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  • JAMA: Equipment Ownership, Prior Imaging Behavior Predict High Rates of Low-Value Imaging for LBP, Headache

    In brief:

    • Researchers analyzed data from 100,977 providers (primary care physicians, chiropractors, and specialists including orthopedic surgery, neurosurgery, back and spine surgery, physical medicine, and rheumatology) to track prevalence of low-value imaging for uncomplicated back pain and headache as identified in the Choosing Wisely campaign
    • Study looked at predictors of higher rates of low-value imaging, including whether the provider owned imaging equipment
    • Clinicians were more likely to order imaging if they owned the equipment or if they had ordered imaging for a previous patient with the same symptoms
    • Equipment ownership was a "consistent independent predictor" of increased use of low-value imaging
    • Authors call for more clinician education on avoiding low-value imaging

    Despite evidence showing that imaging for low back pain (LBP) and uncomplicated headache is not necessary, too many health care providers still order these services for their patients, who incur greater financial costs. In a new study published in JAMA Internal Medicine, researchers identified several factors associated with higher rates of low-value imaging—including whether the providers owned the imaging equipment.

    Using 4 years' worth of claims data from 1 insurer, authors analyzed clinician characteristics as predictors for imaging for uncomplicated back pain and headache—2 low-value services identified by the Choosing Wisely campaign guidelines as inappropriate for imaging.

    The study included 100,977 providers divided into 3 categories: primary care physicians, chiropractors, and providers in specialties including orthopedic surgery, neurosurgery, back and spine surgery, physical medicine, and rheumatology.

    Low back pain. Primary care physicians were 1.81 times more likely to order low-value imaging for back pain if they had ordered it for a prior patient than those who didn't order earlier imaging. Chiropractors and specialists were nearly 3 times more likely to do so.

    All clinician types were more likely to order imaging for low back pain if they owned the equipment, but chiropractors (7.76) and specialists (4.96) had the greatest increased odds, compared with primary care physicians, who had increased odds of 2.06.

    Headache. For headache, clinicians who ordered imaging for a previous patient were twice as likely to do so for the next patient than those who had not made a previous order. Clinicians who owned the imaging equipment had 1.88 times higher odds of ordering low-value imaging for headache than those who didn't own equipment.

    High rate of low-value back imaging as a predictor of low-value headache imaging. Primary care physicians who had high rates of low-value back pain imaging were 1.78 times more likely to order low-value headache imaging than those whose low back pain imaging rates were low.

    Ownership of imaging equipment. Clinician ownership of imaging equipment was a "consistent independent predictor of low-value imaging across clinician type and imaging scenario," authors write. Primary care physicians with the highest rates of low-value back imaging were also 1.53 times more likely to order low-value headache imaging if they owned the imaging equipment.

    Authors believe the findings have direct implications for patients, who shoulder a greater cost share with the additional services. For example, the study found that patients with private insurance were more likely to be referred for low back and headache imaging if their provider had higher rates of imaging and/or owned the imaging. This was especially true among chiropractors and specialists.

    According to authors, underlying factors may include "discomfort with clinical uncertainty, overestimating the benefits of testing, group practice trends, and other practice-related factors," as well as "the pervasive fear of malpractice."

    Researchers also pinpoint the challenges regarding equipment ownership in the changing payment environment and consolidation of practices and health systems. "Previous legislation has limited imaging equipment ownership and clinician self-referral; however, exceptions have been made for patient convenience and evolving practice models," authors write. "As a result, these laws may be less effective than intended. Although there are payment programs that hold health care provider groups responsible for the cost of care, early evidence shows that their effectiveness at reducing low-value care has been modest, even among self-selected provider groups."

    Still, authors note, to optimize patient care and cost, "stakeholders should design clinician-targeted interventions to reduce low-value care."

    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.

    Problems With Humana Claims? Let APTA Know

    Physical therapists (PTs) in several states are reporting claims difficulties with Humana's commercial and Medicare Advantage insurance plans, but more input from providers is needed.

