Based on new evidence on the effectiveness and harms of primary care-relevant interventions to prevent falls in community-dwelling older adults, the US Preventive Services Task Force (USPSTF) recommends physical therapy or exercise and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.
USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older, because it says the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values.
In extensive comments to USPSTF, APTA commended the task force for "its focus on physical therapy and the role that it plays in reducing the societal burden that falls present as the number one cause of injury among adults ages 65 and older." APTA also stated that it was "deeply concerned with the statement that 'the benefit is small' for multifactorial risk assessments in Recommendation 2." The association added, "… we feel that the approach to quantifying the effect of the risk assessment is misrepresentative given the unique considerations for falls prevention evaluation. A risk assessment may, in fact, not be appropriate for every member of the population, but a falls screening as outlined by the American Geriatrics Society and British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons is an important consideration to justify those individuals for which a multifactorial risk assessment is very impactful."
The recommendations and supporting documents are posted on USPSTF's website.A summary for patients is available in Annals of Internal Medicine.
APTA recently revised its Balance and Falls webpage, which includes a variety of patient care resources, consumer education materials, and links to CEU courses.
Poorer performance preoperatively on the Six-Minute Walk Test (6MW), Stair Climbing Test (SCT), and Timed Up and Go Test (TUG) was related to poorer performance in the same measure after total knee arthroplasty (TKA), say authors of a study designed to develop a preliminary decision algorithm predicting functional performance outcomes to aid in the decision of when to undergo TKA. Age and decreased mental health were secondary predictors of poorer performance at 6 months on the TUG and SCT, respectively. These measures may help further develop models that predict thresholds for poor outcomes after TKA, the authors add.
One hundred and nineteen patients undergoing primary unilateral TKA were evaluated before and 6 months after TKA. A regression tree analysis using a recursive partitioning function was performed with TUG time, 6MW distance, and SCT time as measured 6 months after TKA as the primary outcomes. Preoperative measures of functional performance, joint performance, anthropometrics, demographics, and self-reported status were evaluated as predictors of the primary outcomes 6 months after surgery.
Individuals taking 10.1 or more seconds on TUG and aged 72 years or older before surgery had the poorest performance on TUG 6 months after surgery. Individuals walking less than 314 meters on 6MW before surgery had the poorest performance on 6MW 6 months after surgery. Individuals taking 17 or more seconds to complete SCT and scoring less than 40 on the SF-36 mental component score before surgery had the poorest performance on SCT 6 months after surgery.
APTA member Michael J. Bade, PT, is lead author of the article, which is published in Journal of Orthopaedic Research. APTA members Joseph A. Zeni, PT, PhD, Jennifer E. Stevens-Lapsley, PT, MPT, PhD, and Lynn Snyder-Mackler, PT, ScD, SCS, FAPTA, are coauthors.
A combination of mobile technology and remote coaching holds promise in encouraging healthier eating and physical activity, say researchers at the National Institutes of Health who examined the best way to change multiple health behaviors in adults. Free, full text of the article is available in Archives of Internal Medicine.
The scientists studied 204 adults who were overweight or obese and had a diet high in saturated fat and low in fruits and vegetables. The participants also engaged in little daily physical activity and had high amounts of sedentary leisure time.
Each participant was assigned to 1 of 4 groups:
Participants received mobile devices and were trained on entering information about their daily activities and eating patterns. Coaches studied the data received and then phoned or e-mailed participants to encourage and support healthy changes during the 3-week study. Participants also were asked to continue to track and submit their data over a 20-week follow-up period. Financial incentives for reaching study goals during the study and continuing participation during the follow-up period were offered.
All 4 groups showed improvements in reaching the assigned health goals, with the most striking results occurring in the group asked to increase fruit and vegetable intake and reduce sedentary leisure activities. After 20 weeks, this group's average daily servings of fruits and vegetables increased from 1.2 to 2.9. The group's average minutes per day of sedentary leisure activity dropped from 219.2 to 125.7, and the percentage of saturated fat in daily calories went from 12 to 9.9.
"Via technology, we will soon be able to deliver fully automated and configurable multiple risk factor interventions that monitor progress continuously and can be delivered throughout the day every day," William T. Riley, PhD, says in accompanying commentary on the study. "It remains an empirical question, however, whether these technological advances improve outcomes, reduce costs, or both."
A model of care adopted in Australia, England, Israel, and Canada that allows patients who are chronically ill with acute medical problems to receive hospital services in their homes is gaining attention in the United States, says a Kaiser Health News article.
Hospital-at-home programs fundamentally refashion care by "testing traditional notions of how services should be delivered when people become seriously ill." In most programs, physicians examine the patient daily, and nurses and aides visit up to 3 times a day, often for an extended period. Programs currently are offered by Presbyterian Healthcare Services in Albuquerque, New Mexico, and through the Veterans Health Administration in Portland, Oregon; Honolulu; Boise, Idaho; and New Orleans.
In a study of 3 hospital-at-home programs published in 2005 in Annals of Internal Medicine, researchers demonstrated that patient outcomes were similar or better, satisfaction was higher, and costs were 32% less than traditional hospitalizations. The programs in the study focused on people with 4 conditions—chronic obstructive pulmonary disease, congestive heart failure, pneumonia, and cellulitis.
Resistance from Medicare and private insurers is the biggest problem these programs face, the article says. Traditional fee-for-service Medicare does not pay for hospital-at-home services, although individual private Medicare Advantage plans may do so.
In addition, physicians may find the new model of care intimidating. Starting a program requires a considerable up-front investment of time and money. Furthermore, "keeping beds full is a financial mandate for most hospitals." However, that may change as hospitals and physicians form accountable care organizations that call for providers to restructure how health care is delivered while participating in the financial rewards and risks of those changes, says the article.
Because most patients in acute care hospitals receiving physical therapy are discharged to the post-acute care environment (eg, home health, rehabilitation facility, skilled nursing facility, or outpatient services), physical therapists must work collaboratively within the profession to ensure the continuum of care for patients in a variety of settings throughout an episode of care.
