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  • No PT in Motion News Nov. 26, 27, 28

    PT in Motion News will not run on Nov. 26, 27, and 28. News stories will resume posting on Monday, Dec. 1. Additionally, there will be no weekly News e-mail blast on Nov. 28. The weekly e-mail blast will return on Dec. 5.

    PT in Motion News wishes you a safe and happy Thanksgiving!

    Study Finds Significant Metabolic Energy Improvements for Older Runners Over Older Walkers

    A small study of adults in their late 60s has found that regular running can reduce the metabolic "cost" of walking in ways that a regular walking regimen can't, and may actually result in walking metabolic energy rates that are comparable to those found in young sedentary adults.

    Researchers write that the older adults who ran for at least 30 minutes 3 times a week demonstrated 7% to 10% better walking economy than study participants who walked at the same durations and rates. The results, they write, support the idea that "higher intensity aerobic activities may mitigate the typical age-related decrease in walking economy, and consequently, preserve mobility into older age."

    The study, published in the November 20 issue of PLoS One, involved 30 adults (14 males and 16 females) who ranged in age from 66 to 72 (average age of 69). Half of the participants were runners who self-reported engaging in that activity 30 minutes or more at least 3 times per week, and for at least 6 months prior to the study. The 15 "walkers" reported the same levels of participation in their activity.

    After evaluation by a physician and a treadmill familiarization session, participants were evaluated after walking on a dual-belt force-instrumented treadmill at 3 speeds—.75, 1.25, and 1.75 m/s—for at least 7 minutes at each speed. Areas evaluated by the researchers included oxygen consumption and carbon dioxide production, as well as ground reaction forces that were in turn used to determine gait cycle events and stride variables.

    Researchers found the runners' 7%-10% reduction in metabolic energy consumption occurred at all speeds tested. At the fastest walking speed, walkers increased gross metabolic power by 95%, while runners required an 86% increase in power.

    The "most striking" finding in the study, according to authors, occurred when researchers compared these data with younger and older sedentary adults who underwent the treadmill testing.

    "The results of this analysis showed that across the range of speeds, older walkers consume metabolic energy at a similar rate as sedentary older adults," authors write. "However, our most striking finding was that older runners consumed energy at a similar rate as young sedentary adults across the range or walking speeds."

    Authors of the study were somewhat surprised to find that the differences in metabolic cost could not be attributed to the actual mechanics of walking, which did not vary substantially between the walkers and runners.

    "Among spatio-temporal gait characteristics, we found no significant differences between older walkers and older runners in regards to stride time, stride frequency (p = .879), single leg stance time (p = .126) or duty factor (p = .126)," they write. The same was true with ground reaction forces relative to first and second peak vertical force, as well as anterior-posterior braking and propulsive reaction forces.

    Researchers are uncertain about the precise reason for the metabolic differences, but cite decreased muscle co-activation and increased muscle efficiency as possible contributors.

    Authors acknowledge the study's limitations, particularly around its small numbers and uneven distribution of males and females in the walker/runner groups (11 females and 4 males in the walking group; 5 females and 10 males in the running group). Still, they write, "while it would have been preferable to have a larger sample size with more similar sex and anthropometric matched cohorts, it would not have changed our overall conclusions."

    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.

    PTNow Blog: COPD Resource Roundup

    The PTNow blog is serving as a temporary 1-stop shop for physical therapist (PT) and physical therapist assistant (PTA) resources on helping to manage chronic obstructive pulmonary disease (COPD). COPD is the third leading cause of death in the US.

    In recognition of November as COPD Awareness Month, the recent post gathers information on COPD from PTNow and offers it up in 1 convenient set of links. The partial listing includes a clinical summary, clinical practice guidelines, tests and measures, and clinical cases.

    Also included: patient education resources from APTA and the National Heart, Lung, and Blood Institute.

    Washington Post: New Magnetic Stimulation Device Being Tested As a Way to 'Prep' Poststroke Brain for Physical Therapy

    A new transcranial magnetic stimulation (TMS) device is being tested as a possible aid to physical therapy for patients poststroke, according to a recent article in the Washington Post.

    In the November 24 article, Post reporter Amy Ellis Nutt describes early efforts at Ohio State Wexner Medical Center to use Nexstim, a technology that painlessly suppresses activity in the healthy parts of a patient's motor cortex. Researchers believe that after stroke, undamaged parts of the brain "[go] into overdrive in order to compensate," which "may actually slow recovery of the injured side," according to the article.

    The Post reports that the process involves using "a technology similar to a GPS" to pinpoint the areas of the motor cortex that have been injured. Researchers then apply low-frequency magnetic pulses to the corresponding healthy area to decrease activity. "This allows the injured side to make use of more energy during physical therapy, which immediately follows the [TMS]," Nutt writes.

    Nexstim is planning on conducting an 8-month double-blind randomized clinical trial with 200 individuals who have suffered a stroke in the past 3-12 months and have weakness in the arm and hand on only one side. According to the Post report, the trial will involve up to 29 visits for each participant.

    Free Webinar, Audio Course Offer Ends Nov 30

    Never mind how many shopping days are left until Christmas—you have a more immediate deadline to think about.

    November 30 is the last day APTA members can enjoy a prerecorded webinar or audio conference, courtesy of APTA. The limited-time offer is the association's way of saying thank you for your membership.

    Choose from programs on audits and appeals, how to overturn denials and get visits approved, the role of the PT in hospice and palliative care, and more.

    To redeem your complimentary recorded webinar or audio conference course:

    1. Check out the recorded webinar or audio conference options and select 1 course.
    2. Click the "Purchase Now" link and complete the online store transaction (login required).
    3. At the "View Shopping Chart" phase, click "Enter Vouchers," then enter promotion code CEUMBR1114. The member price for the program will be zero.

    Once you receive your order confirmation number, go to "My Courses" to launch the course. This offer is nontransferable and expires November 30, 2014.

    Questions? Contact Member Services or call 800/999-2782, ext 3395, M-F, 8:30 am to 6:00 pm, ET.

    RockTape Named APTA Strategic Business Partner

    RockTape Inc, a leading provider of sports medicine products, has been named a Strategic Business Partner of APTA. Its flagship product, RockTape kinesiology tape, is used by more than 8,000 medical professionals worldwide to treat and prevent common sports injuries.

    "We are pleased to welcome RockTape to APTA's Strategic Business Partners family," said APTA President Paul A. Rockar Jr, PT, DPT, MS, in an association news release. "It is important to APTA to enhance our business relationships and develop meaningful partnerships with for-profit companies. We are pleased that our services and marketing opportunities provide mutual benefits to our partners and APTA."

    "We knew that to best leverage all of our great relationships in the physical therapy profession, we needed to partner with and support the profession through the APTA Strategic Business Partners Program," said Alyson Evans, director of US sales.

    In 2015 RockTape will exhibit at APTA's Combined Sections Meeting, the NEXT Conference, and National Student Conclave.

    The APTA Strategic Business Partners program seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA. For further information on the program, visit the Strategic Business Partners webpage.

    IOM: Physical Activity Measures Should Be Among Standard 'Social and Behavioral' Domains Tracked on EHRs

    The Institute of Medicine (IOM) is recommending that future electronic health records (EHRs) include patient "social and behavioral data"—including data on physical activity—acquired through a set of 12 measures.

    The 300-plus page report, "Capturing Social and Behavioral Domains and Measures in Electronic Health Records," makes the case for the Centers for Medicare and Medicaid Services (CMS) to include the measures as part of the EHR certification and meaningful use regulations.

    Data on 4 of the domains—alcohol use, tobacco use and exposure, race/ethnicity, and residential address—are already being widely collected, the report states. But additional domains should be included, each with its own measures—education, financial resource strain, stress, depression, physical activity, social connections/isolation, exposure to violence/intimate partner violence, and neighborhood compositional characteristics.

    The IOM report describes "a large body of empirical evidence" around the dose-response relationship between physical activity and improved physical and mental health throughout the lifespan, with "little evidence that an upper threshold exists." Authors write that not only is the relationship strong enough to be worth collecting data, the very act of obtaining this information from patients at outpatient visits is associated with "significant, yet small, changes in patient weight loss and [plasma glucose concentration] levels compared [with] those who were not asked about their physical activity levels."

