treatment for up to 45 days or 12 visits, whichever comes first.
"With the ability to evaluate and provide interventions to the direct access patient immediately, physical therapists in California can quickly address the needs of their patients," stated APTA President Paul A. Rockar Jr, PT, DPT, MS.
While the end result of AB 1000 helps California physical therapists achieve the longstanding goal of direct access, the final version also includes language that allows physical therapists to be employed by medical professional corporations. This aspect of the bill was not without controversy, and created debate among some California chapter members, given that the legislation combined two significant and unrelated public policy issues. The provision of the law allowing medical professional corporations to employ physical therapists stipulates that a physician, surgeon, podiatrist, or other referring practitioner must inform patients that they may seek physical therapy treatment services by a practitioner of their own choice, and that the practitioner does not have to be employed by the medical corporation. The legislation also authorizes the organization of physical therapy professional corporations with majority ownership by physical therapists that, as well, may employ other health professionals.
In addition to CPTA's work with AB 1000, the chapter successfully advocated against 2 other bills earlier this year: SB 381, which would prohibit physical therapists from performing manipulations; and AB 864, which would have licensed athletic trainers. Both SB 381 and AB 864 were defeated.
APTA state chapter leaders from Indiana, North Carolina, Kansas, Michigan, and Nebraska were honored for their efforts to ensure that physical therapists and physical therapist assistants have a strong voice in the legislative process. The awards were part of the activities of the most recent APTA State Policy & Payment Forum, held September 15-17, 2013, in Omaha, Nebraska.
In recognition of their individual leadership on legislation advancing or defending Vision 2020 in the state arena, the APTA Board of Directors awarded the 2013 State Legislative Leadership Award to Pauline Flesch, PT, MPS, of the Indiana Chapter; Dean McCall, PT, DPT, OCS, of the North Carolina Chapter; and Pam Palmer, PT, of the Kansas Chapter. State Legislative Commitment Awards were presented to Jake Jakubiak Kovacek, PT, of the Michigan Chapter and Kirk Peck, PT, PhD, CSCS, CCRT, of the Nebraska Chapter in recognition of their long-term commitment to their chapters' state advocacy activities. Future advocacy efforts will seek to advance the Vision Statement for the Physical Therapy Profession, adopted by the APTA House of Delegates in 2013.
More than 200 physical therapists, physical therapist assistants, and physical therapy student advocates from across the country attended the forum, cohosted by APTA and the Nebraska Chapter. The event featured a variety of informational and strategy sessions on topics including the implementation of health care reform at the state level, fair physical therapy copay legislation, telehealth, emerging scope of practice issues, strategies for negotiating with insurance companies, and infringement challenges. Highlights from this year's event and awards reception can be found on the APTA website.
The quality of care patients receive may depend on the type of insurance they have, even when variations in facility-level factors like geography and ownership are accounted for. The findings, released in the October 2013 issue of Health Affairs, suggest that after data are adjusted for risk, privately insured patients have lower mortality rates than their Medicare-enrolled counterparts, even when these patients were treated in the same hospital.
The findings are based on an analysis of State Inpatient Database records of hospital discharges in Arizona, California, Florida, Iowa, Maryland, Massachusetts, New Jersey, New York, North Carolina, Washington, and Wisconsin—a diverse sample that represents nearly 39% of the country's acute care discharges. Records from 1,434 hospitals were reviewed in the study, which focused on 8 surgical procedures and 7 medical conditions.
Researchers found that privately insured patients had lower mortality rates than Medicare patients in 12 of the 15 selected procedures or conditions. For instance, Medicare patients had a 104% higher mortality rate than the privately insured for hip replacement and a 22% higher rate of mortality for hip fractures. Medicare patients showed lower mortality rates in stroke, congestive heart failure, and pneumonia, but the differences were smaller.
The study cites no clearcut reason for why Medicare patients would have higher mortality rates than patients with private insurance, but the authors suggest that some of the inequality may have to do with the ways attending physicians are assigned, the availability of referral networks, unequal access to newer technologies, and possible overcoding of premorbidities for private insurance patients. The report recommends that "to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals." A report on the findings appeared in Medscape on October 8.
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