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  • APTA, AOTA, ASHA Combine Voices to Speak Out for Providers' Clinical Judgment

    APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASL) have come together to deliver the message that inappropriate administrative mandates, quotas, and productivity standards should never stand in the way of professional clinical judgment and knowledge of billing and reporting requirements.

    The 3 organizations have released a "Consensus Statement on Clinical Judgment in Health Care Settings (.pdf)" as part of a combined effort to highlight the central role of the clinician in a health care landscape that increasingly looks to patient-centered outcomes as the true measure of quality.

    "Respect for the therapist's clinical judgment and expertise is critical to achieving optimum patient/client care," according to the statement. "Overriding or ignoring clinical judgment through administrative mandates, employer pressure to meet quotas, or inappropriate productivity standards may be a violation of payer rules, may be in conflict with state licensure laws, and may even constitute fraud."

    The statement provides examples of unacceptable practices and reminders on the importance of knowing all rules and regulations, following proper evaluation and treatment protocols, and completing all documentation. Clinicians are encouraged to take action if they encounter a billing process that may be suspect and are provided with possible steps to take in response to employer policies or practices that conflict with clinical judgment.

    The partnership between APTA, AOTA, and ASHA is not new. The 3 organizations have worked together to produce guidelines on cotreatment and engage in advocacy around ending the therapy cap.

    “This is an important step both for APTA, its partner organizations, and the patients we serve,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. “It provides further clarity and framework to help ensure appropriate treatment and it is just one of many steps APTA has taken to ensure patients are receiving the highest quality, most efficient care; care that is skillfully thought out and planned with the patient’s wants and needs at the forefront. This has long been a driving principle for our organization.”

    The statement on clinical judgment follows a charge made earlier this year by APTA’s House of Delegates (RC-16-14) for the association to identify and develop resources that equip physical therapists and physical therapist assistants in negotiations for conceptual frameworks of productivity and performance that ensure the provision of quality physical therapy care.

    This and other resources on clinical judgment contribute to APTA's Integrity in Practice Campaign, and can be found at the APTA Center for Integrity in Practice website. In addition to the consensus statement, the website's resources include information on the Choosing Wisely® list of "5 Things Physical Therapists and Patients Should Question;” a primer on preventing fraud, abuse, and waste; a free course on compliance; and other information on regulation and payment systems, evidence-based practice, ethics, professionalism, and fraud prevention.

    For Patients With Meniscus Tear, Exercise Therapy Outperforms Surgery in Key Muscle Strength Measure

    Exercise therapy can improve certain functions to a degree not possible through arthroscopic surgery for middle-aged patients with degenerative meniscus tears, according to a new study from Denmark. Researchers believe the improvement in function through exercise—more than 16% greater than improvement experienced by the surgery group—may lead to better long-term outcomes.

    In a study that turned the tables on common research that uses exercise therapy as a control group to evaluate the effectiveness of arthroscopic surgery, authors of a study e-published ahead of print in the American Journal of Physical Medicine and Rehabilitation (abstract only available for free) used the surgery group as a control to measure improvements in isokinetic quadriceps strength and neuromuscular function. Such improvements, they write, "can provide functional improvements, pain relief, and possibly also a delay in the onset of osteoarthritis (OA)" in individuals with the tears.

    A total of 82 patients with a degenerative meniscus tear and mild to no OA were placed into 2 groups—1 group underwent arthroscopic partial meniscectomy (APM), and the other was assigned to a 12-week supervised exercise therapy program. Participants had a mean age of 49 years, were able to perform physical activities and exercise, and had not undergone knee surgery in the past 2 years. Males made up 65% of the study group.

    The 12-week exercise program consisted of 2–3 sessions per week, each session lasting 60 to 80 minutes. About 20 minutes was spent in warmup on a stationary cycle, 20–30 minutes on neuromuscular exercise, and another 20–30 minutes on strength training. A physical therapist individually supervised sessions once per week. The APM group received "written and oral instructions for simple home exercises" to be performed 2 to 4 times daily.

    After recording baseline information, researchers assessed isokinetic knee muscle strength, lower extremity performance, and self-reported global rating of change 3 months after intervention.

    While researchers noted no significant differences between the groups in performance tests—knee bends, one-leg hop for distance, and a 6-meter timed hop—or in self-reported assessments of change, a significant improvement occurred in the areas of knee extension total work and knee flexion peak torque. The mean difference of just over 16% reflected improved quadriceps muscle strength that authors write "is effective in relieving pain and improving physical function in patients with knee OA, which could also apply to patients at earlier stages of the degenerative disease."

    Although both the nonsurgical and surgical groups reported about the same levels of self-assessed change after 3 months, researchers speculated that "more invasive procedures are associated with greater placebo effects," which might explain the perceived improvement even in the absence of improvement in muscle strength for the surgical group.

    Authors note that more long-term studies of self-reported pain and function are needed to better compare exercise programs and APM, but they write that their findings are statistically significant enough to support the role of exercise therapy for patients with degenerative meniscus tear.

    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.

    Lunch and Learn: Hospital-Based Exercise

    Get insights on a study of a hospital-based exercise program and its outcomes in older adults when the Osteoarthritis Action Alliance (OAAA) hosts another in its series of free "lunch and learn" webinars on Wednesday, October 15.

    The 30-minute program will feature presenters from the Hospital for Special Surgery in New York City. Speakers will cover design, implementation, and assessment of the program in terms of individual outcomes and community impact.

    The session will begin at 12:00 pm ET, and online registration is now open. The slide presentation for the session can be accessed in advance, and OAAA archives its webinars for viewing at a later time.

    APTA is a member of OAAA.

    APTA Google Hangout Looks at Midterm Elections

    You've probably heard a thing or 2 about the upcoming midterm elections, and depending on where you live there’s been no shortage of ads. But what does it all mean for physical therapy and health care policy?

    Get your questions answered at an APTA Roundtable via Google+ Hangouts on Wednesday, October 15, at 8:00 pm, ET.

    Mike Matlack, APTA director of grassroots and political affairs, will be taking your questions. Submit your questions via Twitter using the #PTAdvocacy hashtag or by mentioning @PTPAC, then visit the hangout to get the answers. You can submit questions up to and throughout the hangout.

    Can't make the hangout? We'll be posting the entire event to the APTA YouTube channel soon after it concludes.