    Authors of the report recommend that 2 "Exercise Vital Signs" questions from the US Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System be used as the standard measures for physical activity in EHRs. The 2 questions are:

    • On average, how many days per week do you engage in moderate to strenuous exercise (like walking fast, running, jogging, dancing, swimming, biking, or other activities that cause a heavy sweat)?
    • On average, how many minutes to you engage in exercise at this level?

    Authors also reviewed the International Physical Activity Questionnaire, a 9-question form, finding it "acceptable" but "more time consuming" than the 2-question measure.

    The report noted that the additional domains would likely add to costs, and that these costs would largely fall to providers. However, the report asserts, the long-term benefits would be significant.

    "The US health system has achieved technological advances but lags behind other countries in population health outcomes," write the report's authors. "Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research."

    APTA offers several resources on information technology and EHRs, including a webpage devoted to the use of EHRs. Additionally, APTA has long supported the promotion of physical activity and the value of physical fitness, and is involved with the National Physical Activity Plan (NPAP), where the association has a seat on the NPAP Alliance board. The association also offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.

    'Text Neck' the Focus of Upcoming Study

    The reasons for a person's neck pain could be as close as his or her phone.

    A recent story in the Washington Post describes the upcoming publication of a study that analyzed the burden placed on the cervical spine through the typical posture of people looking at their smartphones—head tilted down at angles as severe as 60 degrees. At that angle, researchers determined that weight on the cervical spine increases to about 60 pounds.

    According to the Post report, the "text neck" posture seen just about everywhere is like "carrying an 8-year-old around your neck several hours per day," at the rate of between 700 to 1,400 hours a year. For adolescents, that number could be 5,000 hours higher. The poor posture can lead to degeneration of the spine.

    The Post reports that the problems associated with text neck have been known for some time, and borrows quotes from a 2013 CNN interview with APTA Private Practice Section President Tom DiAngelis PT, DPT, in which he describes the dangers of the posture over time.

    The article offers suggestions from Kenneth Hansraj, lead author of the upcoming study, on how to counteract text neck. His biggest piece of advice: look down with your eyes—no need to bend your head. Second, he suggests specific exercises to improve mobility and posture.

    USBJI Young Investigators Program Accepting Applications

    Physical therapist (PT) investigators have an opportunity to receive guidance in getting their research funded and "other survival skills required for pursuing an academic career" through a program that connects them with experienced researcher-mentors.

    The United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada announced that they are now accepting applications for the Young Investigator Initiative, a career development and grant mentoring program. Investigators chosen to participate in the program will attend 2 workshops 12-18 months apart and work with faculty between workshops to develop grant applications.

    This grant mentoring workshop series is open to promising junior faculty, senior fellows, or postdoctoral researchers nominated by their department or division chairs. It also is open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed and have a commitment to protected time for research. Basic and clinical investigators, with or without training awards (including K awards), are invited to apply.

    Application requirements and more details can be found at the USBJI website. Deadline is January 15, 2015, to participate in the next workshop, April 24-26.

    According to an announcement from USJBI, 140 program participants have obtained more than $130 million in research grants. APTA is a founding member of USBJI.

    Nurses' 'Choosing Wisely' List Should Resonate With PTS, PTAs

    A recently released list of practices nurses and patients should question will likely get nods of agreement from physical therapists (PTs) and physical therapist assistants (PTAs) for the ways the recommendations promote early mobility in hospital settings.

    The American Academy of Nursing (AAN) became the most recent nonphysician profession to add to the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely® campaign aimed at educating consumers and health care professionals on health care-related tests, procedures, and practices that may not be necessary or appropriate under certain circumstances. In September, APTA became the first nonphysician group to join the campaign when it unveiled its list of "5 Things Physical Therapists and Patients Should Question."

    Of particular interest to PTs and PTAs in the AAN list of "5 Things Nurses and Patients Should Question" (.pdf) are recommendations that nurses should not let older adults lie in bed or only get up to a chair during their hospital stay, that physical restraints should not be used with patients who are older and in the hospital, and that urinary catheters should not be placed or maintained in a patient "unless there is a specific indication to do so."

    "PTs know that an important contributor to hospital-associated disability is immobility during hospitalization, which leads to decreased function, increased fall risk, and increased length of stay—especially in older adults," said Anita Bemis-Dougherty, PT, DPT, MAS, clinical practice director at APTA. "The AAN Choosing Wisely list is an excellent addition to the support for greater mobility in hospitalized patients."

    Bemis-Dougherty noted that the AAN recommendations around restraints are consistent with The Joint Commission (TJC) restraint standards. In addition, she said, the AAN list correlates strongly with APTA's Choosing Wisely recommendations against using continuous passive motion machines after uncomplicated total knee replacement, and against bed rest following diagnosis of acute deep vein thrombosis after anti-coagulation therapy, unless significant medical concerns are present.

    "Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls," noted Bemis-Dougherty. "If the patient is restrained, the immobility could lead to poor outcomes."

    APTA Senior Director of Practice and Research Nancy White, PT, DPT, OCS, was involved in the development of the APTA Choosing Wisely list, and thinks that the AAN recommendations add to the reach of a campaign that's making a difference.

    "Choosing Wisely is recognized as a great way to improve outcomes of care and reduce the use of treatment approaches that are either not effective or that may even be harmful," White said. "AAN has identified several practices that are common in many hospital settings that result in prolonged and unnecessary bed rest—something that PTs know leads to poorer outcomes and prolonged hospital stays."

    Bemis-Dougherty believes that the AAN list can help APTA in its efforts "to change the culture of immobility in the hospital to one of mobility."

    "Creating that kind of change is a daunting task and can't be accomplished by PTs alone," Bemis-Dougherty said. "To have nursing recognize the problem caused by immobility is huge and hopefully can contribute to a more widespread culture of mobility that involves all health care professionals within hospital settings."

    APTA's Choosing Wisely list is offered in several forms, including consumer-focused versions in English and Spanish, and an expanded version containing citations on the association's Center for Integrity in Practice website. Resources on that site also include a ProfessionWatch paper from Physical Therapy that details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation.

    Humana Resumes MPPR Policy

    After a 9-month delay, the Humana health insurance corporation has restarted a multiple procedure payment reduction (MPPR) policy that applies to Medicare Advantage and commercial insurance plans.

    On October 29 Humana reinstated the MPPR policy on the initial claims adjudication for non-facility providers. The policy will be applied to facility settings in late January.

    The 50% reduction applies to the practice expense (PE) portion of the relative value unit (RVU). Humana will pay 100% of the first code with the highest PE RVU, and all codes billed after that will be reduced by multiplying the PE portion of the code by 50%. For Medicare advantage plans, Humana will apply the reduction regardless of whether the therapy services were provided in 1 therapy discipline or multiple therapy disciplines.

    Humana originally implemented this policy in the fall of 2013 and applied the program retroactively, requiring physical therapists (PTs) to pay back portions of reimbursement that Humana claimed exceeded MPPR standards. APTA raised questions about the accuracy of the overpayment calculations and concerns about the administrative burden of the overpayment recovery process on PT practices, among other issues. As a result of those efforts, Humana temporarily ceased application of the MPPR policy in January 2014 to focus on correcting its payment logic and refunding inappropriate overpayment recoveries.

    Members who have questions about the reimbursement policy and suspect a calculation error should contact APTA at advocacy@apta.org.

    Need more information on MPPR? Visit APTA’s MPPR webpage. Resources include FAQs, strategies for managing contracts, approaches to verify payment accuracy, and more.

    APTA Posts Summary of Changes to Veterans Care

    The US Department of Veteran's Affairs (VA) has issued an interim final rule amending regulations in the Veterans Choice Program, which allows eligible veterans to receive care from non‐VA entities and providers in certain circumstances. APTA is helping members understand how the changes could affect physical therapists (PTs).

    APTA posted a summary (.pdf) of the interim rule (under the "summaries" header) from VA. Many of the changes focus on definitions in Veterans Choice and clarifications around the non-VA providers who can provide hospital and medical services through the program. The APTA summary provides highlights of provisions that may impact PTs, including copayment regulations, program scope, key terms, eligibility requirements, payment rates, and other issues.

