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  • Final 2015 Physician Fee Schedule Rule Announces 1% Payment Rise for PT, Increase in PQRS Reporting, Delay of VM for PTs

    Note: This version corrects an earlier PT in Motion News post that described the 2.0% PQRS penalty as being implemented in 2016. That penalty will be put in place in 2017.

    The final 2015 Medicare physician fee schedule rule released by the Centers for Medicare and Medicaid Services (CMS) includes an aggregate increase in payment for physical therapy services of 1%--provided Congress stops implementation of a payment cut due to the flawed SGR formula by March 31. In addition, despite objections from APTA and other organizations, the new rule increases the number of Physician Quality Reporting System (PQRS) measures required for reporting of physical therapists (PTs) in private practice and other health care professionals to as many as 9.

    The new PQRS rules were opposed by many other professional health care provider organizations and APTA, which provided CMS with comments when the rule was first proposed.

    The PQRS change will increase the number of individual measures required to be reported in order to avoid the 2017 2.0% PQRS penalty, from 3 to as many as 9, depending on whether the provider is using claims ( 6 measures available for 2015), or registry (9 required, or as many as apply to the provider). As in 2014, providers must report on at least 50% of eligible Medicare patients.

    Other changes include:

    • The 2015 therapy cap will be $1,940, up $20 from the 2014 cap.
    • If Congress fails to act before March 31, 2015, the process for exceptions to the therapy cap will end, including the $3,700 manual medical review process.

    In other rules announcements, CMS issued final rules on the methodology for adjusting the DMEPOS feel schedule payment amounts, and the establishment of alternative payment rules for a phase-in of a competitive bidding program.

    APTA will post detailed summaries of the new rules in the coming weeks.

    Visit PT in Motion News for more information on recently-released rules from CMS, including the 2015 outpatient prospective payment system and home health prospective payment system.

    Final Rule On Outpatient Prospective Payment Includes 2.2% Rate Increase

    The final rule for the outpatient prospective payment system (OPPS), released by the Centers for Medicare and Medicaid Services (CMS) on October 31, includes a 2.2% increase in payment rates to hospital outpatient departments beginning January 1, 2015.

    The rule includes the packaging of payment for certain ancillary services provided in the hospital as well as comprehensive payments for a list of 25 primary services. The comprehensive payments include adjunctive services and supplies that support delivery of the primary service, which may include some physical therapist services that occur in the perioperative period. Further, the rule requires physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.

    Except for a small subset of ‘‘sometimes therapy’’ services delivered without a certified therapy plan of care, most physical therapist services provided in the outpatient hospital department are paid under the Medicare physician fee schedule (PFS), not the OPPS. CMS provides an annual update of these “sometimes therapy” services that are paid under the OPPS and subject to direct supervision requirements.

    A detailed summary of the rule will be available for APTA members in the coming weeks.

    Visit PT in Motion News for more information on recently released rules from CMS, including the 2015 physician fee schedule and home health prospective payment system.

    Scary-Good Savings Ending Soon

    It's no trick—you still have time to treat yourself to big National Physical Therapy Month discounts at the APTA Marketplace. Get 20% off everything if you order before the witching hour on October 31!

    'Game Changing' New Devices Include Gait, Pressure Wound Monitoring Systems

    Never mind the latest iPhone 6—how about an insole than can gather and transmit motion data, or a monitoring system that can provide detailed assessments of wounds to help thwart the development of wounds?

    Recently, Medscape published a list of 15 "game changing" wireless health technology devices selected by cardiac electrophysiologist David Lee Scher, MD, clinical associate professor of medicine at Penn State University, director of a digital health consulting firm, and chairman of the Healthcare Information and Management Systems Society (HIMSS) Mobile Health Roadmap Task Force. While cardiac, records, and medications monitors made up much of the list, Scher also included 2 devices that could be of special interest to physical therapists and physical therapist assistants—"WoundRounds" and "Moticon."

    WoundRounds combines a special app with a dedicated device that allows providers to record the state of a wound over time, and share that information with other providers. Though intended for use in facilities, the device and app can also be used in home care settings.

    Moticon is a removable device that its developers describe as the world's "first integrated sensor insole." Once slipped into a wearer's shoe, Moticon wirelessly transmits data on gait to a special smartphone app and, according to Scher, could even help providers track when a patient is experiencing a growing risk for falls.

    Pre and Post-ACLR Rehabilitation Shows Benefits 2 Years After Surgery

    A new study of individuals who undergo anterior cruciate ligament reconstruction (ACLR) shows that patients who participate in both pre- and postoperative rehabilitation not only get a head start on recovery, but experience markedly better outcomes than patients receiving usual care even 2 years after surgery. The study was e-published ahead of print in the October 28 British Journal of Sports Medicine (abstract only available for free).

    Researchers compared Knee Injury and Osteoarthritis Outcome Scores (KOOS) of 84 patients who participated in progressive pre- and postoperative rehabilitation between 2007 and 2011 with 2,690 patients who received usual care between 2006 and 2010. The usual-care patient data were taken from the Norwegian National Knee Ligament Registry (NKLR); patients receiving the progressive pre- and postoperative care were from the US and Norway.

    Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points.

    Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills. Authors did not include a description of usual-care.

    Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write.

    Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements.

    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.

    CMS Eases Reassessment Requirements in 2015 Home Health Rule

    Beginning in 2015, the Centers for Medicare and Medicaid Services (CMS) will adopt a change suggested by APTA and others, and replace a requirement that home health therapy reassessments be performed at the 13th and 19th visits with one that requires a reassessment every 30 calendar days by each therapy discipline. The new requirement is part of a set of finalized changes to the Home Health Prospective Payment System rule announced by CMS on October 30.

    Under the final rule, set to be implemented January 1, 2015, physical therapists (PTs) must "perform the needed therapy services, assess the patient, measure progress, and document objectives and goals at least once every 30 calendar days during the home health episode of care." The reassessment policy applies to physical therapy, occupational therapy, and speech-language pathology, and must be conducted by a qualified therapist from each discipline. In the case of physical therapy, "qualified therapists" would be limited to PTs.

    CMS had originally proposed that the reassessment be performed every 14 calendar days, but increased the requirement to 30 days after receiving comments from the public, including APTA.

    CMS also announced that it will eliminate the mandate for a "narrative" to be supplied by a physician in order to comply with a physician "face to face" requirement. APTA supported this change, expressing concerns that the current rule creates an undue burden on the home health community. The physician (or nonphysician practitioner) will still be required to certify that a face-to-face patient encounter occurred in order to meet the requirements for the home health stay. That encounter must take place no more than 90 days before the start of home health care or within 30 days after it begins.

    The final rule also includes 0.3% ($60 million) reduction for Medicare home health payments in 2015. This decrease is caused by a 2.1% increase to the home health market basket, which was then reduced by 2.4% for the second phase of home health rebasing. In addition, there are new provisions for the home health quality reporting program.

    The rule has been posted on the federal register. APTA will draft a complete summary of the final rule in the coming days, and will offer educational programs on this and other CMS rule changes for 2015.

    CMS will also be issuing rules for 2015 on the physician fee schedule and the outpatient prospective payment system. Visit APTA's PT in Motion News page to get the latest reports.

    Exercise Can Help Ease Fibromyalgia Symptoms, But No Clear Winner Between Aquatic and Land-Based Programs

    Exercise therapy can improve some symptoms of fibromyalgia, but conclusive evidence favoring aquatic or land-based programs as the best way to achieve those improvements is still lacking, according to a new Cochrane review of randomized controlled trials (article available through the Cochrane Database of Systematic Reviews in PTNow ArticleSearch). The study is part of a larger update of a Cochrane review on exercise for treating fibromyalgia syndrome.

    In an effort to determine how aquatic exercise training stacked up both to no exercise and land-based programs, researchers analyzed 16 aquatic training studies that included 866 women and 15 men. Aquatic exercise was compared with a non-exercise control group in 9 studies, and compared with land-based programs in 5 studies. In 2 studies, different types of aquatic exercise were compared with each other.

    When it comes to the benefits of aquatic exercise compared with no exercise, researchers found that individuals with fibromyalgia who participated in the aquatic programs reported improvements in physical function, pain, and stiffness. The studies also noted improvements in muscle strength and cardiovascular fitness. Although improvements were characterized as statistically significant across all measures, only stiffness and muscle strength met researchers' 15% threshold for clinical relevance. In general, authors described the evidence as "low to moderate quality" in favor of aquatic training.

    Comparisons of aquatic programs with land-based exercise yielded no clinically relevant differences between the 2, according to the study's authors, with evidence characterized as "very low to low quality."

    The final analysis is that there can't really be a final analysis when it comes to an assessment of aquatic vs land-based exercise for improvement of fibromyalgia symptoms, according to the review. "As so few studies have been done so far, we are very uncertain about the results," authors write.

    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.

    Video of McMillan Lecture Ready for Viewing

    Those who heard the 45th Mary McMillan Lecture at the 2014 NEXT Conference and Exposition have been talking about it ever since. Now's your chance to see why.

    "If Greatness Is a Goal," by James Gordon, PT, EdD, FAPTA, is now available to watch on APTA’s website.

    In his lecture, Gordon called for fewer physical therapy programs. These programs, he said, should consist of faculties committed to a 3-part academic mission of research, education, and clinical practice.

    Members can also read Gordon’s lecture in the October issue of PTJ, as well as view a NEXT dispatch interview. A PTJ podcast discussion with Gordon, Editor-in-Chief Rebecca Craik, PT, PhD, FAPTA, and other participants will be available in December at PTJ’s Podcast Central.