APTA provides several resources for members aimed at supporting many of the elements of Vision 2020 in the acute care setting. These resources include a toolkit to help incorporate physical therapist (PT) practice in the emergency department, a video and accompanying handout that illustrates how early physical therapy in intensive care units can help reduce health care costs and improve patient care, and audio conferences, available at APTA's Learning Center, highlighting the role of the PT in preventing hospital readmissions and direct access in a facility-based outpatient clinic.
Hear more about the resources in this prerecorded podcast by APTA's Clinical Practice Department.
A new study published in Spine shows that early treatment by a physical therapist for low back pain (LBP) was associated with less risk of subsequent health care utilization and lower overall health care costs than delayed treatment.
Using a national database of employer-sponsored health plans, researchers examined a sample of 32,070 patients who were newly consulting a primary care physician for low back pain. Patients were identified and categorized based on their use of physical therapist services within 90 days of the consultation. Those who were referred to a physical therapist early (within 14 days of the consultation) showed a reduced risk of subsequent health care utilization and experienced lower overall health care costs than did those patients with delayed treatment by a physical therapist (within 15-90 days of consultation).
During an 18-month follow-up period, researchers found that early treatment by a physical therapist was associated with reduced risk of subsequent surgery, injections, physician visits, opioid use, and advanced imaging, along with a corresponding reduction in overall LBP-related medical costs relative to delayed treatment by a physical therapist. Total health care costs for patients receiving early care from a physical therapist were an average of $2,736.23 lower.
The study found that patients using a PPO plan were more likely to receive early treatment from a physical therapist (53.4%) than those using an HMO plan (44.7%). Also, the highest rates of physical therapist utilization were found in the Northeast and West. Patients in the Midwest were more likely to seek early treatment from a physical therapist (58.7%).
Read more about this study, including comments from lead author and APTA member Julie M. Fritz, PT, PhD, ATC, and an April 20 article in Spine that also supports the benefits of early physical therapy for low back pain, in APTA's press release.
The toll of multiple deployments in Iraq and Afghanistan on soldiers' bodies and how physical therapy can help them keep "doing their job, living their lives with as little pain as possible," is highlighted in a New York Times article featuring APTA member CPT Rachel Odom, PT.
Odom is the only physical therapist (PT) assigned to the 3,500 men and women of the Fourth Brigade Combat Team of the 25th Infantry Division serving in Afghanistan. Odom manages the soldiers for "twisted knees, back pains, or shoulder strains," injuries associated with elaborate body armor that can add "at least 35 pounds to a soldier's load," and concussions sustained by roadside bombs.
Army Ranger units were the first to include PTs, rather than have them stay back at the hospital or in separate medical units. But now with their success, PTs have spread into mainstream combat units. Odom is the first PT assigned to her brigade, says the Times.
A new website recently launched by the Department of Health and Human Services offers information and resources about Alzheimer disease and related dementias. Users can find links to authoritative, up-to-date information from agencies and organizations with expertise in these areas and comprehensive information from federal, state, and private organizations on a range of topics. Visitors to www.alzheimers.gov/ will find tools to identify local resources that can help with the challenges of daily living, emotional needs, and financial issues related to dementia. Video interviews with real family caregivers explain why such information is essential to successful caregiving.
It's not too late to register for APTA's 2-day preconference course Alzheimer Disease: Rehabilitation Considerations in the Examination, Evaluation, and Interventions, to be held June 5-6 in Tampa, Florida. This 5-part course will address pathological changes, functional manifestations, and changing rehabilitation perspectives related to Alzheimer disease. The course offers 1.7 CEUs (17 contact hours/CCUs).
The Physical Therapist Professional
describes the ideal physical therapist professional and the ideal physical therapy experience. Through illustrations, dialogues, tools, and resources, it shows physical therapists how to provide that experience through behaviors that make a difference. A part of the Move Forward brand campaign, this tool will help physical therapists provide a consistent, quality experience to their patients, deliver on the brand promise, and ultimately raise the profession.
The Physical Therapist Professional illustrates how behaviors, such as the way a physical therapist introduces himself or herself to a new patient and how to provide documentation throughout the episode of care, influence the way consumers and other health care professionals perceive physical therapists and the profession. The booklet also provides tips to help build trust among important audiences. APTA encourages members to download the booklet to a mobile device, such as a tablet or smartphone, or print it to keep at their workplaces, so they can refer to it often to remind them of the important role they play in delivering this experience. This free resource will help physical therapists become the professionals they strive to be every day, providing outstanding care, compassion, and understanding in a welcoming and healthy environment.
Members can find more tools and information to help live and share the brand at the www.apta.org/brandbeat.
Move Forward News, a quarterly e-blast to members, will debut on Thursday, May 31. Move Forward News is designed to help physical therapists effectively live the physical therapist brand. Each issue will feature the latest news, tips, tools, and testimonials as well as information about the importance of branding. Also included in this first issue is a video of what members had to say at CSM 2012 about how they are living the brand. Watch for your debut issue!
Cable-driven robotic resistance training may be used as an adjunct to body-weight-supported treadmill training (BWSTT) for improving overground walking function in patients with incomplete spinal cord injury (SCI), particularly those with relatively high function, say authors of an article published in Archives of Physical Medicine and Rehabilitation.
This study took place in research units of rehabilitation hospitals in Chicago. Researchers randomly assigned patients with chronic incomplete SCI (N=10) to 1 of 2 groups. One group participated in 4 weeks of assistance training followed by 4 weeks of resistance training. The other group participated in 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by using a cable-driven robotic locomotor training system, which is highly backdrivable and compliant, allowing patients the freedom to voluntarily move their legs in a natural gait pattern during BWSTT, while providing controlled assistance/resistance forces to the leg during the swing phase of gait.
Primary outcome measures were evaluated for each participant before training and 4 and 8 weeks after training. Primary measures were self-selected and fast overground walking velocity and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and strength.
A significant improvement in walking speed and balance in participants was observed after robotic treadmill training using the cable-driven robotic locomotor trainer. There was no significant difference in walking functional gains after resistance versus assistance training, although resistance training was more effective for higher functioning patients.
APTA member T. George Hornby, PT, PhD, is coauthor of the study.