    The interim final rule took effect on November 5.

    Volunteers Needed to Focus on Early-Career Members

    The best way to ensure a healthy future for physical therapy is to ensure that physical therapists (PTs) and physical therapist assistants (PTAs) get involved in APTA early in their careers.

    Now's your chance to help.

    APTA is calling for volunteers to serve on the Recruitment and Retention of Early-Career Members Task Force, the group charged with analyzing and evaluating existing membership trends and current outreach practices for early career PTs and PTAs, and identifying innovative strategies to increase membership value. Deadline for application is December 1. Complete details on the task force can be found on APTA's Volunteer Groups webpage.

    APTA relies heavily on its volunteers, who gain valuable leadership and growth opportunities while working with some of the most outstanding physical therapists in the country.

    Interested? Complete a volunteer interest profile, then click on the "Apply for Current Vacancies" button and select the task force you're interested in joining.

    TBI Reauthorization Act Ready to be Signed by President

    Legislation that will enhance government-sponsored research and data collection on traumatic brain injury (TBI) will move to the president's desk for signature, now that the TBI Reauthorization Act (S. 2539) has been passed by the House of Representatives. Individual House and Senate versions of the legislation were passed in the summer and fall, but last week the House decided to adopt the Senate version instead of reconciling the 2 bills.

    APTA was among the organizations advocating for the legislation as part of the association's broad push to bring attention to TBI and rehabilitation in general.

    If signed by the president, the finalized, bipartisan legislation will:

    • Allow the US Department of Health and Human Services (HHS) to issue grants to states and advocacy systems to improve access to TBI-related rehabilitation and community services
    • Provide funding to the US Centers for Disease Control and Prevention (CDC) to gather data on TBI and conduct public education programs that include prevention
    • Direct the Secretary of HHS to develop a TBI coordination plan
    • Direct CDC and the National Institutes of Health (NIH) to conduct a scientific review of the management of children with the TBI

    The Senate version of the bill was sponsored by Sen Orrin Hatch (R-UT) and cosponsored by Sen Bob Casey (D-PA).

    Besides its efforts in support of TBI reauthorization legislation, APTA has participated in the Joining Forces initiative, promoted the Protecting Student Athletes From Concussions Act (H.R. 3532) (.pdf), and participated in a congressional Brain Injury Awareness Day in March. Concussion management awareness was also the focus of this year's student-led Flash Action Strategy, which resulted in the largest concussion-related grassroots effort in APTA history.

    APTA provides extensive resources to its members on the role of physical therapy in brain injury treatment and recovery, and offers a TBI webpage that includes continuing education courses and links to other interest groups.

    Education Leadership Fellowship Program Accepting Applications; Deadline Dec 1

    Physical therapist and physical therapist assistant education program directors interested in developing their leadership skills have an opportunity to participate in a yearlong fellowship program designed to do just that.

    APTA's American Board of Physical Therapy Residency and Fellowship Education’s accredited Education Leadership Institute (ELI) Fellowship, a collaborative with the American Council of Academic Physical Therapy, Education Section, Physical Therapist Assistant Educators Special Interest Group, and APTA, now is accepting applications for 2015. Submission deadline is December 1, 2014, 5:00 pm ET.

    This yearlong, invitational, blended learning (online and onsite components) fellowship program includes experienced mentorship, and is designed to develop emerging and novice (0-7 years) physical therapist and physical therapist assistant education academic program and residency and fellowship directors with leadership skills to facilitate change, think strategically, and engage in public discourse to advance the physical therapy profession.

    Applicants are selected based on the strength of their application and meeting all eligibility criteria. To learn more about the Education Leadership Institute Fellowship, go to the ELI webpage.

    Considering the fellowship experience? Check out the video testimonials of ELI graduates.

    Obamacare Enrollment Period Opens With Moderate Premium Increases, Some Changes to Cost-Sharing

    The November 15 startup of the second open enrollment period for insurance under the Affordable Care Act's (ACA) insurance exchange system is marked by some increases in premiums, and cost-sharing amounts for physical therapy and other services that will generally hold steady—with exceptions that will result in significant increases and decreases in a few cases.

    As reported in Bloomberg.com, the Washington Post, and elsewhere, the average premium for a "silver" plan will rise by 2% in 2015, while the average "bronze" plan increase will be closer to 4%.

    At a more granular level, different parts of the country are seeing more significant increases—and a few reductions. For example, Alaska residents will experience a 28% increase to marketplace premium rates that are already among the highest in the country, while Mississippi residents well see a 19% drop in premium rates for a bronze plan.

    The approved rates released by CMS also contain information on deductibles and cost-sharing increases or decreases, depending on the plan. While there are variations, in general, physical therapists (PTs) can expect to see a continued trend toward higher cost-sharing and more limited participation in narrow networks, said Gillian Leene, senior regulatory affairs specialist at APTA.

    "In 2014, we saw high deductibles and high cost sharing, such as copays and coinsurance, for patients with coverage through the health insurance exchange plans, which in many cases limited access to physical therapist services," she said. "Additionally, many plans sold on the health insurance exchanges are narrowing their provider networks to contain costs and have very limited out-of-network coverage."

    Leene suggested that the startup of the open enrollment period is a good time for PTs to reacquaint themselves with the ACA through APTA's Health Care Reform page, and in particular via the association's series of resource documents titled Making Sense of Health Reform. Topics covered in the series include narrowed networks, cost-sharing, and the grace period. "It's a great way for PTs to understand practical implications and get a few tips on how to mitigate some of these issues," she said.

    Sharing information and experiences is another way to stay on top of health care reform. Members are urged to contact APTA with any issues they're experiencing through the association's feedback form.

    New Text and App Support for People Living With Type 2 Diabetes

    The American Diabetes Association (ADA) has expanded its free "Living With Type 2 Diabetes" program to offer text messaging, web, and app support through a program called Care4life. The expanded offering joins other resources targeted at patients who recently have been diagnosed with the disease.

    Care4life allows participants to set reminders for appointments, medications, and glucose testing; as well as set and track weight and exercise goals. The features are available through text message, on the app, and by logging on to www.care4life.com.

    ADA continues to offer "Where Do I Begin," a hardcopy guide for patients with a recent type 2 diabetes diagnosis. The 16-page guide helps patients understand the fundamentals of type 2 diabetes and the steps that can be taken to live with the disease, including exercise and proper diet. Multiple copies of the booklets are available at no charge to PTs and PTAs to give to their patients.

    Hospital Hand Hygiene Rates Can Drop Dramatically Over a Single Shift

    A study that evaluates on how job demands affect compliance with professional standards chose hand hygiene in hospitals as its focus—and the results aren't especially good.

    In an analysis of 4,157 hospital-based health care providers in 35 hospitals, researchers monitored compliance with 13.7 million hand-washing opportunities, and found that over the course of a single 12-hour shift, hand-washing compliance rates dropped by just over 20%, from rates that weren't all that high to begin with. Authors of the study, published in the November issue of the Journal of Applied Psychology (abstract only available for free), believe that this is the first research to show that the negative effects of job demands on workplace compliance accumulate much more quickly than previously believed.

    Researchers looked at data from hospitals that use radio frequency identification technology in the form of badges worn by providers that track behavior. The badges are capable of registering when and where providers use hospital room sanitizer dispensers. Authors of the study correlated hand-washing opportunities to specific shifts, and examined compliance through the course of a shift as well as the ways compliance changed after the provider took a break or had more than 3 days off.

    The study sample comprised nurses (65%), patient care technicians (12%), physicians (4%), and unspecified "therapists" (7%), with behaviors reviewed over a 3-year period.

    First, the bad news: compliance with hand-washing standards (washing upon entering and leaving a patient's room) started at 42%, and dropped by more than 8 percentage points over the course of a single 12-hour shift, to 34.8%. Authors write that "for every additional hour worked, the fitted odds of compliance are estimated to decrease by … 4%." Making matters worse, compliance drops even more dramatically "when caregivers have had more frequent interactions with patients during a shift and when caregivers have spent a larger proportion of their time in patient rooms," they write.

