• Tuesday, May 13, 2014RSS Feed

    New American Diabetes Association Patient Resource Available for Free to PTs, PTAs

    Physical therapists (PTs) and physical therapist assistants (PTAs) have access to a new free resource for patients and clients recently diagnosed with type 2 diabetes, courtesy of the American Diabetes Association (ADA).

    Called "Where Do I Begin," the 16-page guide helps patients and clients understand the fundamentals of type 2 diabetes and the steps that can be taken to live with the disease. The publication includes information on the role of exercise, proper diet, medicines, and support in managing the condition, and encourages patients to sign up for a free 1-year ADA program called "Living With Type 2 Diabetes."

    The booklets are being offered at no charge. PTs and PTAs interested in obtaining copies of "Where Do I Begin" can order online.


    Tuesday, May 13, 2014RSS Feed

    Innovative Physical Therapy Models Vie for Support at Workshop

    How do you bolster widespread replication of promising models of health care delivery across the country? Feed them to the sharks.

    Although the inhabitants in APTA’s Innovation 2.0 Workshop “tank” resembled friendly dolphins more than bloodthirsty sharks, their valuable feedback gave presenters at the workshop plenty to consider as they now refine proposed models, in search of funding and other support from the association.

    The May 8-9 workshop in Alexandria, Virginia, featured a “Shark Tank” set-up, in which 21 proposed models were presented to expert panelists for questions and critique. These 21 finalists, chosen before the workshop from 60 submitted models, will use the advice to finalize detailed proposals in hopes of being among those chosen by APTA to receive funding and in-kind services to advance their models. In return, APTA will be able to access model data that potentially helps the association develop and disseminate resources that enable members to promote the impact of physical therapy in the emerging health care environment.

    While each proposed model was different, a few common themes emerged:

    • The promise of overall cost savings often was the attention-getter for receiving internal support for a project, even if physical therapy-specific expenditures increased, if they enabled other expenditures to drop.
    • Working to even out health disparities among underserved or disadvantaged populations was an important factor in many programs.
    • Interprofessional collaboration was key in most cases.

    Interspersed between the model presentations, speakers offered their expertise on several relevant topics.

    Alan Jette, PT, PhD, FAPTA, stressed that what we do now won’t be useful unless it becomes the new normal—translating the results from clinical studies to everyday practice. From here, Jette said, we need to plan initiatives to achieve dissemination and adoption of clinical innovations, such as a “PT innovation extension service” or “PT innovation fellowships.” By fostering innovation in this way, not only can initiatives such as the 21 described at the workshop start making a difference now, but, as noted by APTA CEO Michael Bowers in opening remarks, they “will make a difference in years to come.”

    To give presenters and audience alike an example of an innovation that already was taking off, Mary Stilphen, PT, DPT, and Diane Jette, PT, DSc, FAPTA, described the Cleveland Clinic’s “6-Click” initiative, which calls for shortened forms to collect examination data—6 list items only per category such as “functional mobility.” The data gleaned from the time-saving forms, among other things, enabled more physical therapy staff to integrate into the ICU, as they could shift away from higher-functioning patients who didn’t need such a high level of help.

    Meanwhile, Tony Delitto, PT, PhD, FAPTA, explained how to collect data and measure outcomes; Carolyn Oddo, PT, MS FACHE, described characteristics of successful relationships and teams; and Bill Boissonnault, PT, DHSc, FAPTA, shared advice on writing administrative case reports for publication in journals such as PTJ.

    More details on the model selection process, timeline for final decisions, and a list of the 21 presentations up for critique are found on the APTA Innovation 2.0 webpage. Look for more coverage when the winners are announced this summer.


    Tuesday, May 13, 2014RSS Feed

    Concussion Symptoms For Children May Change Over Time, Include Emotional Elements

    Children who experience concussions may find some symptoms fading relatively quickly while others emerge later in a progression that authors of a new study believe should inform how these children are cared for at home and school. This "significant burden of disease" tends to begin with physical symptoms that end soon after the injury, emotional symptoms occurring later, and cognitive symptoms beginning immediately at lasting for 1 month or more.

    The new study, e-published in the May 12 issue of Pediatrics (abstract only available for free), tracked self-reports of 235 patients aged 11 to 22 who presented to a hospital emergency department (ED) with concussion. Patients (or their parents) filled out the Rivermead Post-Concussion Symptoms Questionnaire at or near the time of injury, and then at 1, 2, 4, 6, 8, and 12 weeks afterwards. Authors chose the Rivermead instrument because of its high inter-rater and test-retest reliability, and because the questionnaire asks participants to rate symptoms relative to their own pre-concussion "baseline."

    Authors found that rather than experiencing many symptoms that gradually abated at different rates, patients often experienced a "course of symptoms," with some arising after others have diminished. "Although headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not been present initially after the injury," they write.

    For example, although fatigue was the second-highest reported symptom at the ED (headache was first) with 64.2% of patients reporting the symptom, another 15.4% of children who did not report fatigue at the ED did list the symptom in later weeks. Additionally, "a substantial number of children" (21.6%) also developed sleep disturbance after initial evaluation. "This finding suggests that children who have a concussion should be warned about the possibility of developing fatigue and sleep issues, and these symptoms should be specifically assessed during follow-up evaluation," authors state.

    Other cognitive and emotional symptoms that developed after initial assessment included forgetfulness (15.8%), poor concentration (13.1%), taking longer to think (11.1%), frustration (17.1%), irritability (14.5%), and restlessness (14.1%). Of patients reporting these symptoms at or after presentation, 18.3% reported taking longer to think as a symptom 28 days after ED assessment, with frustration, irritability, and restlessness still present in 14.7%, 14.2%, and 10.6% of patients respectively.

    "Cognitive symptoms were particularly significant in our cohort," the authors write. "They were present in substantial percentages initially, still went on to develop in many additional patients, and had greater than average duration of symptoms, with the exception of forgetfulness …. These findings support the importance of academic accommodations for children after concussion."

    APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a physical therapist (PT) and offers multiple resources. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and access to evidence-based practice research through PTNow.

    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.


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