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  • The View From Capitol Hill: 5 Things for PTs and PTAs to Watch for in This Session of Congress

    Congress is back in session, and while other issues may grab front-page headlines, the next few months also could prove significant for the physical therapy profession—sometimes thanks to the ripple effects of big-ticket legislation, and at other times when lawmakers turn their attention to more physical therapy-specific bills.

    PT in Motion News asked Ken Sprague, APTA's senior congressional affairs specialist, about the legislative issues that should be on the radar of physical therapists (PTs), physical therapist assistants (PTAs), students, and their supporters. Here's Sprague’s list of the top 5 issues to track over the coming weeks:

    1. Repeal of the Medicare Therapy Cap
    Congress is arguably closer than it's ever been to coming up with partial or full repeal of the Medicare therapy cap. A bill in the US House of Representatives to end the cap has strong bipartisan support, with 177 cosponsors as of late July.

    Sprague’s take: "Watch for movement with this legislation through 1 of the several September must-pass legislative packages, such as the Children's Health Insurance Program (CHIP) reauthorization or the various Medicare extenders that will require congressional action. APTA continues to work with committee staff in the House and Senate to develop amendment language and garner even more support for the bill."

    Tip: Coming September 12 and 13, take part in a Flash Action Strategy, an effort led by student members of APTA that will invite PTs and PTAs to participate in a high-intensity, short-duration advocacy effort around repeal of the therapy cap (#FAS2017 and #StopTheCap). Also, be sure to check out a video of APTA CEO Justin Moore, PT, DPT, testifying before a House subcommittee on repeal of the cap.

    2. Inclusion of PTAs in TRICARE
    TRICARE, a major part of the US Department of Defense health care system, says that physical therapist assistants (PTAs) aren't payable under the program—but that may be changing. In June, a House committee directed the US Secretary of Defense to look at ways to bring PTAs, occupational therapy assistants, and other support personnel into the TRICARE payment system.

    Sprague’s take: "APTA continues to work with the Senate to advance this initiative by way of the National Defense Authorization Act. That act hasn't passed in the Senate, so we're working with members of the Armed Services Committee to make it happen."

    3. Protection for PTs traveling with sports teams
    Known as the Sports Medicine Licensure Clarity Act, this legislation would provide added legal protections for sports medicine professionals—including PTs—when they're traveling with professional, high school, college, or national sports teams by extending the provider's "home state" professional liability insurance to any other state the team may visit. The bill already easily passed in the House, and now it's in the Senate.

    Sprague’s take: "APTA is continuing to gain additional cosponsors for this bill in the Senate, so we hope to see advancement—hopefully we could see a committee hearing or markup on this before the end of the year."

    4. Appropriations challenges
    One of the biggest challenges Congress is facing is whether and how it will keep the federal government open, which means passing appropriations bills that pay for many of the agencies associated with physical therapy and other health care—the US Centers for Medicare and Medicaid Services, other agencies within the Department of Health and Human Services, the National Institutes of Health, and so on. The final shape of these appropriations was still very much up in the air by late August.

    Sprague’s take: "APTA is tracking this issue closely because of the huge number of agencies that are affected by the appropriations process. While President Trump released an extremely skinny budget in May with many dramatic cuts across the board, Congress already has shown they likely will not implement those cuts through the appropriations process. We will probably see a short-term continuing resolution at some point in September to keep the government open and larger appropriations packages later in the fall."

    5. Repealing and replacing the ACA
    The Senate was unable to pass its plan for repealing and replacing the Affordable Care Act (ACA) before its August recess and seems increasingly unlikely to try again any time soon. In the absence of those efforts, bipartisan efforts are emerging aimed at stabilizing the insurance markets in the ACA's state exchanges.

    Sprague’s take: "Legislators are looking at efforts such as legislating the cost-sharing reduction payments made by the federal government to offset the high cost of premiums and deductibles for individuals who purchase insurance through the exchanges. Other initiatives that likely will be discussed are the repeal of the employer mandate, revisiting the medical device tax, and other more bipartisan efforts. There's already movement in these areas, with meetings of the Senate Health, Education, Labor, and Pensions Committee already scheduled for the first 2 weeks of September."

    Turn It Off: Study Finds TV-Watching Linked to Higher Risk of Later Mobility Disability in Older Adults

    In brief:

    • Study compared survey responses of 134,000 adults, aged 50-71, who were asked about sedentary behavior and physical activity (PA) once in 1995-1996 and again in 2004-2005
    • All participants in the first survey reported no mobility disability; by the 2004-2005 survey, mobility disability was reported at a higher rate among participants with high amounts of sedentary behavior and low amounts of weekly PA(mobility disability status was assigned whenever a respondent reported an inability to walk, or the ability to walk only at an "easy" pace)
    • Strongest association was with time spent watching TV, with mobility disability risk increasing with hours-per-day spent watching TV regardless of reported PA time
    • Respondents who spend more than 5 hours a day watching TV and fewer than 3 hours engaged in PA increased their risk of mobility disability by 65% over referent group

    Older adults who choose to spend most of their time sitting and very little time being physically active risk sacrificing their mobility later on: that's the conclusion of a new study that says adults 50 to 71 who spend more than 5 hours a day watching television and fewer than 3 hours a week being physically active triple their chances of experiencing a mobility disability at some point in the future.