    Not only were the compliance effects cumulative over the course of a single shift, the problem was compounded as a caregiver worked through consecutive shifts. "The more total hours a caregiver had worked in the past week, the faster his or her compliance decreased during a given shift," authors write.

    The relatively good news is that researchers discovered a strong relationship between time off and subsequent compliance. Specifically, authors found that taking as little as an additional half-day off was associated with a 1.3% increase in the probability that a caregiver will comply with hand-washing on his or her next shift.

    While authors acknowledge that the improvement rate may seem small, they maintain that the real-world effects could be significant, citing a Swiss study that correlated a 1% improvement in hand hygiene with a reduction in hospital-acquired infections of 3.9 per 1,000 patients. When evaluated against another study that estimated a per-patient cost of $20,549 for every hospital-acquired infection, authors concluded that across the US, the rates of noncompliance they observed could produce an additional 600,000 infections per year at an estimated annual cost of $12.5 billion.

    "The findings reported here suggest that demanding work environments can produce negative consequences far more rapidly than prior [research] … has recognized," authors write. "In other words, a day in the saddle can indeed take its toll."

    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.

    Summaries Now Available for 2015 CMS Rules; Webinar, Podcast on PQRS Changes

    New resources from APTA are aimed at helping physical therapists (PTs) understand Centers for Medicare and Medicaid Services 2015 changes to the physician fee schedule, outpatient prospective payment system (OPPS), home health prospective payment system (HHPPS), and provisions around durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). In addition, the association will offer a webinar next week focusing on the new requirements for PTs under the Physician Quality Reporting System.

    APTA members can now access summaries of final rules for the following areas:

    To access each document, scroll down to the "APTA Summaries" headline and select the link for 2015 rules.

    The association will also hold a webinar on November 20 for PTs who bill Medicare for outpatient physical therapy services in private practice settings (using the 1500 claim form or 837-P) and face new requirements under PQRS. The 90-minute session, which will begin at 2:00 pm ET, will help PTs understand how to comply with the new rules in 2015 in order to avoid a 2% pay cut in 2017. APTA Director of Quality Heather Smith, PT, MPH, will lead the discussion. Registration includes on-demand access to a recording of the webinar for later listening.

    APTA also offers an overview of the PQRS changes through a podcast, free to members.

    Help Say Happy Birthday to Charles Magistro

    Here's your chance to join in the celebration of a living legend in the physical therapy profession.

    Charles M. Magistro, PT, DPT (Hon), FAPTA, DrSci (Hon), former President of APTA, first chairman of the Foundation for Physical Therapy (Foundation), and emeritus member of the Foundation’s board, will celebrate his 90th birthday on Tuesday, November 18. In response to requests, the Foundation has created a way for you to add to the celebration by making a donation in Magistro's name. A card will be sent to Magistro notifying him of your gift.

    Magistro has been a steadfast donor to the Foundation and created the Magistro Family Endowment Fund in 2005 to support the investigation of innovative therapeutic interventions in rehabilitation.

    "Charles Magistro was one of the visionary leaders instrumental in helping to establish the Foundation in 1979," said Foundation President William G. Boissonnault, PT, DPT, DHSc, FAPTA, FAAOMPT. "His impact on the Foundation is reflected in the leadership and guidance he continues to provide. We at the Foundation wish Charles a very happy birthday."

    Rep Phil Crane, Direct Access Supporter, Dead at 84

    US Rep Phil Crane, a 35-year veteran of Congress and sponsor of APTA's legislation to include direct access to physical therapists (PTs) under Medicare, died November 8. He was 84.

    Crane represented the 8th district of Illinois from 1969 to 2005. During that time, he became known as a champion of smaller government who was also willing to reach out to lawmakers regardless of their political perspectives.

    In 2002, Crane received APTA's Public Service Award for his efforts on behalf of direct access to PTs, efforts that he led from 2001 until he lost his reelection bid in 2004.

    Crane's life and political career were reported in theWashington Post,Chicago Tribune, Reuters, and many other media outlets earlier this week.

    WSJ: Newest Exoskeleton Coming From Industrial Equipment Manufacturer

    According to a recent Wall Street Journal article, the latest developments in robotic lower limb orthoses are coming from a manufacturer "whose components have long helped propel construction equipment, factory machinery, and airplanes" for companies such as Caterpillar and Boeing.

    The November 11 edition of WSJ includes a story of how Parker Hannifin Corporation developed a prototype set of robotic leg braces designed to allow individuals with paraplegia to walk. The new device, named Indego, is now undergoing trials with 40 people at 5 rehabilitation centers.

    According to the WSJ story, Indego is an exoskeleton device that weighs in at 26 pounds. Users control walking speed by leaning forward and backward, while "tiny gyro-chips commonly used to rotate images on cellphones" help users keep from veering off-course, and serve as part of a vibration-based alert system for changes to speed and position.

    Parker Hannifin is seeking FDA approval for the device, which the company says could come as soon as 2015. The WSJ reports that if successful, Indego would be only the second device to receive FDA approval for a robotic orthosis for home use by people with lower-body paralysis. The company estimates a $69,500-$100,000 pricetag for the device.

    Could 'Sponge Scaffold' Become a Less Invasive Option for ACL Tears?

    A Boston physician has just received Food and Drug Administration (FDA) approval to begin safety studies of a new, far less invasive approach to anterior cruciate ligament (ACL) tears that uses a "sponge scaffold" to allow torn tissue to reconnect.

    The new approach, developed by Martha Murray, physician with the Boston Children's Hospital Division of Sports Medicine, was the subject of a recent Q and A article in the Boston Globe. In the article, Murray outlines how the procedure works and its possible benefits over traditional ACL surgery.

    Murray describes how her team focused on the ways fluid in the knee joint prevents the torn ACL ends from properly reconnecting through clotting. "Once we figured that out, we developed a scaffold, basically like a sponge, that you can use to hold the blood between the 2 torn ends of the ACL long enough for the cells around and the tissue around to grow into it and reunite," she says in the article. "When we do the repair of the ACL and we sew it back together, we sew it with the sponge between the 2 ends."

    Besides being much less invasive than traditional ACL surgery, the procedure has shown promise in animal trials in reducing the development of later arthritis. Murray told the Globe that the FDA has approved a 10-patient safety study that she hopes to begin in January, 2015.

    In the article, Murray also describes the rehabilitation process that will be used with the new procedure. "What we've done is gotten advice from multiple physical therapists who have a lot of experience with ACL rehabilitation," she told the Globe. She characterized the rehab protocol as "very similar" to what is done after traditional graft surgery, but added that the protocol would be adjusted as the study continues.

    "Our relatively simple solution of a sponge and putting the blood there where it belongs may not be the final solution," Murray says in the article. "If we can just get some really smart scientists to think this could work, then maybe they'll design an even better scaffold or figure out an even better growth factor to put in there."

    NSC Highlights Now Posted

    It's not the same as being there, of course, but APTA is offering several ways to catch up with—or revisit, or possibly even catch a glimpse of you or your friends at—the 2014 National Student Conclave (NSC), held October 30–November 1 in Milwaukee.

    NSC-related resources include Storify highlights that feature pictures, videos, tweets from attendees, and other submissions.

    Interested in even more detail? Check out the collected video dispatches from NSC.



    And if you need any more reason to put NSC on your calendar for next year, watch the archived livestream of 6 dynamic NSC sessions that were broadcast live, including a powerful story from Joanna Rolek on the importance of interprofessional communication, and a closing keynote address from Scott Chesney that left attendees inspired and energized.

    WSJ: Newest Robotic Exoskeleton Coming From Industrial Equipment Manufacturer

    According to a recent Wall Street Journal article, the latest developments in robotic lower limb orthoses are coming from a manufacturer "whose components have long helped propel construction equipment, factory machinery, and airplanes" for companies such as Caterpillar and Boeing.

    The November 11 edition of WSJ includes a story of how Parker Hannifin Corporation developed a prototype set of robotic leg braces designed to allow individuals with paraplegia to walk. The new device, named Indego, is now undergoing trials with 40 people at 5 rehabilitation centers.

    According to the WSJ story, Indego is an exoskeleton device that weighs in at 26 pounds. Users control walking speed by leaning forward and backward, while "tiny gyro-chips commonly used to rotate images on cellphones" help users keep from veering off-course, and serve as part of a vibration-based alert system for changes to speed and position.