APTA now offers a comprehensive resource to help physical therapists (PTs) understand and fulfill their role in reducing avoidable hospital readmission—a high priority of health care reform.
The Affordable Care Act's Hospital Readmissions Reduction Program, which begins in 2013, is aimed at adjusting hospital payments for those institutions that have higher-than-expected readmissions. Hospital readmission quality metrics are being introduced into other settings, such as inpatient rehabilitation facilities in 2014, and are expected to be integrated into additional settings in the near future.
PTs serve an important role in patient safety and patient care transitions. They should advocate and communicate their expertise and critical-decision making in providing recommendations for the most appropriate level of care after acute care discharge within the health care team prior to and during care transitions to help reduce hospital readmissions.
Find clinical practice resources, patient education materials, and links to related information on APTA's new Hospital Readmissions webpage.
Several new resources available at www.apta.org/GovernanceReview explain the proposed governance review recommendations adopted by the Board of Directors at its April 2012 meeting, and the next anticipated steps for member review and feedback. A 14-page illustrated brief, Update on Governance Review: Proposals for a Brighter Future, highlights the most significant elements of the Board’s proposals, and 2 podcasts, "A Conversation on Governance Review," provide additional details on the proposals related to chapters and sections (Part 1) and the Board and House of Delegates (Part 2). Feedback about governance review can be directed to email@example.com.
Two studies released this week from researchers at the Centers for Disease Control and Prevention (CDC) and National Institutes of Health show both encouraging and discouraging news about the nation's mortality and health as it relates to diabetes.
The first study, published in Diabetes Care, found that death rates for people with diabetes dropped substantially from 1997 to 2006, especially deaths related to heart disease and stroke. Deaths from all causes declined by 23% and deaths related to heart disease and stroke dropped by 40%.
According to CDC, some healthy lifestyle changes contributed to the decline, as did improved medical treatment for cardiovascular disease and better management of diabetes. In particular, the study showed that people with diabetes were more likely to be physically active and less likely to smoke than in the past. Better control of high blood pressure and high cholesterol also may have contributed to improved health. However, obesity levels among adults with diabetes continued to increase.
The second study found a 15% prevalence rate for prediabetes/diabetes among adolescents during a survey period from 1999 to 2008. According to a Reuters Health News article based on the study, the conditions were seen in 9% of teens in 1999-2000, but that figure rose to 23% in 2007-2008. "That was unexpected," lead researcher Ashleigh May, MS, PhD, told Reuters, because the research team found that obesity rates for teens leveled off during the study period. The rates of high blood pressure and high LDL cholesterol also remained steady.
Although the study gauged prediabetes and diabetes from a single blood sugar measurement, which may be less reliable in adolescents than in adults, May says the overall results show that children and teenagers need more help with staying physically active and following a healthy diet.
Physical therapists interested in serving on a Federation of State Boards of Physical Therapy (FSBPT) examination committee have until May 30 to submit their nominations. Under the 1989 Transfer Agreement of the physical therapy licensing examination and a more recent settlement agreement, APTA is entitled to seat candidates for at least 40% of the positions on the FSBPT Examination Development Committees. This year APTA will be providing 1 nominee for the Examination Development Committee-PTA (EDC-PTA) and 1 nominee for the Item Bank Review Committee-PT (IBRC-PT).
APTA nominees to all committees will be physical therapists and active APTA members. Experience as National Physical Therapy Examinations (NPTE) item writers or American Board of Physical Therapy Specialties (ABPTS) writers is desired but not required. For the EDC-PTA, the nominees must have expertise in neuromuscular, cardiovascular/pulmonary, musculoskeletal or pediatrics; for the IBRC-PT, the nominees must have expertise in pediatrics, musculoskeletal or neuromuscular.
To submit for nomination, complete and submit a Personal Information Form and a current résumé/CV by Wednesday, May 30, to Brandy Bradley in the Clinical Practice Department.
From the equipment physical therapists use in patient management, and the electronic health records (EHRs) they use to document, to the evolving clinical research in areas such as robotics, genetics, and regenerative medicine, certain technologies will have profound impact on the profession and its patients. In this new podcast, hear the calls of APTA leaders and researchers to increase the profession's ability to use technology, collaborate in developing and lead in testing new technologies, and work closely with basic scientists to guide the development of clinically relevant protocols as they relate to regenerative medicine.
Check out 2 upcoming opportunities to learn more about these new technologies at PT 2012 in Tampa—Emerging Technologies: Implications for the Future of Physical Therapist Practice and The New Genomics: Applications and Implications for Physical Therapist Practice and Education.
If you work with Olympic athletes and/or will be heading to London to serve on an Olympic team's medical staff, APTA wants to hear from you. During the 2012 Summer Olympic Games, APTA would like to spotlight member physical therapists (PTs) who have helped the nation's elite athletes prepare to compete on the world's biggest stage. Contact Erin Wendel, senior media relations specialist, by e-mail or phone at 703/706-3397 by Monday, May 28, for more details. APTA also intends to use this opportunity to promote the physical therapist's role in helping athletes of all ages and skill levels reach their goals by preventing and treating sports-specific injuries.
A new policy brief from The Commonwealth Fund describes recommendations of more than 75 researchers who identified a core set of standardized measures to evaluate the patient-centered medical home (PCMH). The brief focuses on 2 domains of medical home outcomes—clinical quality and cost/utilization.
The researchers broadly agreed about the importance of assessing changes in clinical quality as part of any medical home program. They expressed concerns that the variation in populations and local PCMH emphasis might make uniform minimum quality measure sets difficult to generalize. Therefore, they agreed to a core set of principles that all evaluators should follow when examining clinical quality. In particular, they call for select measures from each of the following core areas of primary care measurement—preventive care, chronic disease management, acute care, overuse, and safety.
The majority of researchers recommend including emergency department visits, hospitalizations, and readmissions as the primary utilization indicators in the minimum measure set. According to the group's analysis, these indicators were both consistent with the logic model that attempted to capture how a medical home could affect utilization, cost, and efficiency and were supported by at least some empirical evidence.
For cost measures, there was consensus that evaluations of PCMHs should always include analysis of total per-member per-month cost effects for high-risk patients, since the PCMH initiative will most likely be able to detect a measureable effect on this patient population.
