A new study is challenging widely made assertions that vitamin D supplements decrease falls risk, particularly in community-dwelling adults over 65. According to the latest analysis, "there is little justification for prescribing vitamin D supplements to prevent falls"—a conclusion in direct contrast to recommendations published as late as January of this year.
Results of the research, e-published on April 24 in the Lancet (abstract only available for free), were based on a sequential analysis of 20 randomized controlled trials that encompassed 29,535 subjects. The trials were designed to assess the impact of vitamin D supplements, both with and without calcium, on falls prevention. The authors of the Lancet article were unequivocal in their conclusion: there was no demonstration of reduced risk above 15%, regardless of whether the vitamin D regimen was accompanied by calcium. "Further clinical trials of the effect of vitamin D supplements on falls might be difficult to justify," the authors write.
The findings mirrored similar conclusions reached by the same researchers around vitamin D's effects on fracture, cardiovascular events, cancer, and mortality. In all cases, they write, "existing trials reliably show that vitamin D supplementation, with or without calcium, does not produce clinically relevant effects." The Lancet article adds falls risk reduction to that list.
The study runs counter to several guidelines, including a consensus opinion published in the Journal of the American Geriatrics Society earlier this year. That opinion echoed a 2012 recommendation from the US Preventive Services Task Force (USPSTF), which advocated for vitamin D supplementation as part of falls prevention in community-dwelling adults aged 65 years or older.
Authors of the Lancet study defended their use of a 15% risk reduction rate in the analysis by writing that "treatment effects [smaller than 15%] are unlikely to be attractive to patients because the absolute benefit is small and does not justify the effort of taking the treatment. Furthermore, the results did not change when a 10% risk reduction threshold was used."
APTA provides education on exercise prescriptions for balance improvement and falls prevention, and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, and information on evidence-based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as take part in an online community where members can share information about falls prevention.
Research-related stories featured in News Now 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.
An unencrypted laptop stolen from a Missouri physical therapy center has resulted in a $1.7 million fine against the center's owners.
The US Department of Health and Human Services Office for Civil Rights (OCR) announced that Concentra Health Services has agreed to pay the fee to settle potential violations of HIPAA rules when a laptop was stolen from the Springfield Missouri Physical Therapy Center, owned by Concentra. The laptop was unencrypted and contained health records protected by HIPAA.
According to a press release from OCR, investigations into the incident "revealed that Concentra had previously recognized in multiple risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information (ePHI) was a critical risk," but made "incomplete and inconsistent" efforts to properly encrypt computers and other devices.
“Covered entities and business associates must understand that mobile device security is their obligation,” said Susan McAndrew, OCR’s deputy director of health information privacy in the press release. “Our message to these organizations is simple: encryption is your best defense against these incidents.” In addition to the fines, Concentra has agreed to adopt a corrective action plan and document its efforts at remediation.
Under the HIPAA Omnibus Rule released in January 2013, providers—including physical therapists—can be subjected to extreme financial penalties for data breaches ranging from $100 per violation to a maximum of $1.5 million in a calendar year.
OCR also announced the settlement of a February 2012 breach from QCA Health Plan Inc of Arkansas involving the theft of ePHI of 148 individuals. The settlement in that case was $250,000.
HIPAA rules can be complex, but the consequences of not understanding them can be serious. APTA provides resources on compliance on APTA's HIPAA webpage. In addition, OCR offers 6 educational programs on HIPAA compliance, including a program devoted to mobile device security.
Some of the best opportunities for physical therapy advocacy don't happen on Capitol Hill, but on a legislator's home turf—and now is a great time to prepare by requesting a meeting, and maybe even shooting your own patient or client video, according to the APTA advocacy team.
The US House of Representatives will be in recess from May 12 to 16, and the Senate's recess is set for May 26 to 30. Recently, APTA sent out a notice to members reminding them of the upcoming opportunities to schedule in-person meetings.
One great advocacy suggestion: a short video of a patient telling his or her compelling story, directly addressing the legislator about the importance of physical therapy. It's a strategy that worked for Eva Norman, PT, DPT, CEEAA, who shot a video of her patient the Rev. Marguerite Voekel, and showed it to Rep Keith Ellison (D-MN) during the 2014 APTA Advocacy Forum in Washington, DC. Rep Ellison was so taken by the video that he shot a personal video response to Voekel on the spot.
The ATPA advocacy team offers some tips on video statements:
Not sure where to start? Visit APTA's Advocacy Involvement Opportunities webpage or contact APTA and we will help you start to build a relationship with your legislators. If you're interested in attending a local fundraiser, contact the PT-PAC. PT-PAC provides funds to send APTA members to local events for members of Congress who support the physical therapy profession.
The latest addition to the APTA website helps to provide physical therapists (PTs) with resources on physical therapy in the neonatal intensive care unit (NICU), the source of medical care for more than 3% of all infants born in the US.
Although not intended to provide PTs with everything they need to know to practice in the NICU, the webpage does include information on roles and training, a list of resources, and links to relevant journal articles.
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