    Parker Hannifin is seeking FDA approval for the device, which the company says could come as soon as 2015. The WSJ reports that if successful, Indego would be only the second device to receive FDA approval for a robotic orthosis for home use by people with lower-body paralysis. The company estimates a $69,500-$100,000 pricetag for the device.

    Bloodflow Restriction Training Featured on ESPN, Part of Military Rehab Program to be Discussed at CSM

    A "tourniquet training" technique that has helped wounded military veterans make dramatic strength gains was the subject of an ESPN feature on Veteran’s Day.

    The approach involves the use of a pneumatic surgical tourniquet to reduce blood flow to the injured limb while the patient participates in strength training. Johnny Owens, PT, a physical therapist and chief of human performance optimization at the Center for the Intrepid, introduced the technique at the Brooke Army Medical Center.

    Owens claims tourniquet training allows patients to train at low loads "to improve their function without compromising vulnerable joints or soft tissue." According to an article that accompanied the ESPN video, the technique has resulted in 50%-80% strength gains.

    In the ESPN segment, APTA spokesperson Stephania Bell, PT, OCS, ESPN.com's injury analyst and senior writer, was interviewed about the possibility that the technique might the useful for rehabilitation of elite athletes. Bell thinks the likelihood is strong. "Our service members are truly highly trained, gifted athletes, and if we can return these ultimate athletes to their field … how can we not consider these results and expand them out to the general athlete population?" she said.

    Owens is a scheduled presenter at APTA’s 2015 Combined Sections Meeting, February 4-7 in Indianapolis, where he will join Jason Wilken, PT, MPT, PhD, to provide an overview of the rehabilitation strategies being used at the Center for the Intrepid.

    Clinical Trials Co-Authored by APTA Members Part of PEDro's International List of 'Ground-Breaking' Studies

    The 2 US trials that made it into a recently released list of the top 15 international trials ever published were coauthored by several APTA members, including 2 Catherine Worthingham Fellows. The "ground-breaking" trials were nominated by physical therapists around the world, and finalists chosen by an expert international panel.

    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. The final top 15 trials are from 7 countries: 4 each from the United Kingdom and Australia, 2 each from the United States and Norway, and 1 each from Sweden, the Netherlands, and Brazil.

    The US-based studies that made it into the list were "Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial," published inJAMA in 2006, and "Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial," published in 2009 in The Lancet (abstract here; APTA members have full access to the article via ProQuest in PTNow ArticleSearch).

    The EXCITE study, co-authored by Steven Wolf, PT, PhD, FAHA, FAPTA, Carolee Winstein, PT, PhD, FAPTA, Philip Miller, AB, Edward Taub, PhD, Gitendra Uswatte, PhD, David Morris, PT, PhD, Carol Giulani, PT, KathyeLight, PT, PhD, and Deborah Nichols-Larsen, PT, PhD, focused on the effectiveness of rehabilitation constraining the "good" arm of individuals poststroke whose upper limb or limbs had been affected. Acccording to primary author Wolf, "this trial was the first large multi-center, randomized controlled trial in stroke rehabilitation that lay the groundwork for many other trials to follow." The trial was funded by the National Institutes of Health.

    The other US trial to make the PEDro list focused the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. Authored by William D. Schweickert, Mark C. Pohlman, Anne S. Pohlman, Celerina Nigos, Amy Pawlik, PT, DPT, CCS, Cheryl L. Esbrook, Linda Spears, PT, Megan Miller, Mietka Franczyk, PT, PhD, Deanna Deprizio, Gregory A. Schmidt, Rhonda Barr, PT, MA, CCS, Kathryn McCallister, Jesse B. Hall, and John P. Kress, the trial found that "therapy in the earliest days of critical illness was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care."

    "These are ground-breaking trials that changed the way people are treated for a variety of conditions seen by physiotherapists and other healthcare professionals," states PEDro on its webpage announcing the winners. "Some of these trials set the stage for breakthroughs, some represent a paradigm shift, and all of them mark important milestones in the evolution of physiotherapy treatment."

    PPS Conference Attendees Donate, Acquire Art, and Bowl for PT-PAC

    Members of APTA's Private Practice Section (PPS) are not only committed to the continuous improvement of their own practices, they're also invested in the continued political strength of the entire physical therapy profession.

    And they have some impressive—and interesting—ways of showing it.

    First the impressive: during the PPS 2014 Annual Conference November 5–8 in Colorado Springs, Colorado, PPS members helped to raise more than $160,000 for PT-PAC, the profession's political action committee. Nearly 2 out of every 3 PPS members made a donation to PT-PAC.

    But a couple of lucky attendees found other ways to show their support.

    Demonstrating that a picture can sometimes be worth more than just words, former APTA Board of Directors member Steve Levine, PT, DPT, MSHA, FAPTA, is now the proud owner of a portrait of basketball superstar LeBron James, painted onsite during the PPS conference keynote from Erik Wahl. Levine donated $2,650 to PT-PAC to walk away with the winning bid for the artwork.

    2014 - 11 - 12 - Steve Levine Story
    Steve Levine, PT, DPT, MSHA, FAPTA, with his newly acquired (and newly-created) LeBron James portrait.   

    And in a successful effort to snag another kind of superstar, Ronald Dean Hasse, PT, spared no expense by donating $1,000 to earn the winning bid for the opportunity to bowl with physical therapy legend Marilyn Moffat, PT, PhD, FAPTA, at the PT-PAC party that took place in conjunction with the PPS conference. No word on who won the match.

    Michael Matlack, director of grassroots and political affairs for APTA, says that the generosity shown by PPS conference attendees benefits the entire profession. "Donating to the PAC is important because it provides the opportunities for APTA staff and members to talk about physical therapy issues that impact their patients and practices and build champions on Capitol Hill," he said.

    Prehabilitation Creates 'Meaningful Changes' in Functional Exercise Capacity 8 Weeks After Surgery in Patients Undergoing Colorectal Resection

    Patients who participate in a prehabilitation program before they undergo colorectal resection surgery for cancer not only enter surgery at a higher functional level, but are able to regain those increased levels of exercise capacity within 8 weeks after the procedure, according to a new study.

    The study, published in the November issue of Anesthesiology, compared the results from the 6-Minute Walk Test (6MWT) administered to 2 groups of patients with colorectal cancer: 1 group of 38 patients who received a "trimodal" exercise/nutrition/relaxation program 4 weeks prior to resection surgery and for 8 weeks afterwards, and another group of 39 patients who received only the postoperative 8-week program.

    Researchers found that the gains made before surgery raised 6MWT scores throughout rehabilitation relative to the control group, and that functional losses didn't dip far past baseline standards. Patients who received only the postoperative program, on the other hand, began functional declines leading up to surgery and were generally unable to return to baseline function 8 weeks afterwards.

    The trimodal program combined aerobic exercise (walking, jogging, swimming, or bicycling) and resistance training with dietary consultation and protein supplementation. Stress reduction techniques provided by a psychologist made up the third element of the program.

    Though both groups began with similar baseline mean 6MWT scores—421 meters (m) in the prehabilitation group, and 425 m in the rehabilitation group—differences began to occur very soon after the prehabilitation program began. By the end of the 4-week program, the prehabilitation group had improved mean scores by 25.2 m, while the rehabilitation group continued to decline, creating a 41.7 m gap between the groups. And while almost 50% of participants in both groups recorded 6MWT scores that were 20 m below their baselines 4 weeks after surgery, by 8 weeks, the prehabilitation group had regained above-baseline scores.

    "In the present trial, the average 25.2 m increase in preoperative walking capacity achieved with trimodal prehabilitation offsets the average 21.8-m decline observed with rehabilitation in the first 4 weeks after surgery, thus providing a buffer and facilitating a faster return to baseline walking capacity," the authors write.

    Researchers noted that, while physical activity was an important component in the gains, "the additional roles of nutritional optimization and psychological motivation cannot be ruled out as essential contributors to the observed improvement."