APTA's goal is to reform payment for outpatient physical therapy services to improve quality of care, recognize and promote the clinical judgment of the physical therapist, and provide policymakers and payers with an accurate payment system that ensures the integrity of medically necessary services.
To this end, the association is proposing a transition from the current fee-for-service, procedural-based payment system to a per-session payment system. APTA needs your feedback on the developmental draft of the Alternative Payment System to refine the system and enhance the model. You can learn more about the Alternative Payment System at www.apta.org/APS. After reading about the system, provide your feedback using this survey by June 15. The survey will only take a few minutes to complete.
E-mail firstname.lastname@example.org with any questions.
Need information for a brochure, slide show, or lecture? The Centers for Disease Control and Prevention's (CDC) annual report on trends in health statistics now is available. Health, United States 2011 contains a chartbook that assesses the nation's health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization, health risk factors, prevention, health insurance, and personal health care expenditures. This year's chartbook includes a special feature on socioeconomic status and health. The report also contains 151 trend tables organized around 4 major subject areas—health status and determinants, health care utilization, health care resources, and health care expenditures. A companion product to the report, Health, United States: In Brief, features information extracted from the full report.
Physical activity is an important but underused intervention for adults with arthritis, says a report released yesterday by the Arthritis Foundation at a Capitol Hill briefing cosponsored by APTA. Physical activity, the report contends, decreases pain; delays the onset of disability; improves physical functioning, mood and independence; and enhances quality of life, aerobic capacity, and muscle strength.
Reps Anna Eshoo (D-CA) Sue Myrick (R-NC), cochairs of the Congressional Arthritis Caucus, also sponsored the briefing. Myrick attended the briefing, which included speakers Jack Klippel, MD, president and CEO of the Arthritis Foundation; Wayne Giles, MD, MS, director of the Division of Population Health, National Center for Chronic Disease Promotion and Health Prevention, Centers for Disease Control and Prevention; Mary Wu, who told her story from a patient perspective; and Zarnaaz Bashir, MPH, director of Strategic Health Initiatives, National Recreation and Parks Association.
Despite the documented benefits of physical activity, adults with arthritis have higher rates of physical inactivity than those without arthritis. Furthermore, the highest rates of physical inactivity are among adults with arthritis and heart disease, arthritis and diabetes, and arthritis and obesity, when compared with adults with none of these conditions. The new APTA-sponsored report, titled Environmental and Policy Strategies to Increase Physical Activity Among Adults With Arthritis, aims to motivate health agencies, business, recreational facilities, and others as partners in providing physical activity opportunities that meet the needs of people with arthritis.
The report also answers the call of the National Public Health Agenda for Osteoarthritis and the Institute of Medicine's recent report Living Well with Chronic Illness: A Call for Public Action. It outlines an initiative that calls on the nation to address barriers and promote physical activity in a way that is safe, accessible, convenient, and inclusive of adults with arthritis in 6 key sectors—park, recreation, fitness, and sports; business and industry; community and public health; health care; transportation, land use, and community design; and mass media.
Walking speed is a feasible measure for patients admitted to an acute care hospital, illustrating that patients walk slowly relative to community requirements but that their speed improves even over a short course of therapy, say authors of an article published online in Journal of Geriatric Physical Therapy.
This observational cross-sectional study included 46 hospital inpatients (mean age 75 years (SD = 7.8) who were referred to physical therapy and able to walk at least 20 feet. Researchers obtained information regarding diagnosis, comorbidities, physical assistance, device use, body height, and weight for each participant. Speed was determined during initial and final physical therapy visits while patients walked at their self-selected speed over a marked course in a hospital corridor.
Therapists reported that measuring walking speed was clinically feasible, requiring inexpensive, available resources, 4 minutes' additional time, and simple calculations for documentation. Initial walking speed was a mean of 0.33 m/s (SD = 0.21), whereas final speed was 0.37 m/s (SD = 0.20). The Wilcoxon test showed the increase in walking speed (0.04 m/s) to be significant over a mean therapy period of 2.0 days (SD = 1.4) and total hospitalization period of 5.5 days (SD = 3.6). The effect size and standardized response mean were 0.19 and 0.36, respectively. Minimal detectable change was 0.18 m/s.
APTA member Heather J. Braden, PT, MPT, PhD, GCS, is lead author of the article. APTA members Richard Bohannon, PT, DPT, EdD, NCS, FAPTA, and Scott Hasson, PT, EdD, FACSM, FAPTA, are coauthors.
A new podcast featuring Jane Sullivan, PT, DHS, associate professor and assistant department chair in the Department of Physical Therapy and Human Movement Science at Northwestern University, outlines the process a Neurology Section-appointed task force used in developing preferred outcome measures for patients with stroke.
Widespread use of standardized outcome measures is "lacking," says Sullivan, who describes the task force's charges, the framework chosen to assess the outcome measures, and how the task force determined which outcome measures to review. She also illustrates the objectives achieved in the recommendations generated by the StrokEDGE group.
A transcript accompanies the prerecorded podcast. A list of the task force members and the recommended outcome measures are available on the Neurology Section's website.
Beginning June 1, the Centers for Medicare and Medicaid Services (CMS) will accept suggestions for potential inclusion in the proposed set of quality measures in the Physician Quality Reporting System (PQRS) for future rulemaking years.
Documentation for each measure submitted must be received by 5 pm ET August 1.
Required documentation includes the Measure Submitted for Consideration Form, measure specifications (measure title, description, numerator, and denominator, including exclusions, exceptions, and inclusions), and electronic specification and data tables for electronic health record-specified candidate measures.
Suggesting individual measures or measures for a new or existing measures group does not guarantee that the measure(s) will be included in the proposed or final sets of measures of any proposed or final rules that address PQRS. CMS will determine what individual measures and measures group(s) to include in the proposed set of quality measures. After a period of public comment, the agency will make the final determination with regard to the final set of quality measures for PQRS.
To learn more about the PQRS Call for Measures, visit CMS' Measures Management System webpage, or contact Heather Smith at APTA with questions.
