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  • APTA Among First Nonphysician Groups to Partner in Choosing Wisely Campaign

    The American Board of Internal Medicine (ABIM) Foundation has announced that APTA will be among the first 3 nonphysician provider organizations to partner later this year in a high-profile national campaign to educate consumers on making informed health care choices. APTA will prepare to join the "Choosing Wisely" initiative by surveying members to refine a list of the top 5 physical therapy tests and procedures that may be unnecessary under certain circumstances.

    The association will join the American Dental Association and the American Academy of Nursing as the first nonphysician provider organizations to be included in Choosing Wisely, a campaign centered around lists of procedures (.pdf) that tend to be done frequently, yet whose usefulness is called into question by evidence. Consumer Reports is partnering with the ABIM Foundation to promote the campaign and helped to create a video describing the effort. According to a press release from the ABIM Foundation, "Consumer Reports will also work with each organization to develop patient-friendly materials based on their lists."

    "Care that is best for the patient has always been a priority for APTA," said APTA President Paul A. Rockar, PT, DPT, MS. "This is why we have chosen to join the Choosing Wisely effort. Choosing Wisely perfectly addresses the patient's role in good health care, and there couldn't be a better fit for what we're trying to achieve with our Integrity in Practice Initiative," a broad effort to eliminate fraud, abuse, and waste from health care and strengthen the good reputation of physical therapy. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion.

    APTA's efforts to create its Choosing Wisely list are already under way. In March, the association called for input from members and received more than 200 suggestions for possible inclusion. APTA will convene an expert panel to review and rate all member submissions and create a list of approximately 10 potential items that will be narrowed down to 5 by way of an all-member survey. The top 5 questioned procedures will then go to the APTA Board of Directors before being submitted to the ABIM Foundation for final approval.

    "APTA is committed to taking the lead in promoting transparency and education of patients and health care providers for a better and more streamlined health care system," Rockar said. "A well-informed patient is a well-treated patient. We are extremely pleased to be joining this outstanding project."

    Arizona: Dry Needling Now Included in PT Scope

    Arizona now specifically includes dry needling in the physical therapist (PT) scope of practice. The legislation was signed into law by Gov Jan Brewer on April 25.

    The final bill, sought by the Arizona Physical Therapy Association and sponsored by Arizona state Sen Kelli Ward (R-5), was the result of "3 years of challenges, hard work, and debate, including a statewide task force that held numerous meetings and public hearings," according to a press release from APTA.

    Arizona Chapter President Linda Duke, PT, said that “Many legislators, educators, professionals, and patients were involved crafting this bill to satisfy the concerns brought forward from outside the physical therapy profession." Duke gave special recognition to chapter members, the chapter's dry needling task force, and the Manual Physical Therapy Alliance. Duke also singled out chapter members Sara Demeure, PT, MSPT, OCS, and Sean Flannagan, PT, DPT, who were key throughout the process.

    "The American Physical Therapy Association applauds the team effort in Arizona that advocated in support of SB 1154,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. "Working together, we can ensure that the patients we serve have access to the full scope of physical therapist services.”

    The new law includes language that gives the Arizona State Board of Physical Therapy the authority to promulgate rules outlining training and education qualifications for dry needling performed by PTs. Dry needling is recognized as part of the PT scope of practice in a majority of US jurisdictions.

    PT in Motion: Women's Health PTs Taking the Pelvic Floor 'Out of Isolation'

    Putting evidence into practice requires hard work, creativity, critical insight, and willingness to approach information with an open mind—exactly the qualities demonstrated by members of APTA's Section on Women's Health featured in the most recent issue of PT In Motion, the association's member magazine.

    In his article "Making Core Connections," APTA Associate Editor Eric Ries interviews several physical therapists who are making advances in treatment of pelvic floor weakness and related problems. For some of these PTs, their motivation arose from their personal experiences with pelvic floor issues; for others, their new approaches are rooted in a commitment to help a patient population often demoralized by what seemed to be an inescapable condition.