    The McMillan Lecture is part of the APTA Honors and Awards program now seeking nominees for recognition in 2015. Visit the Honors and Awards webpage to learn more. Nominations close December 1.

    How Did You Celebrate National Physical Therapy Month

    What did you do for National Physical Therapy Month (NPTM) this year? Time to share it with the world!

    Whether you participated in the "7 Myths" campaign or created your own ways to honor the profession, APTA would like to know. Share your NPTM 2014 celebration images and descriptions by using the #PTmonth hashtag on Twitter, Facebook, and Instagram, or by e-mailing us at public-relations@apta.org.

    CDC Still Looking for Answers to Condition Producing Paralysis in Children

    The US Centers for Disease Control and Prevention (CDC) is still trying to identify the cause of an illness that has now resulted in various degrees of paralysis among 51 children in 23 states as of October 23. The agency began asking states to track the condition after a cluster of cases were reported in Colorado in August and September.

    The New York Times reports that CDC officials continue to describe the cases as "extremely rare," and they are not supporting a connection between the polio-like condition and respiratory virus enterovirus 68, although some doctors "suspect a link." The NYT article quotes Mark Pallansch, director of the division of viral diseases at CDC, as saying, "We don't have a single clear hypothesis that's the leading one at this point."

    Early reports cited the condition as appearing in 40 states. Since those initial reports, CDC ruled out several cases that do not meet its definitions for inclusion, which require the presence of spinal lesions largely in the gray matter, among other factors.

    The condition seems to strike younger children and advances rapidly, becoming most acute within 1-3 days of initial symptoms of weakness. The paralysis varies in severity, and most recovery is made within the first 2 months, with a slowdown in gains as time progresses. A pediatric neurologist quoted in the NYT story describes recovery as "highly variable," saying that "some patients recover very well, others not."

    CDC updates case tallies every Thursday, and continues to ask state and local health departments to report cases that meet its criteria for inclusion: sudden-onset acute limb weakness experienced in August or after in a patient 21 or younger, and the presence of a spinal cord lesion largely restricted to gray matter. The agency has also posted a report on its investigation into the cluster of cases in Colorado in August and September.

    PTNow Blog: Good Research Needs More Than Good Stats

    In the latest PTNow Blog, a self-described "research geek" says that when it comes to evaluating research results, it's time for rehabilitation clinicians to move toward a nuanced approach that takes things such as confidence intervals, effect sizes, and clinical judgment into account.

    A clinical commentary authored by Phil Page, PT, PdD, ATC, CSCS, FACSM, is the subject of the new post, which describes Page's efforts to bring attention to so-called "magnitude-based inferences" that rely less on a simple black-or-white analysis of statistical significance, and more on an evaluative process that factors in whether and how that intervention will benefit the patient in a meaningful way.

    Along the way, the blog reports, Page also encourages physical therapists to take little for granted and never assume that research is good simply because it appears in a respected journal.

    Check out the blog, follow the link to Page's article, and join the conversation.

    Slides, Video From IOM/NRC Workshop on Future of Home Health Now Available

    Presentation slides and videos from an innovative Institute on Medicine (IOM) and National Research Council (NRC) workshop on the future of home health care are now available for download at the IOM website. APTA was among the sponsors of the 2-day event.

    The workshop, held September 30 through October 1, brought together leaders in health care, academia, and the federal government to talk about the present and future of home health care, with particular emphasis on how data can inform and improve outcomes. Highlights of the workshop were featured in US News & World Report.

    The workshop touched on issues that affect the entire home health system, including innovation, the role of social support, silos in postacute care settings, customized technologies, and the creation of a standard definition that combines skilled, unskilled, and caregiver services. Cindy Krafft, PT, COS-C, president of APTA's Home Health Section, participated in the workshop along with APTA staff.

    The Alliance for Home Health Quality and Innovation will hold a follow-up symposium on January 13 in Washington, DC. Registration information will be posted on the Future of Home Health website.

    New Study: Steroid Treatments Shouldn't Be the 'First-Line Stand-Alone' Approach to Neck Pain

    Authors of a new study say that epidural steroid injections used as a stand-alone treatment should not be a "first line" approach to cervical radicular pain, and instead suggest that a combination of treatments including physical therapy may offer the best chances for improvement.

    In a multicenter, randomized study published in the November issue of Anesthesiology, researchers tracked treatment outcomes for 3 groups of patients with neck pain that radiated through the shoulders and arms. A total of 55 patients received epidural steroid injection (ESI); 59 received pain medication and physical therapy; and 55 had both treatments. The study measured pain scores at outset, and 1, 3, and 6 months after treatments began.

    What researchers found was that both the conservative and steroid-only treatment groups improved at the same rate, and that while patients in the combination group reported greater rates of pain reduction, "the difference reached statistical significance only at 3 months." At that measurement point, 56.9% of the combination group reported decreased arm pain, compared with 36.7% of the steroid-only group and 26.8% of the conservative treatment group.

    "The main finding is that although the combination group experienced superior results for some outcome measures compared with stand-alone therapies, most differences generally fell shy of statistical significance, including for the primary outcome measure," authors write. "On the basis of these findings and the risks associated with ESI, one might reasonably conclude that ESI should not be a first-line, stand-alone treatment for cervical radiculopathy."

    Although authors did acknowledge that the combination group seemed to fare better than the stand-alone groups, they noted that "the effect size was more modest than we anticipated." Still, they offer several explanations for the differences, including the ways the treatments may enhance each other, the potential placebo effect of experiencing all treatments offered in the study, and the possibility that ESI treatments "provide significant short-term pain relief that allows optimal participation in [physical therapy], which provides long-term benefit."

    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.

    APTA Candidate Nominations Due by November 3

    APTA's strong and diverse leadership can continue—but only with your help.

    The APTA Nominating Committee is seeking candidates for the 2015 slate for the open positions of president, vice president, 3 directors, and a Nominating Committee member. The committee encourages APTA members to fill out an online nomination form (NC1) to identify leaders eager to serve in a national position. Deadline is November 3.

    But don't stop there. Once you've submitted your nominations, be sure to reach out to your nominees to encourage them and tell them exactly why you think they have what it takes to help APTA achieve its vision of transforming society.

    Time to Pick the Next PT in Motion Cover

    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 December/January, editorial staff is proposing 3 designs and asking members to vote on their favorite cover to illustrate the concept of "pioneering PTs." The design that receives the most votes will be the next cover.

    Take the quick and simple survey by November 3. Just pick the design you think is likely to get you to open up the magazine, and then check out the December/January issue to see which cover was most popular.

    Don't Miss Miami – Marquette Challenge Student Social at NSC

    Attending the National Student Conclave October 30 – November 3 in Milwaukee? Don't miss the Miami – Marquette Challenge Student Social on Thursday 7:00 pm–10:00 pm.

    There's no admission charge. If you submitted your RSVP, a brown ticket to the event will be included with your conference badge then head over to Buckhead Saloon, 1044 Old World 3rd Street, to hang out, catch up, see, be seen, and get excited about this year's Challenge to benefit physical therapy research. For those who didn't RSVP, additional tickets will be given out onsite to the first 100 students arriving.

    Need more incentive? Free drink tickets will be handed out to the first 350 students who arrive. Buckhead Saloon is also offering $2 drink specials throughout the evening.

    Visits to EDs Up Overall, but Sprains and Strains Show Decrease

    Emergency department (ED) visits continue to rise overall, but between 2006 and 2011 the most common reason for a visit to the ED—sprains and strains—decreased 10%.

    According to a report released last month (pdf) by the Healthcare Cost and Utilization Project (HCUP), the total rate for ED visits rose 4.5 % from 2006 to 2011, from 40,200 per 100,000 to a 2011 rate of 42,100 per 100,000 population.

    The uptick was not consistent across all areas studied, however. HCUP reports that while some of the most common reasons for an ED visit—conditions including abdominal pain, nonspecific chest pain, and nausea and vomiting—continued to rise, the 2 top reasons for visits to the ED—sprains and strains, and superficial injuries and contusions—actually decreased. Visits for sprains and strains dropped by 9% to 1,933 per 100,000 population during the study period; superficial injuries and contusions saw an 11% decrease, to 1,832 per 100,000.

    Other findings in the report:

    • Intracranial injury was the only injury-related condition that appeared on the HCUP list of the ED visits with the largest rates of increase during the study period, showing a 19% rise to 229 per 100,000.
    • Visits for diabetes increased 33%, to 102 per 100,000 population.
    • Infection-related diagnoses showed the single largest rate of increase—a 74% rise to an estimated 980,000 total ED visits for septicemia in 2011, and a 48% rise in visits for influenza.
    • ED visits rose by 6.3% for females and 2.4% for males.
    • Infants 1 year or younger saw an 8.3% drop in ED visits; adults aged 45–64 showed an 8.3% rise.
    • Regionally, the Midwest experienced the largest increase in ED visits (9.2%), and the West recorded the lowest increase (1.6%). The Northeast reported a 4.8% increase, and the South saw a 3.3% rise between 2006 and 2011.

    HCUP is a project within the Agency for Healthcare Research and Quality.

    Find out more about the integral role of physical therapists in emergency care: check out APTA's webpage devoted to physical therapy practice in EDs.

    'Well to Do' Column Joins PT in Motion Magazine's Online-Only Lineup

    In recognition of the growing emphasis on physical therapy's role in prevention, wellness, and fitness, PT in Motion magazine adds "Well to Do," a new column on the topic, to its lineup of online-only content.

    Longtime contributor Brad Cooper, PT, MSPT, MBA, MTC, ATC, CWC, writes the monthly column, which begins with the November 2014 issue is now posted ahead of print.

