Need confirmation of physical therapy's role in education, prevention and treatment of concussion in youth sports? Would an invitation from the White House do?
APTA President Paul A. Rockar Jr, PT, DPT, MS, and APTA staff were on hand for a May 29 gathering at the East Wing of the White House during which President Barack Obama announced new public and private sector commitments to increase awareness of concussions in youth sports, and to encourage more research into the topic. APTA was among the groups invited to attend the event.
The association has a long history of support for concussion education and research, and shared its "planned commitment to action" with the White House and summit attendees. That commitment includes member education; the development of multi-disciplinary treatment standards; interprofessional collaboration to raise awareness; the development of new prevention, identification, and rehabilitation tools; and the creation and dissemination of concussion-related resources for parents and coaches.
APTA has also advocated for policy changes and guidelines on the state and federal level, and has worked with the Centers for Disease Control and Prevention (CDC) on the issue of concussions. Two APTA members serve on the CDC Pediatric Traumatic Brain Injury Guideline Workgroup.
"Physical therapists provide a unique contribution to the concussion care management team, particularly in the areas of balance and vestibular evaluation and rehabilitation," said Rockar in an APTA news release. "We continue our commitment to research, education, prevention, education, and treatment. We are honored today to be invited by the White House to participate in this summit and look forward to future work with other stakeholders involved in addressing this important issue."
Check out APTA's practice-focused resources on concussion, including a TBI webpage, a series of podcasts, a PT's guide to concussions, online learning opportunities on when to return to sport, and information on managing concussions with an interprofessional team. Members can also access evidence-based practice research through PTNow.
APTA is asking its members to choose wisely in order to help consumers do the same.
This week, all APTA members were invited by e-mail to participate in a survey that will help the association identify the "top 5 things physical therapists (PTs) and patients should question," for consideration to be included in the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign. This high-profile effort aims to educate consumers on health care procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. The survey is now available online.
APTA is among the first 3 nonphysician provider organizations to be invited to join this project, which is being promoted by Consumer Reports and has already garnered media attention.
The association's work to create a physical therapy-related list began with a call for suggestions from members. A member expert panel reviewed over 170 suggestions and narrowed the list down to 9 candidates, basing its choices on Choosing Wisely requirements that the tests or procedures have been called into question through generally-accepted evidence, yet are frequently done.
Members have until June 3 to complete the survey. The top 5 questioned procedures will go to the APTA Board of Directors before being submitted to the ABIM Foundation for final approval. Members who missed the initial e-mailed survey link are being advised to be on the lookout for a reminder e-mail coming soon. (Not receiving e-mails from APTA? Update your e-mail preferences or check your spam folder.)
Choosing Wisely is a consumer-focused effort that is not intended to influence payment or coverage decisions. Instead, the initiative is designed to foster conversations between patients and health care providers about the care that is truly necessary for the individual health care consumer.
Once approved by the APTA Board of Directors and accepted into the program, APTA's Choosing Wisely list will become a feature of its 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 was the subject of a feature article (members-only access) in the February issue of PT in Motion.
A new study comparing physical therapy with a sham procedure in the treatment of hip osteoarthritis pain and disability contains some interesting findings—and some notable limitations.
The research, published in the May 21 issue of JAMA (abstract only available for free), followed the progress of 102 individuals with diagnosed hip osteoarthritis (OA) and accompanying pain and disability, half of whom received physical therapy treatments and home exercises "typical of current practice," and half of whom received a "sham" procedure involving application of an inactive gel. The results, according to the authors, showed that physical therapy was not more effective than the sham treatment at any evaluation point during the study.
"Unfortunately, as a physiotherapist, the findings weren't what we hoped for," said lead author Kim A. Bennell, PhD, in an interview with JAMA. "We found that the active physical therapy program was equally beneficial as the sham program at both the 12-week timepoint and the 9-month follow up. There is a benefit to going to physical therapy, but the benefits are not related to the specific effects of our treatment."
Those conclusions might not be as sweeping as they sound at first blush, according to Kathleen Mangione, PhD, PT, FAPTA, physical therapy professor at Arcadia University and former PTJ editorial board member. While she believes the study was soundly constructed, she thinks the research may be saying more about exercise selection and dose than about the efficacy of physical therapy. "This is a well-done study looking at the specific effects of manual therapy and unsupervised exercise prescribed by PTs, but it is not a definitive study on physical therapy and hip osteoarthritis," she said.
"A recent systematic review by Juhl found that supervised aerobic and strength training exercises for the knee, 3 times a week, reduced pain and lowered self-reported disability for patients with knee osteoarthritis," Mangione added. "What the JAMA article describes was a program that was in large part passive."
In the study, 8 physical therapists (PTs) with 5 or more years of clinical experience delivered 2 kinds of treatments to patient participants—an "active" program and the sham program. The active group attended 12 physical therapy sessions over 10 weeks (twice weekly the first week, once weekly for 6 weeks, then about once every 2 weeks until week 11 or 12). The first sessions were for 45–60 minutes, with the rest lasting 30 minutes.
According to authors, all active group participants received manual therapy techniques that included hip thrust manipulation, hip-lumbar spine mobilization, deep tissue massage, and muscle stretches. Participants were also prescribed 4 to 6 home exercises to be performed 4 times a week, and received education and advice. Where appropriate, some participants also received walking sticks, and PTs involved in the study were permitted to engage patients in "optional techniques and exercises depending on assessment findings," though few did.
Participants in the sham group received the same amount of clinician contact as the active group, but the treatment consisted of application of an inactive ultrasound gel, with no manual therapy or home exercise instructions. Instead, participants were instructed to self-apply the gel for 5 minutes 3 times a week during the 6-month follow up period.
Authors state that among the 2 groups, improvement in pain was statistically significant but not significantly different, with both groups showing notable gains. Similarly, function assessments among the groups improved at nearly identical rates, with the sham group slightly outperforming the active group. Researchers used the Western Ontario and McMaster Universities Osteoarthritis Index to measure function.
"The absence of significant between-group differences despite the use of skilled therapists and excellent adherence rates to home exercise (85%) suggest that the active physical therapy program was truly ineffective," the authors state. Instead, authors believe improvement—at least in the sham group—may be linked to the placebo effects of contact with a clinician, benefits that are "more from indirect effects you get from contact with a practitioner," Bennell said in the JAMA interview.
Mangione cautions against generalizing from the study. "I don't think we can say physical therapy isn't effective. I think we can say 4 specific manual therapy techniques and a home-based program of unsupervised stretching and infrequent strengthening was not more effective than the sham therapy," she said. "Physical therapy is a complex biobehavioral intervention and to lump all of physical therapy together—especially when the only physical therapy … in this study was 4 manual therapy techniques—is oversimplifying what physical therapy is and what PTs do."
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.
UnitedHealthcare announced in its May bulletin that the Medicare outpatient therapy functional reporting requirement would apply to UnitedHealthcare Medicare Advantage plans beginning August 1 (the announcement can be found on page 46 of the bulletin).
G-codes and severity/complexity modifiers will be required on contracted physical therapist claims with dates of service on or after August 1, 2014. Claims that do not include the appropriate G-code and modifiers will be rejected.
APTA offers a functional limitation reporting webpage that provides resources to help members meet this reporting requirement.
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