    The study, published in theJournals of Gerontology: Medical Sciences, analyzed data from 134,269 participants in surveys jointly sponsored by the National Institutes of Health (NIH) and the American Association of Retired Persons (AARP) in 1995-1996 and again in 2004-2005. Authors analyzed respondents' self-reported television viewing and other sedentary behaviors and average number of hours per week spent in light- and moderate-intensity physical activity. Next they matched up data sets with respondents' mobility status as reported in the later survey (all respondents used in the study reported no mobility disabilities in the first survey). "Mobility disability" status was assigned whenever a respondent reported an inability to walk, or the ability to walk only at an "easy" pace.

    Researchers were particularly interested in teasing out the impact of television viewing from other sedentary behaviors such as computer time, napping, and sitting without watching TV. On the PA side of the equation, they were interested in finding out to what degree PA offset the debilitating effects of sedentary behavior. Here's what they found:

    • After adjusting for PA, the relationship between total sedentary time to mobility disability was "almost negligible." However, disability increased steadily with increased reported hours of TV time.
    • Compared with the referent group who reported watching no more than 2 hours of TV per day, respondents reporting 3-4 hours per day of TV viewing experienced 25% higher odds of mobility disability. Respondents reporting watching TV for 5 or more hours a day were found to have 65% increased risk of mobility disability.
    • The odds of mobility disability dropped progressively as frequency and intensity of PA increased, although hours spent watching TV consistently pushed odds higher.
    • Respondents who reported 7 or more hours of PA a week and up to 6 hours a day of sitting did not see their risk of mobility disability rise appreciably; however, increased hours of TV time were associated with increased mobility disability risk regardless of the hours spent in PA.

    "Our findings corroborate those of other studies reporting sedentary behavior to be a risk factor for loss of physical function that is distinct from level of moderate-to-vigorous-intensity [PA]," authors write. As for the stronger association between TV time and mobility disability than for the more generic "sitting" time and mobility disability, researchers believe 2 issues could be at play: first, respondents may be reporting TV watching time with greater accuracy; and second, sitting time may be broken up during the day by periods of PA, whereas TV watching tends to take place in long periods of sitting uninterrupted by PA.

    "Sitting and watching TV for long periods, especially in the evening, has got to be one of the most dangerous things that older people can do," lead author Loretta DiPietro, PhD, MPH, told National Public Radio. She speculated that binge-watching made possible by streaming video is likely making the problem worse. "Before binge watching, at least when a show ended you got up and walked around," she told NPR. "It's now possible to watch several hours without moving."

    Authors of the study acknowledge limitations including a sample that was 94% white with a high school education or higher, and no way to know for certain if every respondent was in fact healthy at the time of the first survey. But they believe the data are conclusive despite those weaknesses.

    "Our findings and those of others indicate that reductions in sedentary time, as well as increases in [PA] are necessary in order to maintain health and function in older age—particularly among those who are the least active," authors write. "Current US public health recommendations for [PA] have not addressed sedentary time, but our results suggest doing so may be useful for reducing mobility disability."

    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.

    From PT in Motion magazine: PTs and Chronic Fatigue Syndrome

    Chronic fatigue syndrome (CFS) is real, and physical therapists (PTs) can play a significant role in helping those who experience it regain at least some semblance of their pre-CFS lives—but only if those PTs truly listen to the patient and validate their struggles.

    This month's PT in Motion magazine takes an in-depth look at CFS, tracking its emergence from a set of symptoms dismissively called "yuppie flu" to the more recent establishment of CFS as a very real, very life-changing physiological condition that could come to be more widely known as systemic exertion tolerance disease (SEID). Currently, CFS is the more common term for the condition and is the terminology used in the article.

    But the article is more than a lesson in history: Associate Editor Eric Ries focuses on how PTs, including one with CFS herself, apply their training to help patients respond to a condition that is often misunderstood and can leave people feeling helpless and isolated.

    The feature includes practical insights on the kinds of interventions used by PTs who've worked with patients with CFS, as well as accompanying articles on the basics of the condition, the emergence of consensus around the need for a transition to use of “SEID” instead of “CFS,” and resources for more information.

    However, as stressed by nearly every PT interviewed for the article, working effectively with patients with CFS requires more than an understanding of the physiological elements of the condition, and treatment won't be effective if the PT thinks of treatment from a one-size-fits-all perspective. Instead, PTs needs to fine-tune their ability to truly listen and empathize.

    In being interviewed for the article, Adriaan Louw, PT, PhD, tells PT in Motion that listening and truly being present with the patient can have a powerful impact almost immediately. "Ninety percent of our patients with chronic fatigue syndrome start crying during [the patient interview] process," Louw says, "simply because we're spending time with them, taking them seriously, and demonstrating that we care about them as human beings."

    "The Real Story About Chronic Fatigue Syndrome" is featured in the September issue of PT in Motion and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.