    This month's timely topic: during the same 8-day period in October that marked the tragic death of an American from the Ebola virus and diagnosis of 2 others, 13,144 Americans died of heart disease and 3,491 of lung cancer. "We can impact these other—far more prevalent—causes of death in both our lives and the lives of those around us," Cooper writes.

    Read why in this debut column—and get a quick tip on a specific aspect of wellness that may not be on your radar.

    Encouraging healthy, active lifestyles is central to the physical therapy profession's ability to transform society. Keep up with the latest resources at APTA's Prevention and Wellness webpage.

    $850 Million CMS Initiative Will Fund Clinical Practice 'Transformation'

    A new initiative announced by the US Centers for Medicare and Medicaid Services (CMS) will offer $850 million in funding to provider networks, professional associations, and other organizations that are providing education and training in the transition to value-based health care.

    The "Transforming Clinical Practice Initiative" unveiled by the CMS Innovation Center is a 4-year project that aims to "support clinician practice through nationwide, collaborative, and peer-based learning networks that facilitate practice transformation," according to a CMS fact sheet.

    Funding will be awarded in 2 general areas: "practice transformation networks" that involve peer-to-peer learning, and "support and alignment networks" that involve learning opportunities created by professional associations, societies, and other organizations.

    CMS envisions successful practice transformation network applicants as those that have relationships and share data with multiple clinician practices, and can lead "clinicians and their practices through the transformation process." CMS-funded support and alignment networks will be organizations that generate evidence-based guidelines, promoting measurement, supporting efforts to reduce unnecessary testing and procedures, and "effectively incorporating safety and patient and family engagement," according to CMS.

    CMS encourages applicants to submit a letter of intent by November 20, with completed applications due by January 6, 2015. The awards are scheduled to be announced in spring or summer of 2015.

    APTA Shares Summary of Proposed HHS Rule on Kickbacks, Remuneration

    The US Department of Health and Human Services Office of Inspector General (OIG) has issued a proposed rule (pdf) on civil monetary penalties and exceptions to the anti-kickback statute, and APTA is helping members understand how the changes could affect physical therapists (PTs).

    APTA posted a summary of the proposed rule (under the "Patient Protection" header) from OIG. Many of the proposals deal with carving out new "safe harbors" for the anti-kickback statute, and refining—and in some cases, loosening—rules around what activities would be considered illegal remuneration. Some of the proposed changes codify existing statutory provisions of the Affordable Care Act (ACA).

    Of particular importance to PTs, according to the APTA summary, are the "safe harbor" proposals, which would permit some forms of free or discounted patient transportation services. Also of note: a proposal to define what is meant by ACA-mandated remuneration exceptions allowing activities that "promote access to care" and have a "low risk of harm."

    Comments on the proposed rule are due on December 2. APTA will provide comments to the proposals, and will post those comments in the coming weeks.

    CSM Early-Bird Discounts Ending Soon

    Early-bird registration for the 2015 APTA Combined Sections Meeting (CSM) in Indianapolis is heading for the final turn. Are you ahead of the pack?

    November 5 is the deadline for saving on registration fees for CSM, set for February 4–7, 2015. Registering now will ensure you're on track for a 1-of-a-kind event that will feature 300 forward-thinking sessions, multiple social events, and a host of lectures, platforms, and poster presentations.

    Start your planning engine: grab an early-bird discount before November 5, take advantage of special rates on housing and travel, then explore the programming coming your way.

    Stock Up on Mythbusting Ideas, Resources

    Think of it as a 1-stop shop for all your debunking needs: APTA's National Physical Therapy Month webpage at www.apta.org/NPTM/MediaCampaign has just about everything you'll need to help knock down "7 Myths About Physical Therapy."

    The page contains ideas for educating patients and clients, infographics, and downloadable artwork that you can use to help spread the truth about how physical therapy can transform society. You can also do double debunking by referring patients and community members to www.MoveForwardPT.com for consumer-oriented information on the myths.

    Think you have another myth about physical therapy that needs a good busting? E-mail it to APTA!

    'Top 15' Clinical Trials in Physical Therapy Released by PEDro

    The "top 15" physical therapy clinical trials include 5 trials related to low back pain, and 1 trial on Bell palsy that dates back to 1958, according to a list based on nominations from physical therapists (PTs) around the world. The list is the focus of the October 22 PTNow blog.

    The list was developed by the Physiotherapy Evidence Database (PEDro), an Australia-based project and collaborative partner with PTNow, in celebration of its 15th anniversary. PEDro solicited nominations from PTs for the clinical trials that had the most impact on the field of physical therapy, then turned over those nominations to an expert panel for final selection.

    Among other trials that made the list: a 2009 trial on early physical therapy in mechanically ventilated, critically ill patients, a comparison of approaches to tennis elbow from 2006, and results of a trial published in 1999 that looked at management of genuine stress incontinence in women.

    For a complete linked list of the trials, check out the PTNow blog—then let PTNow know what you think of the list.

    US Ranks Near Bottom in Level of Trust in Medical Profession; Near Top in Personal Satisfaction With Treatment

    It's accepted wisdom that 21st century Americans generally mistrust Congress but feel good about their own representatives. Apparently, the same seemingly paradoxical views are true for the medical profession, and in a big way—the US ranks near the bottom among 29 countries in level of trust in the overall medical system, and near the top in satisfaction with individual care.

    A study published in the October 23 issue of the New England Journal of Medicine (summary available for free) reports on polling data that show a dramatic drop in Americans' confidence in the medical profession between 1966 and 2014. The decline is significant: in 1966, nearly 3 quarters (73%) of Americans expressed "great confidence in the leaders of the medical profession," but that rate is now 34%.

    Americans' lukewarm level of confidence in the medical profession in general puts the US near the bottom of 29 countries surveyed from 2011 to 2013, tied for 24th place with Croatia in terms of the percentage of respondents who agreed with the statement, "All things considered, doctors [in your country] can be trusted." A total of 58% of Americans agreed, putting the US behind countries such as the Philippines (#17), Turkey (#5), and Portugal (#16). Switzerland ranked highest in this category, with an 83% rate of agreement. Only Chile, Bulgaria, Russia, and Poland scored lower than the US.

    But in a shift that authors describe as "unique among the surveyed countries," Americans tend to rate their satisfaction with their own medical treatment higher than all but 2 other countries, with 56% of American respondents reporting that they were "completely" or "very" satisfied with their last visit to a physician. Switzerland had the highest rate (64%), followed by Denmark (61%). Lithuania (13% rate) and Russia (11% rate) were at the bottom of the list. Authors note that the rate of institutional trust and personal satisfaction tends to be similar in nearly all countries, and that the US is an "outlier."

    Authors of the study write that the lack of trust in the medical institution puts doctors at risk of losing political clout as the future of US health care is shaped.

    "If the medical profession and its leaders cannot raise the level of public trust," they write, "they're likely to find that many policy decisions affecting patient care will be made by others, without consideration of their perspective."

    Authors suggest that public trust could be improved "if the medical profession and its leaders deliberately take visible stands favoring policies that would improve the nation's health and health care, even if doing so might be disadvantageous to some physicians."

    Other findings in the study related to Americans' perceptions:

    • Mistrust of the medical profession is lower among low-income families (47% rate of trust) compared with families not considered low-income (63% rate of trust); however, individual satisfaction was relatively stable across the groups.
    • Americans 65 and over were more likely to agree that doctors can be trusted (69%) compared with those under 65 (55%).
    • Men tended to express more trust than women (63% vs 54%).

    New DOT Initiative Aimed at Reducing Pedestrian, Bicycle Fatalities

    Americans' steadily increasing rate of walking and biking is definitely good news—but that healthy shift needs to be accompanied by more attention to safety, according to a new initiative from the US Department of Transportation (DOT).

    This fall, the DOT launched "Safer People, Safer Streets (.pdf)," an effort to curb a recent uptick in the rate of fatalities among bicyclists and pedestrians, which accounted for 16% of all traffic-related fatalities in 2012.

    The initiative will begin with a survey of pedestrian and bicyclists "gaps" across the country—places where safety is compromised by lack of sidewalks or other safety infrastructure. With gaps identified, DOT and its agencies will work with state, local, and private industry partners to help create so-called "road diets" that are more attentive to safe space allocation for pedestrians and bicyclists.

    The initiative will also include public education campaigns on safety, according to DOT.

    Encouraging healthy, active lifestyles is central to the physical therapy profession's ability to transform society. Keep up with the latest resources at APTA's Prevention, Wellness, and Disease Management webpage.

    Cell Transplant Procedure Repairs Severed Spinal Cord

    A Bulgarian man whose spinal cord was completely severed has regained limited mobility and feeling in his lower extremities after a surgical procedure that used nerve-supporting cells taken from his nose. Once completely paralyzed in both legs, he can now walk with a walker and drive a car.

    According to an article in the Guardian, Darek Fidyka is believed to be the first person to recover from a complete severing of the spinal cord, an injury he sustained in a knife attack in 2010.

    Polish surgeons accomplished the recovery by transplanting olfactory ensheathing cells (OECs) from Fidyka's nose into the severed ends of his spinal cord. The cells connected and allowed nerve impulses to once again travel through the entire spinal cord. The technique was developed by the University College of London's Institute of Neurology.

    Although Fidyka's recovery is not complete, 1 of the authors of a study on the procedure published in Cell Transplantationdescribed the technique as one that "opened the door to a treatment of spinal cord injury which will get patients out of wheelchairs," according to an article in the Washington Post.

    Ebola News: CDC Tightens Ebola Guidelines, Victim's Family Released From Quarantine

    In the wake of 2 Dallas nurses contracting Ebola from the first person to die of the disease in the US, the US Centers for Disease Control and Prevention (CDC) has issued "tightened" guidance for health care workers interacting with infected patients. The announcement was one of several Ebola-related developments occurring recently.

