physical therapists (PTs) are preparing for a key hearing and possible vote on
legislation aimed at prohibiting them from performing joint manipulation.
California Senate Bill 381 (SB 381),
authored by state Sen Leland Yee and
sponsored by the California Chiropractic Association, is scheduled to be heard on Monday, April 15, at 1:00 pm, in the California Senate Business,
Professions, and Economic Development Committee in Sacramento.
legislation would prohibit anyone other than a chiropractor, physician, or
osteopath from performing joint manipulation in the state and make the term
"joint manipulation" synonymous with "joint adjustment."
Under SB 381, any health care practitioner other than a chiropractor,
physician, or osteopath who performs a joint
manipulation in California would be considered to be engaged in the unlawful
practice of chiropractic and result in the possible revocation or suspension of
the health care practitioner's license.
The legislation has been introduced under the guise of "public
protection," despite that fact that there is no data or evidence suggesting that
there is a greater threat to patient safety from physical therapists performing
joint manipulation techniques. The performance of joint manipulation by
physical therapists is different from a joint adjustment performed by
chiropractors. The legislation is part of an ongoing turf battle against
qualified physical therapists who perform joint manipulation.
APTA and its California Chapter strongly oppose SB 381, as treatment
interventions do not fall under the exclusive domain of any one specific
profession. Physical therapists, chiropractors, medical doctors, and
osteopathic physicians are all educated and trained to employ joint
manipulation within the scope of their respective licenses and in a manner that
protects the public's health, safety, and welfare. Unnecessarily restricting
any qualified licensed health care providers whose education and scope of
practice includes joint manipulation from being able to provide joint
manipulation is anti-competitive, and would diminish patient choice and
increase health care costs.
California Chapter members are encouraged to contact their state legislator and the members of the Senate Business,
Professions, and Economic Development Committee to
oppose SB 381 and, if possible, attend the April 15 hearing at the state
capitol in Sacramento.
the chapter has a number of other contentious legislative battles looming this
year: legislation to provide for full patient access (Assembly Bill 1000) was
recently introduced in the California
Assembly, while legislation to repeal its current anti-POPTS law (Assembly Bill
1003) also has been introduced.
The Centers for Medicare and
Medicaid Services (CMS) released a proposed rule
yesterday outlining standards that "navigators" in federally facilitated
and state partnership exchanges, also known as marketplaces, must meet.
Navigators are entities or
individuals that will provide accurate and unbiased information to consumers
about the exchanges, qualified health plans, and public programs including
Medicaid and the Children's Health Insurance Program. For those who are not
familiar with health insurance, have limited English literacy, or are living
with disabilities, navigators will help ensure that they understand their
health coverage options.
The proposed standards would help
ensure that navigators and other assistance personnel will be fair and
impartial and will be appropriately trained, and that they will provide
services and information in a manner that is accessible.
CMS also proposes 2 amendments to
the existing regulation for navigators that would apply to all navigators in exchanges,
clarifying that any navigator licensing, certification, or other standards
prescribed by the state or exchange must not prevent the application of the
provisions in the Affordable Care Act. The proposal also seeks to make entities
with relationships to issuers of stop loss insurance (policies that protect
catastrophic claims) ineligible to become navigators, including those who are compensated directly or indirectly by
issuers of stop loss insurance in connection with enrollment in qualified
health plans or non-qualified health plans. The same ineligibility criteria
that apply to navigators would also apply to non-navigator assistance personnel
providing services in any federally-facilitated exchanges, including in state
consumer partnership exchanges, and to federally funded non-navigator
assistance personnel in state-based exchanges.
In addition to navigators, consumers
will have access to assistance through services such as a call center, which
will be operated by the Department of Health and Human Services, for obtaining
referrals to the appropriate state or federal agencies, in-person assistance
personnel, certified application counselors, and agents and brokers.
leading injury analyst for fantasy sports joined Move Forward Radio today to
discuss one of the most talked-about injuries in professional sports: anterior
cruciate ligament (ACL) tears.
the latest episode of APTA's consumer-oriented online radio show, Stephania
Bell, PT, OCS, CSCS, describes the injury that in recent years has affected
elite athletes—ranging from football's Adrian Peterson to baseball's Mariano
Rivera and skiing's Lindsey Vonn—and is becoming increasingly common among
youth and amateur athletes.
the interview, Bell outlines possible similarities and differences between
treatment programs for elite and nonelite athletes, and she provides advice for
parents of youth athletes about ways to protect against ACL tears, which are
more likely to be suffered by girls than boys.
the course of the 37-minute episode, which was a Blog Talk Radio "Staff Pick" for April
4, Bell also describes her path to becoming the face of injury analysis for
fantasy sports at ESPN.
issued a press release about the show
and also promoted MoveForwardPT.com's Physical Therapist's Guide to ACL Tear via social media.
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.
members are encouraged to alert their patients to this 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 firstname.lastname@example.org.
rehabilitation for long‐term care residents may be effective,
reducing disability with few adverse events, but effects appear quite small and
may not be applicable to all residents, say authors of an updated Cochrane review
first published in 2009. There is insufficient evidence to reach conclusions
about improvement sustainability, cost‐effectiveness,
or which interventions are most appropriate, they add. Future large‐scale
trials are justified.
For this update, the authors
searched the trials registers of Cochrane entities, trials and research
registers, and conference proceedings; checked reference lists; contacted
authors, researchers, and other relevant Cochrane entities; and updated
searches of electronic databases in 2011 and listed relevant studies as
awaiting assessment. They selected randomized studies comparing a
rehabilitation intervention designed to maintain or improve physical function
with either no intervention or an alternative intervention in older people
(over 60 years) who have permanent long-term care residency.
Two review authors independently
assessed risk of bias and extracted data. The primary outcome was function in
activities of daily living. Secondary outcomes included exercise tolerance,
strength, flexibility, balance, perceived health status, mood, cognitive
status, fear of falling, and economic analyses. The authors investigated
adverse effects, including death, morbidity, and other events. They synthesized
estimates of the primary outcome with the mean difference; mortality data with
the risk ratio; and secondary outcomes, using vote-counting.
The authors included 67 trials
involving 6,300 participants. Fifty-one trials reported the primary outcome, a
measure of activities of daily living. The estimated effects of physical
rehabilitation at the end of the intervention were an improvement in Barthel
Index (0 to 100) scores of 6 points (7 studies), Functional Independence
Measure (0 to 126) scores of 5 points (4 studies), Rivermead Mobility Index (0
to 15) scores of 0.7 points (3 studies), Timed Up and Go Test of 5 seconds (7
studies), and walking speed of 0.03 m/s (9 studies). Synthesis of
secondary outcomes suggested there is a beneficial effect on strength,
flexibility, and balance, and possibly on mood, although the size of any such
effect is unknown. There was insufficient evidence of the effect on other
secondary outcomes. Based on 25 studies (3,721 participants), rehabilitation
does not increase risk of mortality in this population (risk ratio 0.95).
However, it is possible bias has resulted in overestimation of the positive
effects of physical rehabilitation, say the authors.
has developed new resources to help physical therapists understand the impact
that regenerative rehabilitation and genetics have on physical therapist
practice. The Regenerative Rehabilitation webpage includes 2
podcasts, an audio course, and other relevant resources. The Genetics in
Physical Therapy webpage provides
general information, links to PT in
Motion and PTJ articles, and
features a 2-part session on genomics presented by leaders in orthopedics and
neurology at the 2013 Combined Sections Meeting.
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