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  • US Senate Makes Statement With Language to Bring PTAs Into TRICARE

    APTA's efforts for revision of the TRICARE payment system to include services by physical therapist assistants (PTAs) got a big push on September 18 when the Senate passed its version of the National Defense Authorization Act (NDAA). TRICARE is a major part of the US Department of Defense health care system.

    The Senate bill includes an amendment to NDAA that calls for the US Secretary of Defense to revise TRICARE so that it recognizes PTAs (as well as occupational therapy assistants). APTA worked with the office of Sen Thom Tillis (R-NC) to introduce the amendment.

    The Senate victory comes on the heels of report language included in the House of Representative’s version of the NDAA that calls for a review on the feasibility of adding PTAs and designated others as health care providers in the military health system, to be completed by April 1, 2018.

    "APTA has long supported PTAs being included in TRICARE, and we're encouraged by this progress," APTA President Sharon L. Dunn, PT, PhD, said about the Senate bill. "Including PTAs in TRICARE will make it easier for uniformed service members and their families to get the quality care they need and deserve." Dunn is a board-certified clinical specialist in orthopaedic physical therapy.

    Representatives from the Senate and House armed services committees now are expected to come together in a conference and work out the differences in the 2 bills. No schedule is set for the conference yet, but with language in both versions APTA believes chances are good that PTA recognition will be included in the final bill that eventually is signed into law. It’s too early to project how long after that implementation would occur, but the association notes that the Senate version is more directive and would take less time to implement than the House bill.

    APTA will continue to educate the chairs of the Senate and House committees to help ensure the best possible language in the final law. Association members with questions can contact Michael Hurlbut, APTA senior congressional affairs specialist, at michaelhurlbut@apta.org.

    Analysis: Exercise, Psychological Treatment Outperforms Drug-Based Approaches for Cancer-Related Fatigue

    Authors of a new meta-analysis say there's little doubt that exercise and psychological interventions, used alone or in combination, are superior to pharmacological approaches in the treatment of cancer-related fatigue (CRF). But evidence pinpointing just what kind of exercise, the specific psychological approach, and the right combination of the 2 is much harder to come by.

    The analysis, originally published in JAMA Oncology but recently released for public access by the US Department of Health and Human Services, evaluated 113 studies involving 11,525 participants in research that evaluated the effectiveness of treatment approaches to CRF. Authors of the JAMA report limited their review to what they described as the 4 most common approaches: exercise, psychological interventions, a combination of exercise and psychological interventions, and pharmacologic interventions. The studies, all of which authors say were of "good quality," were conducted between 1999 and 2016.

    After the analysis, authors were clear in their conclusion: "Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF."

    To arrive at that conclusion, authors generalized results by establishing 3 groups of effect sizes—small, moderate, and large—and placing each study's results within those groups to create predictors of intervention effectiveness. Authors found that significant moderate effects were achieved through exercise, psychological, and combination interventions, but the effects of pharmaceutical interventions, while significant enough to register, were "very small."

    While authors could vouch for the effectiveness of the exercise and psychological interventions, they were somewhat less definitive on the details of individual approaches. When it came to psychological approaches, cognitive behavioral therapy achieved the best results over psychoeducational or "eclectic" approaches, but exercise interventions achieved equally successful results regardless of whether the program was based on aerobic, anaerobic, or resistance-anaerobic approaches. As for the studies that looked at combinations of exercise and psychological interventions, authors cited "inconsistent results" that were "sometimes equivalent to or inferior to a single modality." Nevertheless, they worked better than the pharmaceutical interventions.

    Authors did find some notable variables associated with effectiveness of various interventions. For example, patients with early-stage, nonmetastatic cancer and those who completed primary stage treatment (surgery, chemotherapy, radiation therapy) reported the most improvement overall. Additionally, exercise-only interventions seemed to work most effectively for patients receiving primary treatment, while a combination of exercise and psychological interventions was most effective when delivered to patients after they had received the primary treatment. Variables including age, sex, and type of cancer didn't seem to affect results.

    Although they call for more research around which types of exercise and psychological interventions work best, and in what combination, authors believe their study makes a strong case against taking a pharmacological approach to CFS.

    "Our results demonstrate that exercise, psychological, and exercise plus psychological interventions are effective improving CRF during and after primary treatment, whereas pharmaceutical interventions, as studied to date, are not," authors write.

    Research-related stories featured in PT in Motion News 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.