    "Efforts to improve recovery have traditionally focused on the postoperative period," write the study's authors. "However, this may not be an opportune time to commence lifestyle changes as cancer patients may be fatigued, concerned about disturbing the healing process, or anxious as they await treatments for the underlying condition. The preoperative period may in fact be a more salient time to intervene, as patients are generally in a better physical condition."

    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 Letter to New York Times on PT's Role in Falls Prevention

    A recent series on falls in the New York Times brings an important issue to center stage but comes up short in providing information on how physical therapists (PTs) can help protect adults at risk, according to a letter to the editor from APTA President Paul Rockar Jr, PT, DPT, MS.

    Rockar's November 6 letter was written in response to "Steps to Avoid an Accident," an article that accompanied a 2-part series that looked at how care facilities are responding to a growing number of falls among an aging population and how one woman struggled to recover from her fall-related injuries.

    The article, Rockar writes, "raises an important point—loss of balance and falls could be prevented if adults take measures to protect themselves." But what the article fails to mention, he adds, is that "assessment and treatment by a licensed physical therapist is the best way to obtain this protection."

    "A [PT] plan of care will include exercises to improve strength, aerobic capability, flexibility, proper gait, and the function of the vestibular (balance) system," Rockar writes. "Although an individual's age is a risk factor for falling, falls are not an inevitable part of aging."

    Move Forward Radio: Getting an Athlete's Head Around Playing Again

    For athletes who have suffered an injury, return to play may depend on how well they tackle their fear of getting hurt again.

    That's the focus of the latest Move Forward Radio, which examines the psychological toll of sports injuries and its potential effect on an athlete's return to play. The podcast was recorded in light of studies indicating that fear of reinjury is common among athletes with anterior cruciate ligament (ACL) tears who don't return to their sport.

    "With something like ACL injury, there's strength gains to be had, but then there's that neurological control and that confidence in the limb," said Carol Ferkovic Mack, PT, DPT, SCS, CSCS, of the Cleveland Clinic's Sports Health Center, one of the podcast's featured guests. "If those aren't there, then that's the percentage that's not going to return to sport."

    Ferkovic Mack was joined on the podcast by Jack Lesyk, PhD, CC-AASP, director of the Ohio Sports Psychology Center. Both Ferkovic Mack and Lesyk stressed the value of gaining an athlete's confidence in the treatment process in order to achieve recovery.

    "From the psychological point of view, we know that athletes as a group are very goal-directed people," Lesyk, said, "but they're also high-information people—they're used to that from their regular sports training. … Giving them very realistic, honest, complete information about the natural course of recovery and physical therapy is just so important."

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

    Study Cites 'Unacceptably Low' Rate of Osteoporosis Evaluation for Men

    A new study asserts that men over 50 who suffer a wrist fracture—the kind of injury that often indicates skeletal fragility—are not getting adequately evaluated for osteoporosis. Researchers believe that these "unacceptably low" rates are putting men at risk and could be linked to a lingering assumption that osteoporosis is a "women's disease."

    "Men were approximately one-third as likely as women to be evaluated for osteoporosis and to initiate calcium and vitamin D supplementation" after a distal radial fracture, authors write. "Moreover, whereas nearly all osteoporotic women received pharmacologic antiresorptive therapy, only one-third of the osteoporotic men received pharmacologic treatment." Researchers described being male as "the strongest predictor of failure to obtain a [bone mineral density (BMD)] test after fracture."

    The study was based on a single-institution retrospective review of medical records from 95 men and 344 women aged 50 and older who experienced a distal radial fracture, and whether they received a dual x-ray absorptiometry (DXA) scan and osteoporosis treatment within 6 months after the injury. Researchers also looked at how the absence of a DXA scan affected the FRAX algorithm used to place men in risk categories for future osteoporetic fractures. Results were published in the November 5 issue of The Journal of Bone and Joint Surgery (abstract only available for free).

    In addition to confirming that men were far less likely than women to undergo a DXA scan, researchers found that when it was used, the procedure dramatically changed how men were classified in terms of risk for future osteoporosis-linked fractures using the FRAX algorithm. When no DXA scan was performed, 63% of the men were placed in high or intermediate risk categories; when the DXA scan was used, those combined categories jumped to 82%. Even more significant, according to authors, is that the percentage of men classified as high risk increased from 8% without the scan to 53% when the scan was used.

    "Numerous expert panels agree that women over the age of 65 years and those over the age of 50 years who have sustained a fragility fracture should undergo BMD evaluation with [DXA]," authors write, adding that similar studies have called for the same steps with men.

    And though the need for BMD evaluation after a distal radial breaks can sometimes be obscured by age and cause of fracture, the gaps in evaluation are there even in cases of potentially telling hip fractures. "Many studies still show unacceptably low rates of BMD testing … in the female population," authors write. "Rates of BMD testing in men who sustain a hip fracture are even lower, highlighting a critical gap in care."

    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 Helps Consumers Choose 'Sabiamente'

    The debut of a Spanish-language version of APTA's Choosing Wisely® list of "5 things physical therapists and patients should question" will help APTA do more to get the word out about the importance of informed communication between patients and health care providers.

    The translated consumer-friendly summary is available at MoveForwardPT.com and joins multiple resources that provide education on APTA's participation in the Choosing Wisely campaign developed by American Board of Internal Medicine (ABIM) Foundation. The initiative aims to help consumers make informed health care choices by providing lists of procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. Consumer Reports partners with the ABIM Foundation and APTA to share the lists with the public.

    APTA was the first nonphysician group to release a list, joining more than 50 medical specialty societies.

    APTA released its list in September and offers an expanded version containing citations on the association's Center for Integrity in Practice website. Resources on that site also include a ProfessionWatch paper from Physical Therapy that details the process of the list's development and provides professional context for APTA's decision to partner with the ABIM Foundation.

    APTA's Choosing Wisely list is part of a larger APTA Integrity in Practice campaign, an effort to support the profession of physical therapy as a leader in the elimination of fraud, abuse, and waste in health care. The Center for Integrity in Practice website will offer resources throughout the course of the campaign, but already provides a primer on preventing fraud, abuse, and waste, and a free online course on compliance and professional integrity.

    PTNow Blog: Hi- and Lo-Tech Solutions to Journal Club Challenges

    So, maybe you think a journal club is a great idea, but it's hard to meet with your peers, or maybe your immediate coworkers aren't interested, or maybe there just isn't enough time in the day. A new PTNow blog post makes the case that where there's a will, there's usually a (technologically assisted) way.

    PTNow continues its discussion of journal clubs with a post that shares some creative ways to meet the logistical meeting challenges through online and hybrid learning platforms. The blog post covers options for real-time get-togethers that range from the good ol' fashioned conference call to video and file sharing programs such as Google+ Hangouts, and touches on ways to set up a club when it's impossible or inconvenient for members to meet at the same time. All options are easy to set up, and most are free.

    The blog post includes plenty of links to the tech tools, as well as examples of some of the technologies in action. Check it out, and get clubbing.

    Have you ever participated in an online journal club? Post comments, suggestions, and questions to the PTNow blog.

    PTs Do Well in State Races

    Election night was a good night for physical therapists (PTs) running for seats in state legislatures, with members of the profession racking up wins from New Mexico to West Virginia. Overall, 10 PTs won elections, with most running as incumbents.

    PT winners include:

    • Sue Allen, PT – Missouri House of Representatives (3rd term)
    • Debbie Armstrong, PT – New Mexico House of Representatives
    • Mick Bates, PT – West Virginia House of Representatives
    • Karen Bennett, PT, MS – Georgia House of Representatives (2nd term)
    • Joe Farrer, PT – Arkansas House of Representatives (2nd term)
    • Ryan Ferns, PT, DPT – West Virginia Senate (formerly in West Virginia House of Representatives)
    • Deb Lavender, PT – Missouri House of Representatives
    • Phillip Lowe, PT – South Carolina House of Representatives (5th term)
    • Sean Roberts, PT – Oklahoma House of Representatives (3rd term)
    • Bo Watson, PT – Tennessee Senate (3rd term)

    Unfortunately, tight races prevented PT candidates from being elected in 2 states: in Wisconsin, State Assembly member Penny Bernard Schaber, PT, lost her race for a seat in the state Senate; and State Representative Elizabeth Thomson, PT, was not reelected in New Mexico.