Patients' control of blood pressure improved when their care was provided by a team of health care professionals—a primary care provider supported by a pharmacist, nurse, dietitian, social worker, or community health worker—rather than by a single physician, says the Community Preventive Services Task Force following a review of 77 studies on team-based care. The task force is an independent, nonfederal, uncompensated body of public health and prevention experts, whose members are appointed by the Centers for Disease Control and Prevention.
The collection of studies showed that team-based care helped increase the proportion of patients with controlled blood pressure, led to a decrease in both systolic and diastolic blood pressure, and improved outcomes in patients who had diabetes and elevated blood lipids.
Team members supplemented the activities of the primary care provider by providing support and sharing responsibility for hypertension care. Support and responsibility included medication management, patient follow-up, and helping the patient adhere to his or her blood pressure control plan, including monitoring blood pressure routinely, taking medications as prescribed, reducing sodium in the diet, and increasing physical activity, says the task force.
Team-based care is a central pillar of the Million Hearts initiative, launched by the Department of Health and Human Services in September 2011. Million Hearts is a national, public-private initiative to prevent 1 million heart attacks and strokes over 5 years. The initiative is aligned with the Healthy People 2020 goal to reduce the number of people in the US with high blood pressure. Blood pressure control is 1 of 4 health behaviors targeted by the initiative—the others are aspirin as appropriate, cholesterol management, and smoking cessation.
Many opportunities and challenges are on the horizon for physical therapists as organizations attempt to eliminate health care silos and integrate patient care. In an effort to prepare physical therapists for health care integration, APTA has produced a video series that highlights innovative clinical practice models and the roles that physical therapists can play in today's health care environment. The videos and accompanying handouts can help physical therapists gain insight and inspiration as they look for ways to become involved in new models of care delivery.
Research literature indicates that wellness programs reduce health care costs, with reductions for large firms averaging $3.27 for every dollar spent on wellness programs, says a new policy brief from Health Affairs. In addition, studies show that health promotion programs at organizations of all sizes result in an overall reduction of about 25% in sick leave, health plan costs, and workers compensation and disability costs.
According to the 2011 Kaiser Family Foundation and Health Research and Educational Trust annual survey of employer health benefits, 67% of companies with 3 or more employees that offered health benefits also offered at least 1 wellness program. Slightly more than half (52%) also offered wellness benefits to spouses or dependents of employees.
Almost all companies with 1,000 or more employees offered 1 type of program. Larger employers usually run wellness programs themselves. For small companies, wellness programs typically are run by the same firms that administer the employer's health benefits plan or by another entity referred to as a third-party administrator.
Typical features of wellness programs are behavior modification programs, such as exercise, weight management, and tobacco cessation; changes in the work environment or provision of special benefits to encourage exercise and healthy food choices, for example, subsidized health club memberships; and health-risk assessments and screenings for high blood pressure and cholesterol health education, including classes or referrals to online sites for health advice.
Although incentives and disincentives prompt workers to participate in wellness programs, the evidence is mixed on whether the result is real improvements in health outcomes, says Health Affairs. To date, there have been no published, independent studies on how changes in premiums or cost sharing affect health outcomes.
The policy brief also includes information about compliance with federal and state requirements, conflict over programs that tie rewards or penalties to individuals achieving standards related to health status, and concerns with privacy issues.
The 2012 Summer Olympic Games are fast approaching. During the games, APTA would like to spotlight member physical therapists (PTs) who have helped the nation's elite athletes prepare to compete on the world's biggest stage. If you work with Olympic athletes and/or will be heading to London to serve on an Olympic team’s medical staff, contact Erin Wendel, senior media relations specialist, by e-mail or phone at 703/706-3397 by Monday, May 28, for more details. APTA also intends to use this opportunity to promote the physical therapist's role in helping athletes of all ages and skill levels reach their goals by preventing and treating sports-specific injuries.
Integrating physical activity into people's daily lives is 1 of 5 obesity prevention strategies proposed in a new report released Monday at the Centers for Disease Control and Prevention's Weight of the Nation conference.
America's progress in arresting its obesity epidemic has been too slow, and the condition continues to erode productivity and cause millions of people to suffer from potentially debilitating and deadly chronic illnesses, says the Institute of Medicine's (IOM) report. Solving this complex, stubborn problem requires a comprehensive set of solutions that work together to spur across-the-board societal change.
The 4 other prevention strategies identified by the committee that wrote the report are making healthy food and beverage options available everywhere, transforming marketing and messages about nutrition and activity, making schools a gateway to healthy weights, and galvanizing employers and health care professionals to support healthy lifestyles. Specific tactics the authors noted include requiring at least 60 minutes per day of physical education and activity in schools, implementing industry-wide guidelines on which foods and beverages can be marketed to children and how, expanding workplace wellness programs, taking full advantage of physicians' roles to advocate for obesity prevention with patients and in the community, and increasing the availability of lower-calorie, healthier children's meals in restaurants.
The full report can be read online. A report brief and an infographic are available on IOM's website.
As reported last week in News Now, HBO will air a 4-part documentary series on obesity on May 14-15 as part of the Weight of the Nation initiative. DVD kits are available for organizations to host screenings of the films in their communities. The kits include the video series and discussion guides in English and Spanish that can be used to delve deeper into the concepts presented and spur individual and community action.
APTA recently named Marsh US Consumer, a service of Seabury & Smith Inc (Marsh), an APTA Strategic Business Partner.
Marsh designs, sells, and administers insurance-related risk management and financial service programs for individuals and groups. Marsh works with APTA to provide the association's members and their families dental, disability, health, and life insurance plans. In addition, Marsh offers APTA's Health Insurance Mart, a service that provides rate quotes on individual or family policies, short-term medical policies, and small employer group policies to APTA members.
Through its Strategic Business Partners Program, APTA seeks to enhance business relationships and develop meaningful partnerships with for-profit companies by offering services and marketing opportunities that provide mutual benefits to partners and APTA. Marsh is a charter partner, which entitles the company to varied promotional opportunities and gives APTA added visibility to its customers.
Read more in APTA's press release.