    Recently, PTs from several states including Florida, Ohio, Kentucky, Louisiana, Virginia, and West Virginia have contacted APTA about Humana-related payment issues that include the retroactive application of the multiple procedure payment reduction (MPPR), further reductions to in-network providers' rates through the MPPR, confusion around Humana's approach to anatomical modifiers, and inconsistent application of the 59 modifier, with denials occurring even when the modifier was visible on the claim.

    In addition, the association has received reports of providers having difficulty accessing Humana personnel to discuss claims issues, and a lack of notification when policies and processes change.

    APTA staff have been in discussion with a representative from Humana to facilitate a resolution to the problems. As part of those efforts, APTA is urging members to contact the association by email at advocacy@apta.org, or by phone at 800/999-2782, extension 8511, to share any new or ongoing issues they've had with Humana.

    Need more information on retroactive claims denials and adjustments? Check out this APTA webpage. Also available: resources from Humana on postpayment recoupment, claims coding processing edits, and gaining a better understanding of other Humana processes.

    AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment

    Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain. But that encouragement won't have much impact unless it's accompanied by payment coverage policies that make the nonopioid approaches more feasible to pursue, they write.

    In a letter to America's Health Insurance Plans (AHIP), the health insurance industry's trade association, AGs affiliated with the National Association of Attorneys General describe the opioid crisis as "the preeminent public health crisis of our time." The AGs say that while addressing addiction and recovery are crucial components in solving the problem, the issue must also be addressed further upstream—namely in the ways opioids are overused as a treatment for pain.

    "The unnecessary over-prescription of opioid painkillers is a significant factor contributing to [the opioid epidemic]," write the AGs. "When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications…to physical therapy, acupuncture, massage, and chiropractic care."

    The AGs write that the needed encouragement must come through insurance company incentives to follow a nonopioid treatment path. "Simply asking providers to consider providing alternative treatments is impractical in the absence of a supporting incentive structure," they write. "All else being equal, providers will often favor those treatment options that are most likely to be compensated."

    Besides helping to reduce the prevalence of opioids, nonopioid pain treatment is consistent with the science around pain management, according to the AGs. "Incentivizing opioid alternatives promotes evidence-based techniques that are more effective at mitigating this type of pain, and, over the long run, more cost efficient," they write. "Thus, adopting such policies benefits patients, society, and insurers alike."

    In a September 22 response, AHIP stated that its members "continue to expand and refine a comprehensive, multi-faceted approach to preventing and managing opioid misuse and related conditions," including "identifying alternative forms of pain management." The AHIP letter lists several member initiatives, including a push by Anthem to encourage providers to follow opioid prescription guidelines from the US Centers for Disease Control and Prevention. AHIP also states that it's working with some members on "exploring and improving access to non-pharmacologic pain treatments that have been proven effective in reducing pain."

    The AHIP letter also asserts that medical management—prior authorization, prescription tiering, plans that require "an evidence-based systematic approach to therapy," and the like—is 1 of the "most effective tools health plans have" in the battle against opioids, and has been mischaracterized as a "barrier" to treatment.

    "To effectively solve the opioid crisis, it must be addressed comprehensively by all stakeholders—from law enforcement and the justice system, to social services agencies and state Medicaid programs, to health care providers, pharmacists, health plans, and pharmaceutical companies," AHIP writes. "Only through collaboration and cooperation can we address—and solve—this crisis, and further improve efforts for prevention, education, intervention, and treatment."

    APTA's award-winning #ChoosePT campaign is aimed at informing consumers that physical therapy is an effective alternative to drugs for the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, #ChoosePT includes a video public service announcement, as well as other targeted advertising and media outreach. Members can also learn more about the PT's role in pain management through offerings on PTNow, including a webpage with resources for pain management and an opioid awareness checklist.

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    APTA: CMS Proposal for Home Health Creates 'Perverse Financial Incentives' to Reduce Care

    APTA delivered comments to the US Centers for Medicare and Medicaid Services (CMS) that make no bones about the agency's proposed changes to the home health payment system. The bottom line, according to the association: The plan contains "significant flaws" that "will have a harsh and dramatic effect on patient care." And what's more, APTA says, CMS may not have the legal authority to do what it wants to do, at least in the way it hopes to do it.