    The new guidelines focus on better training, more extensive personal protective equipment (PPE), and more rigorous monitoring of donning and doffing. The enhanced recommendations are informed by practices at Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center—facilities that have had success in handling patients with the disease. The CDC reports that the guidelines are similar to those developed by Doctors Without Borders.

    A story in Modern Healthcare (free access with one-time registration) quotes CDC Director Thomas Frieden as describing Ebola care as "hard," saying that "the way care is given in this country is riskier than in Africa. There's more hands-on nursing care, and there are more high-risk procedures."

    CDC is recommending all of the same PPE included in the August 1, 2014, guidance, with the addition of coveralls, disposable hoods, and full-face shields instead of goggles. Also recommended:

    • Double gloves
    • Boot covers that are waterproof and go to at least mid-calf
    • Single-use fluid resistant or impermeable gown
    • Respirators, including either N95 respirators or powered air purifying respirators
    • Aprons that are waterproof and cover the torso to the level of the mid-calf used if Ebola patients have vomiting or diarrhea

    The CDC warns, however, that "focusing only on PPE gives a false sense of security of safe care and worker safety," and urges extensive training and practice, as well as a careful monitoring process as health care workers put on and take off PPE.

    Other recent Ebola-related developments:

    • Family members and the fiancée of Thomas Eric Duncan, the first person to die from Ebola in the US, were among the 43 people released from quarantine this week after they passed the suspected Ebola incubation period without coming down with the disease.
    • The Spanish nurse infected with Ebola is now free from the virus, as is the NBC News photographer who was treated in Nebraska.
    • Nina Pham, the Dallas nurse who contracted Ebola from Duncan, has been upgraded from "fair" to "good" condition. Pham is now at the National Institutes of Health. Amber Vinson, the second nurse to become infected, is being treated at Emory University in Atlanta.
    • The World Health Organization announced that 2 Ebola vaccines will be tested in West Africa as early as January 2015, and at least 3 others will be tested in healthy volunteers outside that region.
    • President Barack Obama appointed Ron Klain, former aide to Vice President Joe Biden, as the US Ebola czar.
    • The US is now requiring all travelers from Liberia, Sierra Leone, and Guinea to enter the US through 1 of 5 designated airports and undergo special screenings.

    Accreditation Committee Members Sought

    The American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) is seeking members with diverse clinical expertise to serve on the Accreditation Services Committee, a group of trained experts who review applications and visit physical therapist education program sites undergoing accreditation.

    Members interested in being considered to serve on the committee should complete the application on the ABPTRFE website by November 30, 2014. The Accreditation Services Council will make appointments in December 2014. Notification about appointments will be sent in January 2015.

    Appointed members must be available for training at APTA headquarters in Alexandria, Virginia, on March 2, 2015. APTA will reimburse all travel expenses for this meeting.

    Stanley Paris Ready for Second Round-the-World Attempt

    Sure, if you're reading this you probably get to put "PT" or "PTA" after your name. And maybe you can even add "DPT" or "PhD." But—and be honest here—can you tack on the word "adventurer" after those designations?

    Stanley Paris can. And he's getting ready to kick that particular part of his qualifications into high gear.

    Stanley Paris, PT, PhD, adventurer, has announced that he will make another attempt to set the age and speed record for solo circumnavigation of the globe by sailboat as a way to raise awareness for the Foundation for Physical Therapy (Foundation) and physical therapy research in general. The adventure is set to begin in early November in St Augustine, Florida. Last year's attempt raised more than $250,000 for the Foundation.

    Paris made his first attempt to break the age record of 56 years and the speed record of 150 days in early December 2013, but he suffered equipment failure that prevented him from completing the voyage. Since that time, both records have been broken, with the speed record now set at 137 days, and the age record now 70. If he's successful, Paris will beat the new age record by 7 years.

    "I am looking forward to taking on this challenge once again and using this opportunity to raise awareness for the Foundation," said Paris in a Foundation news release (pdf). "We need more research that demonstrates the value of physical therapy, and the Foundation is doing just that."

    Foundation Board of Trustees President William G. Boissonnault, PT, DPT, DHSc, praised Paris's commitment and generosity and said that his efforts are "important in the Foundation's determination to support research that helps physical therapists improve the quality of life."

    Paris will once again sail in his 63-foot yacht, the Kiwi Spirit, a craft that will run solely on wind and solar energy. If successful, Paris will also become the first person to circumnavigate in a completely "green" way—or at least the first person to do so in a really, really long time.

    2014 - 10-21 Stanley Paris 2nd Attempt

    Paris will document his journey, post videos, and provide other information on his Facebook page, www.facebook.com/uofstaugsolo. Visit the Foundation's website to find out how to contribute to physical therapy research.

    Healthy People 2020 Seeking Comment

    Healthy People 2020, a US Department of Health and Human Services initiative that establishes goals for improving the health of all Americans, is being updated and needs your input.

    The program, which provides a set of 10-year national objectives, has issued proposed new objectives in the areas of arthritis, osteoporosis, and chronic back conditions; early and middle childhood; heart disease and stroke; maternal, infant, and child health; and tobacco use. The objectives include issues around hypertension, chronic pain, and attention deficit-hyperactivity disorder. Participants may review and comment on the proposed objectives.

    APTA is a member of the Healthy People Consortium, and will gather comments from member experts to develop a formal response from the association.

    Plan on submitting individual comments? Be sure to identify yourself as a PT sharing your own perspectives to avoid confusion with the official APTA response.

    Grant Opportunities for Training in Work With Children With Disabilities Announced

    The US Office of Special Education and Rehabilitative Services (OSERS) has announced funding opportunities for nonprofits and institutes of higher learning that train individuals to work with children with disabilities, and physical therapy is among the training areas that could qualify for the awards. An estimated 26 awards averaging $237,500 will be made.

    The funding is intended to help address state-identified needs for personnel preparation in special education, early intervention, related services, and regular education to work with children with disabilities. Special attention is being focused on ways to ensure that personnel have the necessary skills and knowledge using scientifically based research and experience.

    Some of the "Personnel Development to Improve Services and Results for Children with Disabilities—Personnel Preparation in Special Education, Early Intervention, and Related Services" grants will be awarded to projects associated with preexisting education programs in special education, early intervention, or a related field; however, grants may also be awarded to projects associated with various assistant programs—among them physical therapist assistant programs. Primary focus areas include projects that prepare related services personnel, such as physical therapists (PTs), to serve children, infants, and toddlers with disabilities. OSERS intends to fund 8 awards under this focus area.

    Other award areas include projects related to preparation for professions in "related" services that include physical therapy.

    For details, requirements, and application instructions, refer to the program posting on the Federal Register (pdf).

    Medicaid Programs in Period of 'Significant Change,' Expansion in Most States

    "Transformative" changes mandated by the Affordable Care Act (ACA) and a slowly recovering economy have contributed to a Medicaid system in which most states are expanding eligibility, adopting delivery system reforms, and increasing community and home-based services, according to a new study from Kaiser Commission on Medicaid and the Uninsured.

    The Kaiser report surveyed Medicaid directors in all 50 states and the District of Columbia to gather information on program changes implemented in the 2014 fiscal year or planned for the next year. Authors of the study write that these years "will stand out as a time of significant change and transformation." Among the findings:

    • As of September 2014, 28 states have moved ahead with Medicaid expansion provided under the ACA; 4 states reported eligibility restrictions.
    • Alaska, Connecticut, and Wyoming are the only states that did not report using some form of managed care, including managed care organizations (MCOs), primary care case management, or a combination.
    • Implementation or expansion of Medicaid health homes was reported by 26 states.
    • States continued to expand the number of individuals served in home- and community-based services, with 47 states reporting growth in this area in FY 2015.

    While the Kaiser report shows more variation in how states are adjusting provider rates, authors note that generally "more states implemented provider rate increases across most major provider types … inpatient hospital rates being the exception."

    "States are expanding their reliance on managed care but also implementing new innovative delivery systems and care coordination arrangements, some of which are new options made available by the ACA," according to the authors. In turn, this expansion could be putting some programs to the test, with most directors "report[ing] staffing and resource constraints in the face of the magnitude of the changes occurring in the program today."

    Keep up with Medicaid as it continues to evolve: check out APTA's Medicaid webpage for resources, including a members-only guide titled "Making Sense of Health Care Reform: Medicaid Expansion."

    AMA Issues Top 10 Least, Most Competitive States for Insurance

    The American Medical Association's (AMA) latest ratings of health insurance competitiveness across the United States finds that in 17 states, a single health insurer commands 50% or more of the market in each state, and that in 45 states 2 insurers have captured over half or more of each state’s share.

    The AMA's Competition in Health Insurance: A Comprehensive Study of US Markets (summary available for free) uses commercial enrollment data from 2012 to create lists of the country's most and least competitive states for insurance companies, and to assess competitiveness in 388 metropolitan areas.

    The 10 least-competitive states are, in order, Alabama, Hawaii, Michigan, Delaware, Louisiana, South Carolina, Alaska, Illinois, Nebraska, and North Dakota. States that have the most competitive markets are, in order, Oregon, Wisconsin, Pennsylvania, New York, Colorado, Missouri, Washington, Ohio, California, and Florida.

    The AMA analysis of metropolitan areas found a "significant absence" of competition in 72% of the areas studied, and identified a single insurer as capturing 50% or more of the market share in 41% of the areas.

    Overall, Wellpoint Inc was found to be the largest insurer in most markets, with a "commanding position" in more than 20% of metropolitan areas—more than double the number of the next 2 largest insurers, Health Care Services Corporation and UnitedHealth Group.

