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  • New Legal Resources Address Expert/Fact Witnesses and Other Legal Matters

    APTA recently developed additional general information for members who may act in the capacity of a fact or expert witness. Reviewing the witness resources may assist in being better prepared when faced with receiving a subpoena or a request to act as a witness. Myriad legal issues come into play and the resources serve to provide information on topics such as qualifications of an expert, compensation, and discovery. APTA also provides a general information page to house existing materials that address a variety of legal matters, such as contracts, informed consent, and advertising. 

    The expert/fact witness resources were developed in response to RC 22-12, a motion passed by the House of Delegates in June. 

    Hyperventilation Shows Benefits for Asthma; Evidence is Limited

    Authors of a comparative effectiveness review issued by the Agency for Healthcare Research and Quality conclude that hyperventilation reduction techniques "may be a useful tool in the larger asthma management toolbox, which also includes medication and other components as needed, such as environmental controls, symptom monitoring, and a plan for handling exacerbations." However, given that none of the studies included in the review were conducted in the United States, available evidence is limited in its strength and applicability to the US population, they add.     

    The authors searched MEDLINE; PsycInfo; Embase; Cumulative Index to Nursing and Allied Health Literature; Physiotherapy Evidence Database; Cochrane Central Register of Controlled Trials; AltHealthWatch; Allied and Complementary Medicine; Manual, Alternative and Natural Therapy Index System; and Indian Medical Journals from 1990 through December 2011. They supplemented searches with manual searching of reference lists and grey literature, including regulatory documents, conference abstracts, clinical trial registries, and websites of professional organizations.

    APTA member Anne Swisher, PT, PhD, CCS, served on the technical expert panel that provided input on the analytic framework, key questions, and review protocol. Two independent reviewers screened identified abstracts against predefined inclusion/exclusion criteria. Two investigators reviewed full-text articles and independently quality-rated those meeting inclusion criteria. Data from fair- and good-quality trials were abstracted into standardized forms and checked by another investigator. The authors summarized data qualitatively and, where possible, used random effects meta-analysis.

    The authors identified 4 types of interventions—hyperventilation reduction breathing techniques, yoga breathing techniques, inspiratory muscle training (IMT), and other nonhyperventilation reduction breathing techniques, which included physical therapy methods. They found the most robust body of evidence for hyperventilation reduction breathing techniques in adults, including the only large-scale trial (n=600, aged 14 and older). Hyperventilation reduction interventions (particularly those with 5 hours or more of patient contact) achieved medium to large improvements in asthma symptoms and reductions in reliever medication use of approximately 1.5 to 2.5 puffs per day, but did not improve pulmonary function. These trials also were more applicable, although still somewhat limited, to the United States than trials examining other interventions due to similarities in applicable treatment guidelines to US guidelines and similar levels of development in the countries in which these studies were conducted.

    Limited evidence suggested yoga breathing may improve pulmonary function in adults in addition to reducing asthma symptoms, but medication use was rarely reported and applicability to the United States was very low. Evidence for IMT and other breathing retraining techniques was limited to small, heterogeneous trials providing insufficient evidence to determine effectiveness. The only harms of breathing retraining techniques identified were minor annoyances associated with taping the participants' mouths. Almost all trials were limited entirely or primarily to adults.

    The authors include recommendations for future trials for hyperventilation reduction and other techniques in their review. 

    Rate of Private Insurance Remains Steady; Public Programs See Increases

    For the first time in the last 10 years, the rate of private health insurance coverage has not decreased, according to a report released today by the US Census Bureau.

    The percentage of people covered by private health insurance in 2011 was not statistically different from 2010, at 63.9%. The percentage covered by employment-based health insurance in 2011 was not statistically different from 2010, at 55.1%.

    The number of people with health insurance increased to 260.2 million in 2011 from 256.6 million in 2010, as did the percentage of people with health insurance (84.3% in 2011, 83.7 % in 2010).

    The percentage of people covered by government health insurance increased from 31.2% to 32.2%. The percentage covered by Medicaid increased from 15.8% in 2010 to 16.5% in 2011. The percentage covered by Medicare also rose over the period, from 14.6 % to 15.2%.

    In 2011, 9.7% of children under 19 (7.6 million) were without health insurance. Neither estimate is significantly different from the corresponding 2010 estimate. The uninsured rate for children in poverty (13.8%) was higher than the rate for all children (9.4%).

    The uninsured rate remained statistically unchanged for people aged 26 to 34 and 45 to 64. It declined, however, for those aged 19 to 25, 35 to 44, and 65 and older.

    In 2011, the uninsured rates decreased as household income increased from 25.4 % for those in households with annual income less than $25,000 to 7.8% in households with income of $75,000 or more.

    The findings are available in Income, Poverty, and Health Insurance Coverage in the United States: 2011. The results were compiled from information collected in the 2012 Current Population Survey Annual Social and Economic Supplement.