    All of the PTs featured in the article share a high level of energy and "a willingness to hear new information with a very open mind," according to Mary Massery, PT, DPT, DSc, a prominent researcher. "I'll offer women's health PTs ideas, coming from my perspective in cardiopulmonary physical therapy, and instead of saying, 'This can't have any relevance to us,' they ask, 'Could it apply?' and ask me to tell them more."

    The PT in Motion article on women's health PTs appears in the May 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.

    Experimental Muscle Regrowth Procedure Involves Physical Therapy

    An experimental approach that uses material from pig bladders to grow new muscle is showing some early promise for victims of volumetric muscle loss, but the success of the procedure depends on physical therapy that begins soon after surgery.

    In the procedure, conducted on only 5 patients, researchers transplanted specially treated extracellular matrix from pig bladders into body areas that had suffered significant loss of muscle. According to the authors, the matrix acts like "scaffolding" that draws a patient's own stem cells to the site when the matrix begins to decay. Researchers say that 3 patients experienced a 20% increase in strength and a 25% improvement in function 6 months after the surgery.

    The research report was published in the April 30 issue of Science Translational Medicine (abstract only available for free). News of the report spread quickly to major media outlets including Reuters, the Los Angeles Times(LAT), National Public Radio, and NBC News.

    While much of the focus of the news reporting was on the use of the matrix tissue, the lead researcher interviewed in the stories stressed that the surgery itself only sets the stage for muscle growth that relies on physical therapy initiated within 2 days after the procedure. Because the stem cells drawn to the site of the matrix can generate a variety of tissues, patients need to engage in physical therapy to train the cells to generate muscle. In the LAT article, lead researcher Stephen Badlyak is quoted as saying "The cells get the idea to say: 'OK. I get it. I'm supposed to line up this way. I'm supposed to be the type of a cell that can bear weight, or contract.' If that doesn't happen when they get there, and they don't get those signals, they can turn into anything else."

    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.

    PTNow Blog: Since When Is Patient Education Not Physical Therapy?

    According to recent stories in major media outlets, physical therapy "may not help whiplash pain" or may be no more effective than "just one exercise education session." According to the latest blog post in PTNow, recent stories are missing the point.

    "It's not that physical therapy isn't valuable for treating … whiplash," the blog states. "It's that one type of physical therapy intervention (patient education, according to this study) may be just as beneficial and more cost-effective than others."

    The blog also includes thoughts from the lead author of the article that generated so much interest. Zoe Michaleff, PhD, warns that her findings "should not be interpreted as encouragement to abandon exercise or physiotherapy in these patients." Instead, she says, the report should make physical therapists think about the role of patient education in their practices.

    What's your take on patient education? Check out the PTNow blog and join the discussion.

    Proposed CMS Rules for Hospitals Would Cut Payments, Institute Function and Mobility Measures

    A $241 million reduction in payments to acute-care hospitals and a slight payment increase (.8%) for long-term-care hospitals (LTCH) are among the proposed Medicare payment and policy changes for hospitals issued by the Centers for Medicare and Medicaid Services. The proposed rule (.pdf) would also institute functional status quality measures around mobility and function for LTCHs. If finalized, the policies will be effective October 1, 2014.

    The $241 million reduction would affect roughly 3,400 hospitals nationwide, while the .8% increase to LTCHs would affect 435 facilities and amount to an increase of $44 million. Additionally, hospitals that successfully participate in Medicare's quality reporting system and meet the criteria for meaningful use of health information technology will receive a 1.3% payment increase.

    In an acknowledgment of the benefits of early mobilization and rehabilitation, the policies also establish 2 functional status quality measures for LTCHs. One of the measures is focused on increasing the percentage of LTCH patients with admission and discharge functional assessments and care plans that addresses function; the second measure is centered on change in mobility among LTCH patients who require ventilator support. Both measures would be implemented in 2018.

    Also included in the proposed rule is a call for suggestions from providers on ways Medicare might handle reimbursement for short hospital stays. The request for input is being made in response to objections from health care providers on the "2 midnight" rule that CMS has yet to fully enforce. Last month, the American Hospital Association (AHA) announced that it was filing a lawsuit to strike down that rule.

    APTA will submit comments on the proposed rule by the June 30 deadline. The final rule will be released by August 1.