    Carmen Elliott, senior director of payment and practice management at APTA, thinks the shrinking competitiveness contributes to a larger picture of insurers looking to reduce costs and control utilization.

    "The lack of competition is a reality," she said. "At the same time, insurers are trying to keep costs down by doing things like narrowing the network of providers covered by the system, increasing copays and deductibles, and implementing utilization management programs. The insurers argue that some of these efforts, like the shift of a greater payment burden to patients, will make consumers more accountable around health care costs and lifestyle choices, but the real challenge is to reduce costs while ensuring high-quality care. That can be a difficult balance."

    Keep up with the insurance industry as it continues to evolve. Check out the APTA Private Insurance webpage to find resources including toolkits, videos, podcasts and FAQs on topics ranging from payment methodologies to patient and client advocacy.

    'Severe' Restriction on Compression Devices on Indefinite Hold

    A planned change to Medicare coverage of pneumatic compression devices (PCDs) that would have severely restricted patient access to the devices at home has been put on indefinite hold, thanks in part to the efforts of an alliance that includes APTA.

    Had it been implemented, the final local coverage determination (LCD) would have imposed restrictions for PCDs that would only allow their use after a 6-month period of "chronic and severe" lymphedema, and would have attached other requirements including the presence of lymphedema into the trunk or chest, the use of manual lymphatic drainage prior to PCDs, and the use of medications. Additionally, the new policy would have denied PCDs to patients who experience any kind of improvement through conservative therapy. The requirements were set to become effective on November 1.

    In an October 13 statement to the Medicare Durable Equipment Medicare Administrative Contractors (DME MACs) responsible for the change, the Alliance of Wound Care Stakeholders wrote that "many of the new requirements have no basis in either published medical literature or professional standards of practice," and that the proposed LCD "virtually eliminates access to medically necessary equipment for a significant portion of Medicare beneficiaries" who need the devices for treatment of lymphedema and venous ulcers. APTA is a member of the alliance.

    The alliance also asserted that the final policy released in October was "significantly different" from the draft policy released in 2011, and that no additional public comment period was provided.

    On October 16, the DME MACs announced that the change would be placed on indefinite hold. The brief announcement stated only that "Additional clinical information published since the release of the draft policy is being reviewed."

    "This is a significant victory for beneficiaries who need PCDs and the physical therapists who are providing treatment," said Gillian Leene, JD, senior regulatory affairs specialist at APTA. "In the end, the alliance was able to halt a policy that not only lacked support in medical literature, but also would have been damaging to patients and severely restricted access to an effective home treatment option for this progressive and chronic condition.”  


    Get Graphic About Physical Therapy Myths

    Help promote National Physical Therapy Month, spruce up your social media posts with snazzy graphics, and bust a few myths while you're at it—all with a few clicks.

    As part of its "7 Myths About Physical Therapy" campaign, APTA is offering free online ad graphics that you can copy and share on social media channels. It's a fun and cool way to get the word out that physical therapy can change lives in ways that might surprise some people.

    Get your graphics today, and let the mythbusting begin.

    Myths - 300x250 - Perform PT

    Midterms and Beyond: Find Out What Could Happen on Capitol Hill

    A recent APTA Google+ Roundtable now available on YouTube makes one point very clear: while there's plenty of media attention on which party will control the US Senate after the coming midterm elections, that's just 1 of several moving parts in Congress that could impact how the physical therapy profession's legislative priorities are addressed on Capitol Hill.

    In a 35-minute video session that covered everything from Senate races to the politics of lame duck sessions, APTA Director of Grassroots and Political Affairs Michael Matlack answered questions about the current political landscape in Washington, and how APTA and its members can continue to influence legislation on issues such as the therapy cap, locum tenens, and direct access.

    In addition to insight on politics and the legislative process, the session also provides viewers with an overview of how APTA relies on its members to identify important issues in the profession, and how those issues take root as advocacy through grassroots efforts and the work of PT-PAC, the profession's political action committee.

    Want to keep up with where your members of Congress stand on the issues important to the physical therapy profession? Download the free APTA Action App for the latest information and easy ways to make your voice heard. Search "APTA Action" in your Apple or Google Play app store to download the app.

    More Information, Opportunities Available for International PT Congress

    Time marches on—and so do the preparations for the 2015 World Confederation for Physical Therapy (WCPT) Congress. The world's largest international physical therapy gathering is set for May 1-4 in Singapore, and the following activities and resources are already available:

    • The WCPT International Scientific Committee is now recruiting potential chairs for abstract presentation sessions at Congress 2015. Interested individuals must submit a completed questionnaire by November 30th.
    • The preliminary program for Congress 2015 is posted.
    • An art and health competition has been launched, and work of the finalists will be displayed in a special art and health exhibition in Singapore.
    • Singapore Airlines has been designated as the official airline partner of Congress 2015. Congress attendees can get preferential rates through online booking. For more details and other options visit the congress travel page.

    Registration for the event is now open for the Congress, to be held at the Suntec Singapore Convention and Exhibition Centre. APTA is a member of WCPT. For more information, contact Rene Malone.

    New Urinary Prosthesis Could be Alternative to Catheterization for Some Women

    The US Food and Drug Administration (FDA) has approved a replaceable urinary prosthesis that could free women with impaired detrusor contractility (IDC) from the mobility problems associated with catheters.

    The inFlow Intraurethral Valve-Pump is a replaceable device consisting of a sterilized single-use urethral insert, an introducer, an activator, and a sizing shaft. According to a news release from the FDA, the device "draws urine out to empty the bladder and blocks urine flow when continence is desired."

    Patients with IDC are unable to spontaneously urinate, a condition that can result from stroke, spinal cord injury, diabetic neuropathy, or other neurologic disease or injury. Typically patients with IDC must use some type of catheter, and are unable to experience continence.

    The FDA reported that in testing, more than half of the 273 women who used the new device stopped using it because of leakage or discomfort. Or those who continued to use the device, 98% had post-void urine volume similar to those recorded with clean intermittent catheterization (CIC). The FDA reported that though urinary tract infection was the most significant adverse event associated with the new device, rates of infection were lower than those associated with CIC.

    After initial sizing and training by a physician, insertion and removal of the device can be performed by the patient or caregiver. Inserted components must be replaced every 29 days.

    "The inFlow device allows women with IDC to urinate, without the need to catheterize daily or be attached to a urine drainage bag," said William Maisel, deputy director for science and chief scientist in the FDA's Center for Devices and Radiological Health. "This may allow for increased mobility and the ability to be more self-sufficient."

    APTA has provided guidance to the federal Agency for Healthcare Research and Quality (.pdf) in its research efforts around urinary incontinence, and the association offers several resources to members and the public, including the APTA Section on Women's Health and the PT's Guide to Incontinence. PTs looking for evidence-based research on UI treatment can find resources at PTNow.

    Exercise Regimen Significantly Decreases Disability in Individuals With RA of the Hand

    Tailored hand exercise used as an adjunct to drug regimens can make a significant, cost-effective difference in function and quality of life for individuals with rheumatoid arthritis (RA) of the hand, according to a new randomized controlled trial from the United Kingdom (UK).

    In the Strengthening and Stretching for Rheumatoid Arthritis of the Hand study (SARAH), 438 participants representing "the population of people with rheumatoid arthritis in the UK in terms of age and sex" were divided into 2 groups, 1 receiving usual care and the other receiving usual care plus special strengthening and stretching exercises overseen by a physiotherapist or occupational therapist. More than 90% of participants in both groups had been placed on a stable regimen of disease modifying drugs (DMARDs) for at least 3 months before the study, and all continued to take the drugs.

    Results of the study were e-published ahead of print in the October 10 issue of The Lancet. Currently only the study's abstract is available for free; however, APTA members will have access to the full article in 2 months via PTNow ArticleSearch. More detailed data on the trial have been posted online.

    Researchers administered the Michigan Hand Outcome Questionnaire (MHQ) at 4 and 12 months after a 20-day baseline to both groups, and found that the exercise group's reported level of improvement was "more than double" the usual care group's ratings. The usual-care group's ratings on the 1-100 MHQ scale averaged 3.56 after 12 months, compared with the exercise group's 7.93 average.

    Other indicators were equally significant. "Changes in secondary outcomes mirrored these trends," authors write, "with significant differences in … activities of daily living, work, and satisfaction subscales, MHQ summed score, and self-efficacy." Global ratings of change in the exercise group improved for 45% of the participants, compared with 21% reporting improved ratings in the usual-care group.

    The 12-week exercise program included 7 mobility exercises and 4 strength training or endurance exercises using bands, balls, or putty, and was tailored to the individual after assessment for baseline strength, pain, and flexibility. Physiotherapists or occupational therapists conducted 6 sessions with each participant, and participants were instructed to perform the exercises daily.

    The mean cost per participant for the exercise therapy was approximately $165 higher than usual care; however, authors noted that "the costs of the intervention were small compared with the annual cost of providing drug regimens." Authors speculate that they may have actually underestimated cost-effectiveness "because the analysis was limited to a time horizon of 1 year."

    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.

    Want More Research Discussion? Join the Club

    The PTNow blog's recommendation for learning more about putting evidence into practice: spend some time in a club.

    A journal club, that is. The most recent PTNow blog post features "9 Hot Tips for Running a Successful Journal Club" that can help you get started creating a lively, engaging forum for discussion of the latest in physical therapy research.

    Tips range from the practical to the aspirational, and include insight from physical therapists who have created successful clubs. Check out the tips and join the conversation by sharing your own experiences.

    Then go clubbing.

    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.