The Centers for Medicare and Medicaid Services (CMS) issued updates today to the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) that include provisions that reduce regulatory burdens and help providers to operate more efficiently. CMS estimates that annual savings to hospitals from the final rule on CoPs could exceed $900 million in its first year.
CoPs are federal health and safety requirements ensuring high-quality care for all patients. Hospitals and CAHs must meet these conditions to participate in Medicare and Medicaid. The final rule includes the following provisions that provide more flexibility and recognize the key role of nonphysician practitioners, such as physical therapists, in providing care:
A copy of the rule is available at this link.
In a final rule released today, the Centers for Medicare and Medicaid Services (CMS) has removed the outdated personnel qualifications language in the current Medicaid regulations and cross referenced them to the updated Medicare personnel qualifications for physical therapists and occupational therapists. (Personnel qualifications can be found under 42 CFR §484.4.)
The final rule has the potential to ensure that certain physical therapists are not excluded from providing services under Medicaid. In addition, it strengthens the consistency of standards across Medicare and Medicaid. APTA has worked since 2010 to eliminate the outdated qualifications.
Specifically, APTA is hopeful that today's rule is a major victory for many foreign-trained physical therapists, in states such as New York, who were previously considered qualified to treat Medicaid patients but were told around 2010-2011 that they were no longer considered qualified to provide services under Medicaid.
In response to comments received regarding certain states that have excluded PTs from treating Medicaid patients due to being trained in foreign countries, CMS states in the final rule, “If practices at the State level are prohibiting individuals from meeting Medicaid qualifications, we suggest addressing those concerns with the State Medicaid Agency."
CMS' comments also stated that, although the Medicaid regulations are silent on the use of physical therapist assistants for Medicaid services, "States utilizing PT or OT assistants would be well served to follow the Medicare definition found at 42 CFR §484.4, to ensure consistency across programs."
Under Medicare, physical therapists are licensed providers in all states and physical therapist assistants are licensed providers in the majority of states. As licensed providers, the state practice act governs supervision requirements. Some state practice acts mandate more stringent supervision standards than Medicare laws and regulations. In those cases, the physical therapist and physical therapist assistants must comply with their state practice act. More information can be found on APTA's Use of Physical Therapist Assistants (PTAs) Under Medicare webpage.
The American College of Rheumatology (ACR) recently updated its 2000 recommendations for hip and knee osteoarthritis (OA) and developed new recommendations for hand OA. The guidelines include nonpharmacologic therapies, such as exercise supervised by a physical therapist for knee and hip OA.
The guidelines, which use clinical scenarios representing patients with symptomatic hand, hip, and knee OA are based on the "best available evidence of benefit and safety/tolerability" of both nonpharmacologic and pharmacologic interventions, in addition to the consensus judgment of clinical experts from a wide range of disciplines. They are published in the April 2012 issue of Arthritis Care & Research.
According to the Technical Expert Panel, patients with symptomatic knee and hip OA should be enrolled in an individualized exercise program commensurate with their ability to perform these activities. The panel also calls for the use of thermal agents and manual therapy in combination with exercise supervised by a physical therapist.
Because there were few high-quality randomized controlled trials of interventions for hand OA published in the peer-reviewed literature, the panel made no strong recommendations for this indication. However, the panel recommends that all patients with hand OA be evaluated by a health professional, either their primary care provider or a physical therapist or occupational therapist for their ability to perform activities of daily living. Based on the evaluation, patients could receive assistive devices as necessary, instruction in joint protection techniques and in the use of thermal agents for relief of pain and stiffness.
APTA members G. Kelley Fitzgerald, PT, PhD, and Carol A. Oatis, PT, PhD, served on the panel.
Free, full text of the guidelines is available from ACR.
During Women's Health Week, which is celebrated May 13-19, APTA is partnering with its Section on Women's Health to build awareness of women's health issues that can be prevented and treated by a physical therapist with its #overshare initiative. APTA will host a 1-hour program on Move Forward Radio and a Twitter party, both on May 15 at 7 pm ET. Women across the country can listen online and call the show to ask questions or submit them in advance via Twitter by tweeting @MoveForwardPT and using the hashtag #overshare. APTA members Pamela Downey, PT, DPT, WCS, of Miami and Rebecca Stephenson, PT, DPT, WCS, of Medfield, Massachusetts, and Los Angeles gynecologist Judith Reichman, MD, author of Slow Your Clock Down: The Complete Guide to a Younger, Healthier You, will discuss women's health issues, covering everything from incontinence and pregnancy to fitness and bone health. APTA also has published a free, downloadable e-book, Women’s Health Across the Lifespan, to support the initiative, which will be available the day of the show at www.moveforwardpt.com/womenshealth. Read more about the initiative in the press release.
APTA responded to FoxNews.com regarding a May 2 article, "How can chiropractors benefit your health?" in which Keith Overland, president of the American Chiropractic Association, said that chiropractic treatment may include "combinations of chiropractic manipulation, physical therapy, and rehabilitative procedures for many musculoskeletal problems." APTA tells Fox News, "'Physical therapy' is not a generic term. It describes only those services provided by a licensed physical therapist. Chiropractors may provide some of the same treatment modalities as physical therapists, but they should portray their services as chiropractic and not as 'physical therapy.'"
Patients who received physical therapy early after an episode of acute low back pain had a lower risk of subsequent medical service usage than patients who received physical therapy at later times, say authors of an article published April 20 in Spine. Medical specialty variations exist regarding early use of physical therapy, with potential underutilization among generalist specialties, they add.
For this retrospective cohort study, the authors analyzed a national sample of the Centers for Medicare and Medicaid Services' physician outpatient billing claims. Patients were selected who received treatment for low back pain between 2003 and 2004 (n = 439,195). To eliminate chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain during the following year.
Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received physical therapy in the acute phase (<4 weeks) compared with those receiving physical therapy in the chronic phase (>3 months) was 0.38, adjusting for age, sex, diagnosis, treating physician specialty, and comorbidity. The adjusted odds ratio for receiving a lumbosacral injection in the group receiving physical therapy in the acute phase was 0.46, and the adjusted odds ratio for frequent physician office usage in the group receiving physical therapy in the acute phase was 0.47.