    Election Results: Power Shifts, But Not APTA's Focus

    The widespread Republican victories in the 2014 midterm elections will set the stage for both continuity and change, with House leadership remaining largely intact while Senate control moves to the Republicans. For APTA and its members, however, the new Republican-controlled landscape won't alter the association's commitment to moving its legislative and advocacy priorities forward.

    Largely through the efforts of the PT-PAC, its political action committee funded by voluntary member contributions, APTA was able to inform and influence several candidates on issues central to physical therapy. From the $1.3 million in campaign contributions given by the PT-PAC this election cycle, candidates had a 92% success rate in their elections. Now the association's efforts will turn to encouraging APTA members to contact their newly elected representatives as early as possible to keep the momentum going.

    In the US Senate, Republicans will gain at least 7 senators, giving them the majority with 52 seats, with the possibility of adding 1 or 2 additional seats with 3 remaining races to be determined. Republicans also solidified their control of the House of Representatives and will begin 2015 with at least 247 seats (and as many as 250)—the largest House majority the party has held since 1928.

    At the important congressional committee level, where details of legislation are often hammered out, there will be changes to account for vacated seats in leadership and membership positions.

    "With the Senate changing hands, Republicans will now chair all congressional committees," said Michael Matlack, director of grassroots and political affairs for APTA. "Republicans will have a different legislative focus, but APTA is well positioned to continue its advocacy efforts, since many of our legislative priorities are bipartisan in nature."

    Matlack added that when the 114th Congress begins in January, APTA will need to educate new legislators on physical therapy issues and reintroduce important legislation including the repeal of the Medicare therapy cap, whose exceptions process is set to expire March 31, 2015. "In the House, there will be more than 50 new members, and they'll need to be informed of the importance of physical therapy and how health care legislation impacts their constituents." Matlack said.

    With dynamics in Congress expected to change, it is more important than ever for members to stay informed by joining APTA’s PTeam e-mail list to receive updates and Action Alerts when members should contact their legislators on issues. In addition, the PT-PAC has initiated a $20 campaign for APTA members, citing if every APTA member donated $20 each year, the physical therapy profession would have the largest health care provider PAC in the country. Learn more about this campaign here.

    Foundation Funding Opportunities Now Available

    The Foundation for Physical Therapy (Foundation) is now accepting applications for 2 major funding programs.

    Eligibility and application information for the postprofessional 2015 Promotion of Doctoral Studies (PODS) Scholarship and the New Investigator Fellowship Training Initiative (NIFTI) is now posted on the Foundation website. The deadline to apply is January 21, 2015, by 12:00 pm, ET.

    Contact Rachael Crockett for more information, or call 800/875-1378, ext 3385.

    Sign up for the F4PT Alert and be first to know about Foundation funding opportunities.

    Prerecorded APTA Webinars, Audio Courses Available Free to Members for a Limited Time

    It's not news that APTA can help you stay up-to-date on the hottest topics in physical therapy.

    What is news is that for a limited time, you can do it for free.

    During the month of November, APTA is inviting members to enjoy a complimentary prerecorded webinar or audio conference as a thank-you for membership. Choose from programs on audits and appeals, how to overturn denials and get visits approved, the role of the PT in hospice and palliative care, and more.

    1. To redeem your complimentary recorded webinar or audio conference course:
    2. Check out the recorded webinar or audio conference options and select 1 course.
    3. Click the "Purchase Now" link and complete the online store transaction (login required). At the "View Shopping Chart" phase, click "Enter Vouchers," then enter promotion code CEUMBR1114 The member price for the program will be zero.

    Once you receive your order confirmation number, go to "My Courses" to launch the course.

    This offer is nontransferable and expires November 30, 2014. Questions? Contact Member Services or call 800/999-2782, ext 3395, M-F, 8:30 am to 6:00 pm, ET.

    Driven to Save Money on CSM Registration? Step on It

    The finish line is close—are you ready to take the preconference savings victory lap?

    Early-bird registration discounts for the 2015 APTA Combined Sections Meeting (CSM) end at 11:59 pm, ET, Wednesday, November 5. Online registration is quick and easy—and this is your last chance to save big, so shift into high gear.

    The 2015 CSM will be held February 4–7 in Indianapolis. Check out the CSM website to learn more about the programs and networking opportunities being offered.

    Get 'Insider Intel' On New CMS Rules for 2015

    You need to know what to expect next year from the final rules governing the Physician Quality Reporting System, Value-Based Modifier Program, 2015 fee schedule payment rates, and new CMS rules on home health and outpatient treatment. APTA will shed light on these changes during its next “Insider Intel” program on November 12.

    The 30-minute call-in program will begin at 12:30 pm, ET. To register for a spot in the session, e-mail advocacy@apta.org with "November 12 Call" in the subject line. Space is limited.

    "Insider Intel" Q&A call-ins are dedicated to specific hot topics in policy and payment, free to APTA members. If you're unable to participate live, recordings of the calls will be available on the APTA website afterward.

    DMEPOS Final Rule for 2015 Makes Changes to Payment, Competitive Bidding Program Use, Contract Sales

    The phase-in of special payment rules for certain durable medical equipment (DME) and clarification over how the DME fee schedule can be adjusted in areas without competitive bidding programs (CBPs) are among the changes to the Centers for Medicare and Medicaid Services' (CMS) rules on DME, prosthetics, orthotics, and supplies (DMEPOS) for 2015.

    The DMEPOS rule (pdf) affects payment for DME—some of which is frequently used in physical therapy, such as standard power wheelchairs and orthotics—and regulates how CBP pricing will impact non-CBP areas.

    The final rule, to be published on November 6, finalizes a limited phase-in of continuous bundled monthly rental payments for standard power wheelchairs and continuous positive airway pressure devices furnished under the CBP. The bundled monthly rental payments will replace capped rental policies, and cover equipment, supplies, accessories, maintenance, and repairs for the devices. However, no specifics on these special payment rules have been released, and physical therapists who deal with standard power wheelchairs in CBPs have nothing new to comply with at this time.

    Details on the timeframe for the phase-in and impacted DME will be announced later, ahead of the bidding competitions. The advance announcement will include an explanation of why the items are bundled together, and will identify the specific standard power wheelchairs and HCPCS codes that will be subject to these special payment rules. APTA will alert members when this guidance is published.

    The new rule also sets fee schedules for DME in areas where CBPs are not yet implemented based on existing pricing, and defines how competitive bidding contracts can be sold or transferred when DME businesses change ownership.

    In addition, the 2015 DMEPOS rule defines how information from the CBP can be used to adjust fee schedules in areas without the bidding programs. The most notable provisions will limit adjustments to a "national ceiling" of 110% of average regional prices and a "floor" of 90% of average regional prices, and upwardly adjust the fee schedule amounts for certain areas based on competitive bidding prices from these areas or the national ceiling, whichever is higher.

    Other changes to the rule:

    • CMS will expand the policy for rural payment to extend the national ceiling to any areas outside a metropolitan statistical area designated as a rural area, regardless of whether the state meets the existing federal "rural" definition.
    • The 2015 DMEPOS rule will stipulate that bidding contracts cannot be sold or subdivided—instead, the entire bidding contract, including all competitive bidding areas and product categories, must be included in the sale. The final rule establishes circumstances when subdividing would be permitted in the sale of a distinct company that furnishes a specific product category or serves a specific competitive bidding area.

    The final DMEPOS rule did not include a proposed update to the definition of minimal self-adjustment for orthotics. The proposed update would have incorporated existing program guidance around the specialized training needed to provide custom fitting services when providers are not certified orthotists. Even though the regulation is not being updated, the program guidance still stands.

    APTA will be posting a detailed summary of the new rule in the coming weeks.

    NYT on Falls, Part 2: One Woman's Journey

    The second installment of the 2-part New York Times series on falls among the elderly brings the issue to a personal level by following the recovery of a 79-year-old woman who fractured her pelvis in a fall in November 2013.

    "A Tiny Stumble, a Life Upended,” focuses on Joan Rees of San Francisco. Rees suffered her fall in Istanbul, Turkey, last year and only now considers herself fully recovered. NYT reporter Katie Hafner chronicles the warning signs and early falls experienced—and discounted—by Rees, and the sometimes-frustrating journey of recovery.