    New System Delivers Sense of Touch From Prosthetic Hand

    A new development in prosthetic hands is not only restoring a sense of touch to individuals with amputations, but seems to be making a significant impact in reducing phantom limb pain.

    Researchers from Case Western Reserve University and the Louis Stokes Cleveland Veterans Affairs Medical Center have found a way to attach sensors to mechanized prosthetic hands that feed touch sensations to nerve bundles in the patient's arm. The connection allows users to actually feel sensations of pressure and texture—video of the system shows a user picking up and holding a cherry delicately enough between finger and thumb to pluck off its stem without crushing the fruit. Another photo shows a user squeezing toothpaste out of a tube.

    The process involves wrapping nerve bundles in cuffs that contain contact points. These points are related to specific sensors in areas of the prosthetic hand, and are able to deliver sensations that users recognize as touch. So far, 2 subjects have been involved in the development of the technology over the past 2 years, with 1 subject able to experience touch sensation in 16 points on the prosthetic hand, and the other able to perceive touch across 19 points.

    The new technology has an additional benefit: the test users reported that the prostheses equipped with touch sensation nearly eliminated phantom limb pain. Researchers are unsure why the pain has been reduced.

    The system is classified as an investigational device, but researchers hope to develop a take-home version in the next few months, and a fully operational model ready for wider implementation in 5 to 10 years.

    A report on the research appears in the October 8 issue of Science Translational Medicine (abstract only available for free), accompanied by a video interview with one of the study's authors that includes footage of the new system. News of the report surfaced on media outlets including NBC News and US News and World Report.

    WCPT Congress Abstract Submissions Due October 31

    October 31 is the deadline for submitting proposals for presentations at the World Confederation for Physical Therapy (WCPT) Congress being held May 2015 in Singapore.

    Submission details can be found on WCPT's call for abstracts webpage. In addition, the confederation offers a mentoring program for anyone with little or no experience in submitting an abstract for a scientific congress.

    The Congress, set for May 1–4 at the Suntec Singapore Convention and Exhibition Centre, is the world's largest international physical therapy gathering. Registration for the event is now open.

    APTA is a member of WCPT. For more information, contact Rene Malone.

    APTA, Other Organizations Focus on Future of Home Health Care at IOM/NRC Workshop

    The future of home health care—and the role of physical therapy in that future—was the subject of a recent Institute on Medicine (IOM) and National Research Council (NRC) workshop sponsored by APTA and 8 other professional, home health, and advocacy groups.

    The workshop, held September 30 through October 1, brought together leaders in health care, academia, and the federal government to talk about the present and future of home health care, with particular emphasis on how data can inform and improve outcomes. Other sponsoring partners included the Alliance for Home Health Quality and Innovation, the American Nurses Association, the American Academy of Home Care Medicine, Home Instead Senior Care, the National Alliance for Caregiving, the Community Health Accreditation Program, Unity Point at Home, and Axxess.

    Cindy Krafft, PT, COS-C, president of APTA's Home Health Section, participated in the workshop and along with staff stressed how patient function will play a key role in evaluating outcomes. Other areas of discussion from APTA included the value of physical therapists (PTs) in a collaborative care team, and the ways PTs can contribute to transitions throughout the care continuum.

    The workshop touched on issues that affect the entire home health system, including how best to encourage innovation, the role of social support in home health care, how to bring down silos in postacute care settings, opportunities to promote individualized care through customized technologies, and the creation of a standard definition that combines skilled, unskilled, and caregiver services.

    The Alliance for Home Health Quality and Innovation will hold a workshop follow-up symposium on January 13 in Washington, DC. IOM provided a live webcast of the workshop and will post a recording of the event in the coming weeks.

    Self-Reported Quality of Life Among Adolescents With Cerebral Palsy Similar to Peers Without Disability

    In what authors describe as "some of the most reliable evidence on how adolescents with cerebral palsy feel about life," a new study from Europe reports that in general, self-reported quality of life (QoL) among this population isn't that much different from their peers without disability, but could be even better with greater attention paid to pain early on.

    Researchers gathered responses to a survey (KIDSCREEN) issued to the same group of 355 individuals with cerebral palsy at 2 different points in their lives—as children aged 8 to 12 (average respondent age 10.4) and then later as adolescents aged 13 to 17 (average respondent age 15.1). The study compared the responses against results from adolescents without a disability and longitudinally within the respondents with cerebral palsy. An article describing the results was e-published ahead of print in the October 7 issue of The Lancet.

    "Our results are encouraging," authors write, stating that among the 10 QoL domains studied (physical wellbeing, psychological wellbeing, moods and emotions, self-perception, autonomy, relationships with peers, social support and peers, school life, finances, and social acceptance), adolescents with cerebral palsy were on a par with their peers without disabilities on 9 domains, with only "social support and peers" scoring lower for the group with cerebral palsy.

    "Individual and societal attitudes should be affected by the similarity [of scores] in children with cerebral palsy and the general population," authors write. "Only the quality of peer relationships is on average lower … and therefore such adolescents need particular help to maintain and develop peer relationships."

    When authors looked at the respondents with cerebral palsy from a longitudinal perspective, they found some correlation between psychological difficulties and parenting stress in childhood to lower QoL reporting in adolescence, and an even stronger connection between pain and the lower scores. "In the models combining the postulated predictors of [quality of life], pain, especially in adolescence, remained a significant predictor of QoL in all domains apart from autonomy, social support and peers, and financial resources," they write.

    "Although the rights of people with disabilities to participate in society are recognized and being implemented in many countries, adolescents with disabilities might still be regarded as having unhappy, unfulfilled lives," authors write. "Findings from qualitative studies, which challenge such a view, are now supported by our large epidemiological study. For children with below average QoL, early interventions to ameliorate high levels of psychological problems, parenting stress, and especially child pain, will probably have long-term benefits across many domains of the young person's life."

    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.

    Hospital Rates, Lengths of Stay Drop; Costs Continue 'Steady' 1.8% Rise

    "Greater use of chronic disease management programs and emphasis on outpatient treatment" may be part of the explanation for an overall decrease in inpatient hospital stays from 2003 to 2012, according to a recent report that analyzed community hospital use over a 10-year period (pdf).

    According to the study, hospitalization rates dropped by an average of .3% per year from 2003 to 2008, and an average of 1.8% per year from 2008 to 2012.

    The report, issued by the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, looked at rates, length, costs, and demographic variables related to hospitalization, and found that in addition to dropping rates, length of hospitalization also decreased by an average of .2% per year between 2003 and 2012.

    Other findings in the report:

    • Mean inflation-adjusted hospital costs grew at a "relatively steady" rate of 1.8% during the 10-year study period. Aggregate rates grew at an average 2.4% per year between 2003 and 2008, then slowed to a .7% growth rate after that.
    • The rate of hospitalization decreased from 128 stays per 1,000 population in 2003 to 116 stays per 1,000 population in 2012. The decrease was noted across all age groups but occurred at the highest rate for individuals 65 and over, a group that saw an average drop of 4% annually from 2008 to 2012.
    • The percentage of stays paid by Medicare increased from 37.1% in 2003 to 39.1% in 2012, while the percentage of stays paid by private insurers dropped, from 36.6% in 2003 to 30.6% in 2012.

    In looking at statistics related only to 2012 stays, the HCUP study reported 36.5 million stays during the year, with an average length of stay of 4.5 days, and cost of $10,000. As in previous years, most stays (56%) were medical, with 21.8% being surgical and 22.2% maternal/neonatal. Females had higher hospitalization rates than males during the year, but males averaged longer stays and higher costs.

    Nursing Homes, Home Health Agencies to Face Expanded Reporting, Quality Requirements

    Greater oversight of the data submitted to Medicare's nursing home rating service and a proposed rule that would apply more scrutiny to home health care agencies are among the changes announced this week by the White House and the Centers for Medicare and Medicaid Services (CMS). The announcements accompanied President Barack Obama's signing of the Improving Medicare Post Acute Care Transformation Act (IMPACT) earlier this week.

    On October 6, the White House announced that additional reporting and inspection requirements would be added to Nursing Home Compare, the five-star quality rating system for the nearly 16,000 nursing homes that participate in Medicare and Medicaid. Most of the changes are focused on greater CMS oversight of data related to staffing levels and quality measures, many of which are currently self-reported.

    The new system set to begin in 2015 will include a quarterly electronic reporting system on staffing that can be checked against payrolls for verification to monitor staff turnover and retention, types of staffing, and levels of staffing among those types. Overall ratings will be more closely tied to data verified by sources outside the nursing home itself.

    In addition, the ratings systems will expand the range of quality measurers used in Nursing Home Compare, beginning in 2015 with data on the extent to which antipsychotic medications are used in a facility, and expand to other areas including rehospitalization and return-to-home rates.

    At the same time the White House announced its actions on nursing homes, CMS released a proposed rule on home health agencies (pdf). That rule would require agencies who participate in Medicare and Medicaid to provide clear explanations of patient rights, expand patient assessments, and establish systems for improved coordination of care among providers, among other changes. The rule would also expand patient care coordination by requiring a licensed clinician responsible for all patient care services. CMS expects to have a final rule in place in 2015.

    APTA will continue to monitor these changes and proposals, and will provide comments on the home health rules proposals as well as keep members informed on progress and implementation.

    IMPACT Act Standardizing Postacute Care Data Signed Into Law

    Legislation that would standardize data used across postacute care (PAC) settings has been signed into law and will join a larger package of reforms. APTA worked to influence this legislation.

    The Improving Medicare Post-Acute Care Transformation (IMPACT) Act signed by President Barack Obama on Monday directs the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for PAC providers including home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs).

    The House and Senate passed the legislation in September.