APTA member Charles R. Scoville PT, DPT, recently was named a finalist for a Samuel J. Heyman Service to America Medal—an award that pays tribute to America's dedicated federal workforce. Honorees are chosen based on their commitment and innovation, in addition to the effect of their work on addressing the needs of the nation.
Scoville, who served in the US Army for 29 years, is chief at Amputee Patient Care at Walter Reed National Military Medical Center. Established in 2003, the program has helped service members with amputation lead active lives, with some returning to duty, through a novel sports medicine approach. The internationally recognized program combines traditional medical and counseling services with a physically active regime for severely wounded service members.
According to an announcement in this week's Washington Post, some of the 1,450 injured service members who have been through the program have gone on to complete triathlons, climb Mount Everest, and compete in gymnastics, skiing, rowing, and other sports.
The Mayo Clinic recently joined with www.theheart.org to provide the latest news and events in the world of cardiology. The Mayo Clinic webpage provides video forums in which Mayo Clinic faculty dissect the latest trials and trends in research and patient care, a new podcast series addressing cardiology issues, the latest thoughts and reflections from the leaders of the Mayo Clinic's heart program, and a set of links to valuable Mayo Clinic resources.
The Foundation for Physical Therapy now is accepting applications for the 2012 Florence P. Kendall Doctoral Scholarships, the 2012 Foundation Research Grant, and the 2012 Magistro Family Foundation Research Grant.
The application requirements and structures for these opportunities have been updated. Be sure to review all guidelines and instructions carefully before beginning an application.
The deadline for all applications is August 15, noon, ET. E-mail the Foundation or call 800/875-1378 with questions.
Physical therapists who receive rejection codes H20203 and/or H45255 on claim forms will need to balance bill their patients' supplemental payers for any balances left after Medicare, according to recent instructions from the Centers for Medicare and Medicaid Services (CMS) that state that this issue is expected to affect a limited number of providers. (Scroll down to article titled "Providers who Receive Error Codes H20203 and H45255 Need to Balance Bill" for details.)
On February 29, CMS alerted Medicare providers and suppliers to 3 edits that they may see on special provider notification letters that they receive from their local Fiscal Intermediary (FI), Carrier, A/B Medicare Administrative Contractor (MAC), or Durable Medical Equipment MAC (DME MAC). These edits had resulted, or are still resulting, from defects within CMS' coordination of benefits (COB) HIPAA 837 compliance editing. The defects associated with edits H51108 and H20203 at the Coordination of Benefits Contractor (COBC) were resolved on January 16 and February 27, respectively.
CMS has released the following additional information regarding edits H20203 and H45255:
A new APTA-sponsored report from the Arthritis Foundation focuses on the unique role of physical, social, and environmental factors in making physical activity accessible, convenient, and effective for adults with arthritis.
Environmental and Policy Strategies to Increase Physical Activity Among Adults With Arthritis is designed to engage 6 important sectors—park, recreation, fitness and sport; business and industry; community and public health; health care; transportation and use and community design; and mass media—as partners in providing physical activity opportunities that meet the needs of people with arthritis.
Several APTA members were instrumental in the development of the report. Bonita Beattie, PT, MPT, MHA, and Julie Keysor, PT, PhD, served as in-person expert meeting participants. Jill Heitzman, PT, DPT, GCS, CWS, Dina Jones, PT, PhD, Ryan Mizner, PT, MPT, PhD, and Carol Oatis, PT, PhD, were content reviewers.
The report will be officially launched at a Capitol Hill briefing hosted by the Congressional Arthritis Caucus, cochaired by Rep Anna Eshoo (D-CA) and Rep Sue Myrick (R-NC), on May 16. APTA will cosponsor the briefing. Look for a link to the final report and coverage of the briefing next week in News Now.
The Nominating Committee candidate interview videos for the 2012 election cycle are available for viewing. The videos are posted online at APTA's Elections and Nominations webpage. Each candidate's video may be accessed by a link titled "Video Interview" next to his or her respective information on the 2012 Slate of Candidates webpage.
Contact Peyton Zeek with any questions.
A mirror therapy program is an effective intervention for upper-limb motor recovery and motor function improvement in patients with acute stroke, say authors of an article published in American Journal of Physical Medicine & Rehabilitation.
For this study, 26 patients who had an acute stroke within 6 months of study commencement were assigned to the experimental group (n = 13) or the control group (n = 13). Both experimental and control group patients participated in a standard rehabilitation program, but only the experimental group members participated in mirror therapy program for 25 minutes twice a day, 5 times a week, for 4 weeks. Researchers used the Fugl-Meyer Assessment, Brunnstrom motor recovery stage, and Manual Function Test to assess changes in upper-limb motor recovery and motor function after intervention.
In upper-limb motor recovery, the scores of Fugl-Meyer Assessment (by shoulder/elbow/forearm items, 9.54 vs 4.61; wrist items, 2.76 vs 1.07; hand items, 4.43 vs 1.46, respectively) and Brunnstrom stages for upper limb and hand (by 1.77 vs 0.69 and 1.92 vs 0.50, respectively) were improved more in the experimental group than in the control group. In upper-limb motor function, the Manual Function Test score (by shoulder item, 5.00 vs 2.23; hand item, 5.07 vs 0.46, respectively) was significantly increased in the experimental group compared with the control group. No significant differences were found between the groups for the coordination items in Fugl-Meyer Assessment.
The Bangor Daily News, with a readership of nearly 48,000, published the results of APTA's Move Forward Low Back Pain Survey on April 26. The article quoted local APTA member Danielle Haggerty, PT, and linked to APTA's Low Back Pain by the Numbers infographic housed on www.moveforwardpt.com.
Higher prices and greater use of technology appear to be the main factors driving the high rates of spending in the United States, rather than greater use of physician and hospital services, according to a Commonwealth Fund report that presents analysis of prices and health care spending in 13 industrialized countries.