    Hafner reports that Rees relied on physical therapy throughout her recovery, and that she suffered a "depressing setback" when she was forced to wait for nearly 2 weeks for Medicare to transfer her case so she could resume physical therapy after moving from her son's house back to her own apartment. During the gap, Rees developed sciatic pain and was prescribed Vicodin. "A few days later, [Rees' daughter] arrived at her mother's apartment to find her on the couch, unconscious and drooling," Hafner writes.

    Hafter reports that "6 months after the accident, with regular physical therapy, Mrs. Rees had recovered remarkably well. But to watch her move through her days was to see a lingering tentativeness. Where once her gait was strong and assured, it had turned cautious." Now, according to the article, Rees considers herself fully recovered and "is back to taking lengthy walks around San Francisco."

    Part 1 of the NYT series focused on challenges facilities face in reducing falls risks.

    APTA's Balance and Falls webpage offers a wide variety of resources for physical therapists and consumers. Also check out PTNow for a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people.

    PT in Motion: Physical Therapy Provides a Lifetime of Benefits

    Are physical therapists (PTs) best described as "movement consultants for life?" Or maybe they're a "gateway to better health?" An article in the current issue of PT in Motion magazine makes the case that no matter the metaphor you choose, one thing is clear: PTs are now uniquely positioned to be integral providers across the lifespan, or as one PT describes it, as professionals who are there for people "in sickness and in health."

    In the November issue's cover story "Opportunity of a Lifetime," PT in Motion Associate Editor Eric Ries takes a look at how APTA's vision statement, "Transforming society by optimizing movement to improve the human experience," is already being engaged in by PTs in a variety of settings. Ries interviews 8 PTs to find out how patient-centered medical homes and other innovative models are helping to establish PTs as "lifelong caretakers of the public's health." The article also explores the concept of an annual physical therapy exam to better address Americans' health and wellness needs.

    The ambitious words of the APTA Vision Statement "at once pack a punch and present a conundrum," Ries writes near the beginning of the article. "Namely, how are [PTs] to go about attempting to meet such a hugely ambitious goal?"

    Some interesting, real-world answers to that question can be found in what follows.

    The PT in Motion article on physical therapy through the lifespan appears in the November issue of the magazine. Hard copy versions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Surgery for Spinal Stenosis All Over the Map

    When it comes to surgical interventions for spinal stenosis, patients across the country are subject to an "accident of geography" that makes spinal decompression surgery more than 8 times as likely in Tacoma, Washington, than the Bronx, New York, and spinal fusion surgery 14 times more frequent in Tyler, Texas, than Bangor, Maine.

    The wide variation not only begs further study into the effectiveness of both surgical and nonsurgical approaches but underscores the need for a more standardized shared decision-making process that better educates patients on risks and outcomes, according to the latest installment in the Dartmouth Atlas of Health Care series (.pdf).

    The Dartmouth Atlas report on spinal stenosis looks at Medicare records from 2001 to 2011 for treatment of the condition, which is thought to affect about 30% of people 65 and older. Authors found "dramatic" variations in the 2 most prevalent surgical interventions and an overall increase in the use of spinal fusion surgery, which they described as a "controversial" procedure whose effectiveness "has not been clearly established."

    The rate of more traditional decompression surgery—the removal of tissues compressing the spinal nerves—has decreased as spinal fusion surgery has increased, according to the study, but still accounted for 80 procedures per 100,000 Medicare beneficiaries across the US in 2011. But the overall rate masks significant variation in usage across the country, where some areas reported fewer than 35 procedures per 100,000 Medicare beneficiaries, and others—topped by Mason City, Iowa, at 216.7 per 100,000—exceeded a rate of 180 per 100,000 beneficiaries.

    Between 2001 and 2011, spinal fusion surgery witnessed a 67% increase, to 52.7 per 100,000 Medicare beneficiaries. This intervention shows even more dramatic regional variation, according to the study, with a low of 9.2 procedures per 100,000 in Bangor, Maine, to a high of 89.2 per 100,000 in Mason City, Iowa—a region that also reported a highest rate of decompression surgeries (216.7).

    "Prior work by the Dartmouth Atlas Project has shown that the marked regional variation in surgery for back pain reflects the local practice styles of spine surgeons," authors write. "For the individual patient, there is often not a single 'right' treatment choice. Each has the potential to benefit the patient, but benefit is not certain. Each also entails the possibility of harm or the need for further surgery."

    Other findings in the study:

    • An analysis of the Maine Lumbar Spine Study (MLSS) found that for spinal stenosis, surgical patients self-reported greater improvements in pain and function over 10 years compared with nonsurgical patients, but that gap narrowed over time.
    • The likelihood of a life-threatening complication after a complex fusion surgery was almost 3 times higher than with decompression surgery.
    • Among Medicare patients undergoing any type of surgery for lumbar stenosis, the 5-year reoperation rate was 16% for patients who underwent fusion, and 14% among those with decompression.
    • Approximately 25% of all surgery patients were readmitted because of a surgery-related complication.
    • The study describes nonoperative therapy as an approach whose benefits "have not been demonstrated." Authors write that although 33% of nonoperative patients in a Spine Patient Outcomes Research Trial (SPORT) reported significant improvement in symptoms after 4 years, "this may be as due to a 'tincture of time' as any treatment offered."

    Authors of the study write that the general lack of definitive research supporting one intervention over another, coupled with the risks involved in surgery and the wide regional variation in approaches, make it extremely important for patients to participate in a careful decision-making process. "In ideal settings, patients should be informed about these options and given the opportunity to participate in shared decision-making," they write, "allowing their values and preferences to guide them to the best decision for them."

    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.

    NYT: Aging Population Causes Facilities to Look at New Ways to Reduce Falls Risk

    The ever-increasing numbers of falls occurring among a growing US elderly population are challenging care facilities to re-think nearly every part of their operations, from policies on exercise and the use of restraints to the color of toilet seats, according to a recent story in the New York Times.

    In "Bracing for the Falls of an Aging Nation," NYT reporter Katie Hafner focuses on the Sequoias, a retirement community in San Francisco. Hafner's report touches on the design and structural changes the facility is making to reduce falls likelihood, and the efforts being taken to educate residents on falls prevention. Hafner writes that the Sequoias must take on these projects while respecting the "feisty independence" of its residents, who she describes as "former professors, physicians, and executives" who are "accustomed to telling others what to do, not the other way around."

    The NYT report includes descriptions of how architects and interior designers are reexamining buildings from the perspective of a person who is elderly with failing eyesight. Designers are now looking at features such as stairs, thresholds, and shower stalls through special glasses that cloud and discolor their vision to simulate the challenges faced by a resident, Hafner writes, and making changes that they hope will reduce falls. Some of those changes at the Sequoias include installing dramatically contrasting color strips at the tops and bottoms of stairs, more clearly visible shower stall thresholds, and black toilet seats on white toilets.

    The NYT article includes video links that show how low-contrast steps and showers appear to individuals with cataracts and glaucoma.

    Hafner's report also examines the challenges faced by facilities to better educate residents on the importance of exercise, the realities of falls risk with age, and mitigation and response options. Often, she writes, residents deny the dangers and forgo exercise until it's too late. "Though the risk of a fall increases significantly once people reach their 80s, researchers have found that people 85 and older in excellent health have no greater risk than someone 20 years younger," Hafner writes.

    The article explains how, once bedridden after a fall, individuals who are elderly can lose muscle mass at a rate of 1% per day; however, the gradual decreases in mobility or balance that can lead to a serious fall are often discounted—or purposefully ignored. The real work for facilities, Hafner writes, is to get residents to move past a sense of denial that causes them to "pay scant attention to their risk for a fall until it happens."

    APTA offers a wealth of resources on balance and falls, most of them accessible via the association's Balance and Falls webpage. Offerings range from consumer-focused information including a video, a PT's guide to falls, handouts on falls prevention and physical therapy and the balance system (members-only .pdfs), to PT- and PTA-focused information on how to develop community events on balance, falls, and exercise. Members can also access several continuing education courses related to falls at the Balance and Falls page, and the PTNow evidence-based practice resource includes a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people.