    APTA and other supporters of the legislation believe standardization will allow HHS to compare quality across PAC settings, improve hospital and PAC discharge planning, and use this standardized data to reform PAC payments in the future.

    The new law will:

    • Require PAC providers to begin reporting standardized patient assessment data at times of admission and discharge by October 1, 2018, for SNFs, IRFs, and LTCHs and by January 1, 2019, for HHAs.
    • Require new quality measures on domains beginning October 1, 2016, through January 1, 2019, including functional status, skin integrity, medication reconciliation, incidence of major falls, and patient preference regarding treatment and discharge.
    • Require resource use measures by October 1, 2016, including Medicare spending per beneficiary, discharge to community, and hospitalization rates of potentially preventable readmissions.
    • Require the Secretary of HHS to provide confidential feedback reports to providers. The Secretary will make PAC performance available to the public in future years.
    • Require MedPAC and HHS to study alternative PAC payment models, with reports due to Congress in 2016 for MedPAC and 2021-2022 for HHS.
    • Require the Secretary to develop processes using data to assist providers and beneficiaries with discharge planning from inpatient or PAC settings.

    The Committees that introduced this legislation have provided a summary (pdf) that can be accessed on their website. In the coming months, details of the legislation will be developed through the implementation process. APTA will be engaged with regulators throughout this process and will continue to provide updates to APTA membership about the application of this law.

    Acupuncture No Better Than Sham for Chronic Knee Pain in Adults 50+

    Regardless of whether it's delivered traditionally or through a more high-tech laser version, acupuncture doesn't appear to have any benefit over sham procedures when it comes to reducing moderate-to-severe knee pain in adults 50 and over, according to a new study in the October 1 issue of the Journal of the American Medical Association (JAMA) (abstract only available for free).

    Researchers in Australia studied treatments of 282 patients who were 50 or older and had been experiencing moderate to severe knee pain on most days for a period of time longer than 3 months. The patients were divided into 4 groups: a needle acupuncture group, a laser acupuncture group, a sham laser acupuncture group, and a control group. Acupuncture treatments were conducted 1 to 2 times weekly for 12 weeks. Both acupuncturists and patients did not know if they were involved in the sham or actual laser treatment, but there was no sham treatment used in the needle-based acupuncture group.

    When the researchers compared self-reported knee pain and function at baseline, 12 weeks, and after 1 year, they found "no significant differences in primary outcomes between active and sham acupuncture at 12 weeks … or 1 year."

    "Although needle and laser acupuncture improved pain after treatment compared with control, improvements were not sustained at 1 year and were of clinically unimportant magnitude," authors write. "Improvement in … physical function with needle acupuncture relative to control at 12 weeks was of a clinically irrelevant magnitude and did not persist at 1 year. Furthermore, this improvement was not different from sham laser."

    "Among patients older than 50 years with moderate to severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function," they conclude. "Our findings do not support acupuncture for these patients."

    Although researchers acknowledged that the study size suffered due to the numbers of patients declining treatment during the course of the study (ranging from 13% o 19%), they argue that the design of the study—patients didn't know they would be participating in an acupuncture study until after recruited to reduce drawing participants with positive attitudes about the intervention—strengthens the findings.

    Still, they write, the findings "likely only apply to patients with clinically diagnosed osteoarthritis and moderate or severe pain … and may not be generalizable to end-stage radiographic disease."

    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.

    White House Summit, Forum Focus on Health and Fitness for Americans With Disabilities

    A White House summit and research forum on improving health and fitness for people with disabilities included presentations from 2 leaders in physical therapy, and brought more attention to a national disability inclusion program that the APTA Student Assembly helped to promote.

    The 2-day program began with a White House summit on Monday, October 6, followed by a series of presentations from researchers the next day. The event was aimed at shining a spotlight on the "I Can Do It, You Can Do It" (ICDI) program, which seeks to improve levels of inclusion in activity, nutrition, and obesity programs in education settings from K-12 to university levels.

    The APTA Student Assembly has spread the word about the ICDI program, and several physical therapy education programs have become ICDI "Advocates," promoting the program's message of inclusion and better education.

    The October 7 research forum focused on looking at research gains and gaps in improving the health and quality of life of children with disabilities. Speakers included Diane Damiano, PT, PhD, chief, Functional & Applied Biomechanics in Rehab Medicine at the National Institutes of Health, and Alan Jette, PT, PhD, FAPTA, director of the Health and Disability Research Institute at Boston University.

    The event was sponsored by the President's Council on Fitness, Sports, and Nutrition, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

    '7 Myths About Physical Therapy' Released – Now It's Debunking Time

    Q: Which of the following statements is true?

    "Physical therapy is painful."

    "Physical therapy is only for injuries and accidents."

    "Any health professional can perform physical therapy."

    A: None of them. In fact, they're among the "7 Myths About Physical Therapy" that need to be debunked.

    During National Physical Therapy Month (NPTM), APTA and its members will be engaging in a public education campaign to counter those myths with a good dose of reality. Joining the myths mentioned above are common misconceptions about referrals, insurance coverage, the need for surgery in all cases, and self-administered physical therapy.

    This campaign is supported by a national online advertising effort that will reach out to baby boomers, women over 50, people recovering from injury, those with a healthy and active lifestyle, and those experiencing joint and muscle pain. Ads will run on various websites, including Health.com, and will link to www.MoveForwardPT.com/NPTM, where visitors can find more information and a physical therapist in their area.

    Go to www.apta.org/NPTM for tools to help you plan and promote this campaign during your NPTM events. Available resources include web ads as well as a “myths" infographic, factsheet, and article. You’ll also find tips on how you can use these resources.

    When myths grow, care suffers. Take this opportunity to educate consumers by challenging fallacy with fact. Show them what you really do, and how physical therapy changes individual lives and transforms society.

    NYT: College Football Education, Reporting of Concussions 'Uneven'

    A recent article in the New York Times that pulls together 3 related studies on how—and if—college football players report concussions characterizes efforts to raise concussion awareness as "uneven."

    The October 3 article (and an in-print variation published on October 4) looks at studies that appeared recently in the Journal of Neurotrauma (abstract only available for free) and the Journal of Law, Medicine & Ethics (2 articles, abstracts here and here). Reporter Ken Belson writes that the studies, based on surveys of college players during 2012, "concluded that for every diagnosed concussion, players sustained 6 substantial hits that they suspected might have caused a concussion but did not report."

    According to the article, researchers found that among positions, offensive lineman were least likely to report a concussion, with a ratio of 1 report for every 8 possible concussions.

    Researchers used the same dataset to look at the effectiveness of efforts to educate players on the importance of reporting head injuries, and according to the NYT report found the results to be "inconsistent," with 40% of players reporting that they did not recall ever receiving information about reporting concussion symptoms.

    APTA has been active in its advocacy for research on brain injury, and was one of the organizations that supported the TBI Reauthorization Act recently approved in both houses of Congress. Additionally, the association is promoting the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf), and concussion management awareness was the focus of this year's student-led Flash Action Strategy, which resulted in the largest concussion-related grassroots effort in APTA history.

    Check out APTA's TBI webpage for resources that include continuing education courses and links to other interest groups.

    Laser Therapy a Slight Winner in Analysis of Electrotherapy Modalities for Adhesive Capsulitis

    It could be that low-level laser therapy (LLLT) is a useful electrotherapy modality for treatment of adhesive capsulitis, but the effects are marginal and evidence is a long way from conclusive, according to a new Cochrane review of randomized controlled and controlled clinical trials (abstract here). The study is part of a larger update of a Cochrane review on physical therapy interventions for shoulder pain.

    Researchers hoped to evaluate the effectiveness of a range of electrotherapy interventions in addition to LLLT, including pulsed electromagnetic field therapy, therapeutic ultrasound, interferential current, and transcutaneous electrical nerve stimulation, both in relation to placebos and other interventions and in relation to each other.

    What they found was that evidence was lacking in nearly all parameters, and nothing conclusive could be drawn from the 19-trial, 1,249-participant review they studied—with 1 possible exception.

    Although authors provided plenty of qualifications to their findings, they did acknowledge low- to moderate-quality support for the use of LLLT in a few ways: it may be slightly better than placebo "in terms of global treatment" at 6 days; and it may be "an effective adjunct" to exercise in reduction of pain up to 4 weeks, and increase in function up to 4 months.

    Authors were not able to render any conclusions beyond those related to LLLT, mostly because of design flaws in trials, all but one of which were downgraded to "low" or "very low" quality primarily because of unclear allocation concealment, lack of blinding, and small sample sizes. In fact, they write, even findings that pointed to possible benefits may change if and when better quality research is conducted. "Further high-quality trials may show even smaller effect estimates than those summarized in this review," they write.

    In the article, authors call for further high-quality research that compares various electrotherapy modalities, evaluates effectiveness versus placebo, and analyzes their use in combination with manual therapy and exercise. Authors also point out a need for studies that examine long-term effects of the modalities, citing the fact that most of the trials they studied "have only assessed outcomes during treatment or in the weeks following cessation."

    APTA members have access to the complete article through PTNow ArticleSearch.

    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.

    List of Hospitals Penalized for Readmissions Grows

    The US Centers for Medicare and Medicaid (CMS) has added about 400 hospitals to its list of facilities that will be penalized in 2015 for having what CMS feels are excessive numbers of patients returning to the hospital fewer than 30 days after being discharged. The revised list now includes 2,610 hospitals and covers readmissions for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, total hip replacements, and total knee replacements.

    According to an article in Modern Healthcare (free access with one-time registration) 39 of the most recently listed hospitals will face the maximum 3% reduction in Medicare reimbursements.