In 2009, there were 2.4 physicians per 100,000 people in the US, fewer than in all the countries in the study except Japan. The US also had the fewest physician consultations (3.9 per capita) of any country except Sweden. Relative to the other countries in the study, the US also had fewer hospital beds, short lengths of stay for acute care, and fewer hospital discharges per 1,000 population. On the other hand, US hospital stays were far more expensive than those in other countries—more than $18,000 per discharge. By comparison, the cost per discharge in Canada was about $13,000, while in Sweden, Australia, New Zealand, France, and Germany it was less than $10,000.
High spending in the United States does not always translate into high-quality care, says the report. The US had the highest survival rates in the study for breast cancer and the best survival rates, along with Norway, for colorectal cancer. However, cervical cancer survival rates in the US were worse than average and well below those of Norway. Compared with other countries in the study, the US had high rates of asthma-related deaths among people ages 5 to 39 and, along with Germany, very high rates of amputations resulting from diabetes. US rates of in-hospital deaths after heart attack and stroke were average.
Enjoy dinner and dancing, and share in the celebration as the 2012 Service Award Recipients are honored, at the Foundation for Physical Therapy's Legacy Gala, June 7, 7:30 pm in the Tampa Marriott Waterside, Grand Ballroom. The total amount of funds raised by students in the Pittsburgh-Marquette Challenge also will be announced.
Individual tickets are $150 ($100 for students). Tables can be purchased for $2,000. Table sponsorships and individual tickets may be purchased when registering for PT 2012. Tickets must be purchased by May 28. A limited number of tickets will be available onsite for $200. Purchase tickets online or call the Foundation at 800/875-1378.
This month's PTJ includes several articles that illustrate clinical decision making by physical therapists, highlighting opportunities for screening and referral and for screening and thoughtful clinical intervention. Hear Editor in Chief Rebecca Craik, PT, PhD, FAPTA, summarize articles on direct access, exercise prescription for fall prevention, using the six-minute walk test for people with traumatic brain injury, hippotherapy for children, and more in her latest Craikcast.
The May issue also includes 2 engaging case reports and a health policy perspective on the role of physical therapists in smoking cessation.
Getting adequate physical activity, maintaining a healthy weight, and eating a healthy diet can reduce the chance of recurrence of many cancers and increase the likelihood of disease-free survival after a diagnosis, say new guidelines from the American Cancer Society. The guidelines encourage survivors to aim to exercise for at least 150 minutes per week, and to include strength training exercises at least 2 days per week.
The society has issued previous reports outlining the evidence on the effect of nutrition and physical activity on cancer recurrence and survival. However, this is the first time the evidence has been strong enough to release formal guidelines for survivorship. For this report, a group of experts in nutrition, physical activity, and cancer survivorship evaluated the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. Among the review's conclusions:
The recommendations also include specific guidance for people diagnosed with breast, colorectal, endometrial, ovarian, lung, prostate, head and neck, and hematologic cancers. It also includes a section with answers to common questions about alcohol, organic foods, sugar, supplements, and several other areas of interest.
Free, full text of Nutrition and Physical Activity Guidelines for Cancer Survivors is available online in CA: A Cancer Journal for Clinicians.
In recognition of Older Americans Month, the Department of Health and Human Services urges older Americans to stay active, take care of their health, and be involved in their communities. This year's theme Never Too Old to Play encourages older adults to maintain their health by taking advantage of Medicare's preventive benefits that include a yearly wellness visit, tobacco use cessation counseling, and a range of free screenings for cancer, diabetes, and other chronic diseases.
Visit the Older Americans Month website for resources and tools to help plan and promote events and activities honoring older Americans this month.
The Centers for Medicare and Medicaid Services (CMS) today issued a long-awaited transmittal (2457) implementing certain provisions of the Middle Class Tax Relief and Job Creation Act of 2012 (HR 3630) related to the therapy cap.
Physical therapists should be aware of the following dates and requirements:
CMS will issue a Medlearn Matters article on these instructions shortly.
Transmittal 2457 does not provide information on the medical review process. CMS is still in the process of determining how to proceed with implementation of manual medical review for claims that exceed $3,700.
Patients in Alabama will soon be able to be evaluated and, in certain cases, treated by physical therapists (PTs) without first having to obtain a physician referral. With the enactment of Alabama House Bill 163, Alabama becomes the 47th state to achieve some form of direct access.
HB 163, sponsored by state Rep Ed Henry and signed by Gov Robert Bentley yesterday, goes into effect July 1. Prior to implementation of HB 163, PTs were prohibited from performing a physical therapy evaluation unless the patient had a referral. The new law provides for direct access to evaluation, fitness, wellness, and prevention services, and for treatment under certain conditions.
The legislation, which faced significant opposition, primarily from physician groups, is the culmination of many years of difficult work by the Alabama Chapter. Despite numerous obstacles, fierce and well-financed opponents, and the devastation of the April 27, 2011, tornado, the chapter was able to obtain a compromise from opponents on the bill that allowed its passage by the legislature. Per APTA's Strategic Plan, the chapter was provided direct access grants in 2011 and 2012 from the association.
Read more about the chapter's advocacy efforts in APTA's press release.
Emmett Parker, PT, MS, ATC, legislative chair for the Alabama Chapter, addresses attendees at a rally in 2011 at the Alabama State House in support of direct access to physical therapist services.
APTA encourages physical therapist members to consider serving on a Federation of State Boards of Physical Therapy (FSBPT) examination committee. Under the 1989 Transfer Agreement of the physical therapy licensing examination and a more recent settlement agreement, APTA is entitled to seat candidates for at least 40% of the positions on the FSBPT Examination Development Committees. This year APTA will be providing 1 nominee for the Examination Development Committee-PTA (EDC-PTA), and 1 nominee for the Item Bank Review Committee-PT (IBRC-PT).
APTA nominees to all committees must be physical therapists and active APTA members. Experience as National Physical Therapy Examinations (NPTE) item writers or American Board of Physical Therapy Specialties (ABPTS) writers is desired but not required. For the EDC-PTA, the nominees must have expertise in neuromuscular, cardiovascular/pulmonary, musculoskeletal, or pediatrics; for the IBRC-PT, the nominees must have expertise in pediatrics, musculoskeletal or neuromuscular.
To apply for nomination, complete and submit a Personal Information Form and a current résumé/CV by May 30 to Brandy Bradley in the Clinical Practice Department.
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