a new APTA podcast, Kim Redlin, a third-year doctor of
physical therapy student at St Catherine University, shares how she has
incorporated motivational interviewing (MI) into her interactions with
patients. Specifically, Redlin describes how while working with a patient who
had knee replacement surgery she was able to obtain meaningful information
about the patient's efforts to quit smoking that "slowly opened the
door" for her to provide education about behavior change. Redlin also
discusses how MI "can be a real challenge for both students and
professionals." She asks, "[Y]ou want to make sure that all boxes get
checked – get informed consent, get a pain rating, get a range of motion
measurement, use an outcome measure, but how often is there a box to check for
addressing health behaviors and talking about change?"
podcast is the fourth in a series
on behavior change.
podcasts are prerecorded discussions and interviews, not live events. Members
can listen to podcasts at their convenience by clicking on the links provided
in News Now articles,
visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.
patients who have primary unilateral knee arthroplasty, as rehabilitation
visits increased there was a direct association to improved interlimb
weight-bearing symmetry when squatting to 60 degrees, say authors of an article in American Journal of Physical Medicine &
For this study, the percentage of body weight placed over both limbs during
stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had
primary unilateral knee arthroplasty was determined. An asymmetry index was
used as a marker that could discriminate between patients who perceived at
least moderate difficulty with functional tasks and those who perceived only slight
or no difficulty with functional activities based on the physical function
dimension of the Western Ontario McMaster Universities Osteoarthritis index
approximately 1 week after surgery. Stepwise regression was conducted to
determine whether clinical characteristics predicted weight-bearing asymmetry
At initial visit (first observation), compared with the uninvolved side,
individuals placed significantly less body weight over the involved or operated
limb for stand and 30- and 60-degree squats. Results were similar at last
rehabilitation visit (second observation). Identifying at least moderate
self-reported difficulty with functional tasks based on the receiver operator
characteristic curve for the asymmetry index for the stand position was 0.64,
whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and
0.89, respectively. At discharge from rehabilitation, there was a moderate to
good direct relationship (r = 0.70) between the number of rehabilitation visits
completed and the weight-bearing asymmetry index for the 60-degree squat.
APTA member Mark D.Rossi, PT,
PhD, CSCS, is the article's lead
author. APTA members Thomas Eberle, PT, DPT, DMT, FAAOMPT, Denis
Brunt, PT, EdD, Marlon Wong, PT, DPT, OCS, MTC, and Matthew Waggoner,
PT, DPT, MTC, are coauthors.
American Diabetes Association
is recommending changes in blood pressure goals for people with diabetes and
clarifying how frequently people with type 1 diabetes should test their blood
The revised recommendations include raising the treatment goal for high
blood pressure from <130 mm Hg to <140 mm Hg, based on several new
meta-analyses showing there is little additional benefit to achieving the lower
targets. Clinical trials have demonstrated health benefits to achieving a goal
of <140 mm Hg, such as reducing cardiovascular events, stroke, or
nephropathy, but limited benefit to more intensive blood
pressure treatment, with no significant reduction in mortality or nonfatal
heart attacks. There is a small but statistically significant benefit in terms
of reducing risk of stroke, but at the expense of a need for more medications
and higher rates of side effects.
The new standards also clarify when people who are taking multiple daily
doses of insulin (MDI) or using insulin pumps, typically those who have type 1
diabetes, should test their blood glucose levels. Previously, the standards
called for those taking insulin to test "3 or more" times throughout
the day, a recommendation that was sometimes misinterpreted to mean that 3
times per day was sufficient. Recognizing that the frequency of testing will
differ by individual and by situation, the new standards do not specify the
number of times that testing should occur but instead focus on the conditions
under which testing should occur. For example, the standards now specify that
patients on MDI or insulin pumps should test prior to meals and snacks,
occasionally after eating, at bedtime, before exercise, when they suspect low
blood glucose, after treating low blood glucose levels until they return to
normal, and "prior to critical tasks such as driving."
Additionally, the new standards highlight that for patients on less
intensive regimens or noninsulin therapies, self-monitoring of blood glucose
needs to be linked to educating the patient about how to use the information
about glucose levels appropriately. These patients must also be educated about
how frequently they need to test and under what conditions.
The new guidelines will be published in a special supplement to the January
issue of Diabetes Care as part of the
association's revised Standards of Medical Care, which are updated annually to
provide the best possible guidance to health care professionals for diagnosing
and treating adults and children with all types of diabetes. The standards are
based upon the most current scientific evidence, which is reviewed by the
association's multidisciplinary Professional Practice Committee.
is rewarding 1,557 hospitals with bonuses and reducing payments to 1,427 others
based on their readmission rates for heart attack, heart failure, and
pneumonia, says a Kaiser Health News article.
The biggest bonus is going to Treasure Valley Hospital, a physician-owned,
10-bed hospital in Boise, Idaho, that is getting a 0.83% increase in payment
for each Medicare patient. Auburn Community Hospital, a nonprofit near
Syracuse, New York, is facing the biggest cut, losing 0.9% of every payment.
On average, hospitals in Maine, Nebraska, South Dakota, Utah, and South
Carolina will fare the best. Hospitals in the District of Columbia,
Connecticut, New York, Wyoming, and Delaware are among the worst, the article
Results for hospitals within the same system often varied. For instance, in
Rochester, Minnesota, the Mayo Clinic's Methodist Hospital will get a bonus.
But Mayo's flagship St Mary's Hospital, also in Rochester, will lose money.
Michael Rock, MD, an orthopedic surgeon at the Mayo Clinic, said that
Medicare's scoring system tends to favor hospitals such as Methodist, which
primarily does elective surgeries, over hospitals with lots of trauma and
emergency cases, which St Mary's handles.
Under the Affordable Care Act's Hospital Readmissions Reduction Program, Medicare will begin adjusting
payments next month through September 2013 and will retroactively apply the
changes to payments made in the last 3 months of this year.
The bonuses and penalties do not apply to money Medicare pays hospitals for
capital expenses, to teach residents, or to treat large numbers of low-income
patients. Hospitals with too few cases and ones that only offer specific
specialties, such as psychiatry, long-term care, rehabilitation, and cancer
treatment, are exempted. Maryland hospitals also are excluded because the state
has a unique reimbursement arrangement with the federal government.
Kaiser Health News reported that more
than 2,000 hospitals were expected to be penalized.
therapists can help serve an important role in patient care transitions and
care coordination and can help reduce readmissions by providing recommendations
for the most appropriate level of care to the health care team prior to and
during care transitions. For more information and to find clinical practice and
patient education resources to reduce readmissions, visit APTA's Hospital
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