    The readmissions penalty program began in 2013 as part of a quality improvement effort in the Patient Protection and Affordable Care Act. According to the Modern Healthcare report, "policy experts are increasingly raising concerns that hospitals in poor communities are unfairly punished by the program after observing that safety net providers were more likely to receive penalties in the first 2 years of the program."

    A complete listing of all penalized hospitals is included in the Modern Healthcare article.

    APTA Board Honors State Advocates

    Physical therapist leaders from Oklahoma, Washington, Arizona, and Arkansas were honored for their successful efforts dedicated to state legislation that advances the physical therapy profession at last month's State Policy and Payment Forum in Seattle, Washington.

    The APTA Board of Directors awarded the 2014 State Legislative Leadership Award to Brandon Trachman, PT, MPT, OCS, of the Oklahoma Chapter for his work on legislation this year making Oklahoma the 49th direct access state; Robin Schoenfeld, PT, OMT, of the Washington Chapter for her work on legislation that removed a 25-year-old prohibition on PTs performing spinal manipulation; and Sean Flannagan, PT, DPT, Cert SMT, Cert DN of the Arizona Chapter for his work on legislation that added dry needling to that state's physical therapy practice act.

    In recognition of his long-term commitment to their chapters' state advocacy activities, the APTA Board of Directors awarded the 2014 State Legislative Commitment Award to Steve Forbush, PT, PhD, OCS, of the Arkansas Chapter.

    Be sure to check out the Storify with video highlights from this year’s APTA State Policy Forum. And don't miss next year's event scheduled for September 12-14, 2015, in Denver, Colorado.

    Preoperative Physical Therapy Results in 'Significant' Reduction in Postoperative Care Use for Patients Undergoing Hip or Knee Replacement

    A new study has found that as few as 1 to 2 sessions of preoperative physical therapy can reduce postoperative care use by 29% for patients undergoing total hip or knee replacement, adding up to health care cost savings of more than $1,000 per individual.

    Researchers in Ohio reviewed 4,733 Medicare cases involving total hip or knee replacement from a combination of 169 rural and urban hospitals with wide geographic distribution, and found that 79.7% percent of patients who did not receive preoperative physical therapy required postacute care services. That rate dropped to 54.2% for patients who received even a small number of physical therapy sessions before surgery. The study was e-published ahead of print in the Journal of Bone and Joint Surgery (abstract only available for free).

    After adjusting for demographic variables and comorbidities, the study's authors estimated a 29% reduction in postoperative care use among the preoperative physical therapy group, which translated into adjusted cost reductions of $1,215 "driven largely by reduced payments for skilled nursing facility and home health agency care."

    Patients with at least 1 billed encounter using CPT codes designating physical therapy evaluation or self-care/home management training were included in the preoperative group, providing they had received the service within 30 days of their surgeries.

    Researchers believe that the benefit of preoperative physical therapy was derived mostly from the way it prepared patients for postoperative rehabilitation. In most instances studied, they write, preoperative physical therapy was limited to 1 or 2 sessions, which "suggests that the value of preoperative physical therapy was primarily due to patient training on postoperative assistive walking devices, planning for recovery, and managing patient expectations, and not from multiple intensive training sessions to develop strength and range of motion."

    "Our study demonstrates a significant reduction in postacute care use associated with the use of physical therapy during the preoperative period for total joint replacement surgery," authors write, adding that in settings where replacement surgery has been recommended by an orthopedic surgeon, "physical therapy appears to provide value within the structure of a standardized preoperative joint replacement education and planning program in which physical therapists may play an important role."

    While researchers acknowledge that more work needs to be done to pinpoint the best way to balance resource allocation between pre- and postoperative activities, they cite the current study's findings as a good first step in refining new models of care.

    "As payments in health care move from a fee-for-service basis to more global payments that require some risk sharing by providers," authors write, "the ability to manage populations across the continuum to high-quality outcomes at low cost will be imperative."

    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 where you can find a clinical summary on total knee arthroplasty that includes information on perioperative care.

    State Policy and Payment Forum Delivers On-Target Advocacy Information

    This year's State Policy and Payment Forum in Seattle, Washington, once again informed and recharged physical therapists (PTs), physical therapist assistants, and physical therapy students from across the country to help them continue to advocate for the physical therapy profession at the state level.

    Cohosted by APTA and the Washington Chapter, the 2014 forum gave more than 200 attendees the opportunity to learn from influential public policy makers and other physical therapy advocates, collaborate with colleagues in developing and improving their components' state advocacy efforts, and network with other professionals. Topics included fair physical therapy copay legislation, a debate on the merits of “any willing provider” legislation, issues surrounding network adequacy, emerging scope of practice issues, PTs' ordering of x-rays and imaging studies, dry needling, state licensure issues, and more.

    The forum's luncheon keynote speaker was Mark McClellan, MD, PhD, a senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution. A former administrator of the Centers for Medicare and Medicaid Services and former commissioner of the US Food and Drug Administration, McClellan focuses his current work on promoting quality and value in patient-centered health care.

    Be sure to check out the Storify with video highlights from this year’s APTA State Policy Forum. And don't miss next year's event scheduled for September 12-14, 2015, in Denver, Colorado.

    October's Here! Welcome to National Physical Therapy Month

    Happy National Physical Therapy Month!

    During National Physical Therapy Month (NPTM), APTA will provide plenty of ways for you to participate in bringing attention to the profession, including a public education campaign to debunk 7 of the most common myths about physical therapy set to launch during the second week of October.

    In the meantime, here are 3 offerings you can take advantage of right away:

    • Download a NPTM e-mail block (a quick and easy graphic that you can insert below your signature line in e-mails) to let everyone know why October is so special. It's easy to do, and it looks great!
    • Visit the APTA marketplace during NPTM, where members save 20% off everything while supplies last.
    • Let the world know how you're honoring physical therapy—share your posts, photos, and videos on social media by using the ‪#‎PTmonth‬‬ hashtag. ‬

    Visit www.apta.org/NPTM for everything you need to create your own NPTM activities. Resources include the 2014 NPTM logo, fact sheet, event planning guide, sample news release and proclamations, and much more. Other resources can be found at MoveForwardPT.com, APTA’s official consumer information website.

    Utah Once Again Gets Top Ranking as Best State for PT Practice; Colorado and Minnesota Not Far Behind

    For the second year in a row, Utah has been declared the best state in which to practice physical therapy, followed by Colorado and Minnesota. The rankings—and the explanations behind the rating system—appear in this month's issue of PT in Motion, APTA's member magazine.

    The rankings were derived from an analysis of 7 factors: well-being and future livability, literacy and health literacy, employment and employment projections for physical therapy, business and practice friendliness, technology and innovation, compensation and cost of living, and physical therapist/physical therapist assistant/student engagement with APTA.

    "Unlike last year, Utah didn't rank first in any specific category—demonstrating that consistently strong numbers across the board is the real key to overall ranking success," writes PT in Motion Editor Donald E. Tepper in the article.

    The article includes explanations of the measures used to rate each factor, as well as a breakdown of ratings for the top 20 states. Rounding out the top 20 were Nebraska, Idaho, Virginia, Iowa, Washington, Arizona, Alaska, South Dakota, Oregon, Montana, North Dakota, Wisconsin, Kansas, Wyoming, New Hampshire, Maryland, and Massachusetts.

    Hardcopy versions of PT in Motion are mailed to all members who have not opted out and to subscribers; digital versions are available online ahead of print to members.

    CDC: Ebola Outbreak in US Highly Unlikely

    The first case of Ebola diagnosed in the United States sparked plenty of anxiety-producing headlines, but health experts from the US Centers for Disease Control and Prevention (CDC) say the chances of an outbreak in the US are almost none.

    CNN, the Washington Post, and nearly every other media outlet reported that a man was diagnosed with the virus in Dallas, Texas, a few days after arriving from Liberia. Initially, the man brought himself to a Dallas-area emergency room, but his symptoms were not connected to Ebola and he was sent home. When he later returned to the hospital feeling worse, he was isolated and the diagnosis confirmed.

    Because Ebola does not become contagious until an individual begins feeling ill, passengers on the flight the man took from Liberia are in no danger of contracting the disease from him, health officials said. Instead, health workers are investigating contacts he may have had with family and others in the US after he showed signs of sickness.

    CDC officials believe that the way the disease is spread—through direct contact with the body fluids of people showing symptoms—makes it unlikely Ebola cases would grow in the US as they have in West Africa, where the World Health Organization estimates that over 3,000 have died. Experts believe that isolation resources, infectious disease protocols, and investigative capabilities in the US can minimize the spread of the disease.

    Thomas Frieden, director of the CDC, was quoted as saying that "It is certainly possible that someone who had contact with this individual could develop Ebola in the coming weeks. But there is no doubt in my mind that we will stop it here."

    The CDC has been adding to its website on Ebola as the West African outbreak continued, and now offers a wide range of resources including infection prevention and control recommendations for health care facilities.

    Infectious disease control should never be an afterthought. Check out APTA's resources at its Infectious Disease Control webpage.

    International Meeting on Neurology and Rehabilitation Coming in June

    Physical therapists and physical therapist assistants have an opportunity to get a global perspective on rehabilitation for neurological patients June 4-6, 2015, when the International Neurology and Rehabilitation Meeting (INEREM) is held in Istanbul, Turkey.

    The upcoming INEREM will devote time to smaller workshops that will allow for more dialogue among participants, and will feature clinical practice topics as well as information on innovations. The meeting will bring together specialties including neurology, rehabilitation, and medicine from different cultures and health care systems.

    Registration and accommodations information can be found on the INEREM website. The INEREM organizing committee is also accepting abstract submissions for presentations until March 14, 2015. For more information, e-mail opteamist@inerem.com.