    The letter from APTA provides a detailed deconstruction of a CMS proposal to radically change the payment environment for home health (HH) in ways that would directly impact patients, physical therapists (PTs), and physical therapist assistants (PTAs)—and not for the better. Those proposed changes would move episodes of care from 60 to 30 days, and would include the adoption of a new case-mix model, known as the Home Health Grouping Model (HHGM), that removes physical therapy service-use thresholds from the mix.

    All told, the changes being proposed could result in a $950 million payment reduction to home health, according to CMS. And CMS wants to roll out the new system in 2019. The CMS proposal generated a strong reaction in the HH community in general, and within APTA in particular, resulting in a record-breaking number of individual comment letters submitted to CMS, facilitated by template text that APTA made available online.

    In its letter to CMS, APTA provides comments on the entire package of proposals, but focuses particular attention on the HHGM, which it describes as a system that "undervalues the important role of rehabilitation and creates perverse financial incentives to deliver less than appropriate care." APTA's letter acknowledges the importance of creating health care delivery systems that are "better, smarter, and healthier," but argues that the HHGM moves things in the opposite direction.

    APTA writes that as a whole, the HHGM "lacks person-centeredness and…fails to support proven interventions to address behavioral, social, and environmental determinants of health. While CMS has committed to putting first the best interest of the people it serves, the motivation behind the HHGM appears to focus solely on reducing Medicare spending."

    On top of that, says APTA, CMS may be going about its proposal in a way that exceeds its authority. The association's argument is based on statutory limitations that require CMS to implement changes in a "budget neutral" manner, meaning that only Congress has the authority to impose changes that significantly impact the HH budget, down or up. APTA writes that while CMS was provided with a temporary window to make non-budget-neutral adjustments under the Affordable Care Act (ACA), that window closed this year.

    "Unless the statute says otherwise, changes to elements of [home health payment systems] must be made in a budget-neutral manner across the system," APTA writes. "If the HHGM unintentionally causes access problems through rate cuts instituted by regulation, Congress would then be tasked with finding budget offsets to cover the 'cost' of fixing the mistake."

    Making matters even worse, according to APTA, is the CMS proposal to begin implementing the HHGM in 2019. The association asserts that if it moves forward, the new model shouldn't be rolled out any earlier than 2020, and that more dialogue and education take place before a finalized system is put in place.

    Among other elements of APTA's comments:

    • APTA encourages CMS not to eliminate rural add-on payments in 2018, citing concerns that the change would worsen workforce shortages in rural areas.
    • The association supports proposed modifications to the HH Quality Reporting Program and Value-Based Purchasing Program, and is in favor of "overarching" CMS strategies around assessing and adjusting for social risk factors.
    • APTA urges CMS to move away from its proposal to use a single diagnosis to categorize an episode into a clinical grouping, and instead allow for combinations of diagnoses to ensure proper therapy interventions. Similarly, the association recommends that CMS expand its list of comorbidity subcategories "to better capture diagnoses that cause higher resource allocation."

    Still, the association's most significant concerns are linked directly to the HHGM.

    "The HHGM would not improve patient care or aid CMS in aligning home health [prospective payment systems] with its overarching…policy goals," APTA writes. "We believe the HHGM would create new program integrity issues, compliance challenges for providers, and new access issues for beneficiaries."

    APTA Board, Nominating Committee Recommendations Must Be In by November 1

    Don't let the November 1 deadline pass you by: now's the time to help APTA identify its next leaders.

    The APTA Nominating Committee is seeking recommendations for the 2018 slate of candidates for elected positions. Positions open for election are Board of Directors president, vice president, and 3 directors; and 1 Nominating Committee member.

    To submit names of qualified members who would be willing to be considered for the upcoming election cycle, visit APTA's Nominations and Elections webpage and use the online form under the "2018" header. Deadline is November 1.

    APTA Opposes Graham-Cassidy Due to Patient Impact

    The specifics of the US Senate's latest attempt to repeal and replace the Affordable Care Act (ACA) could evolve before any vote, but the basic outline of the "Graham-Cassidy" (or "Cassidy-Graham") legislation raises enough concern that APTA opposed the bill this week.

    "APTA is open to ACA reform but opposed to eliminating essential health benefits and access for millions," APTA said via Twitter and Facebook on Wednesday. "APTA is opposed to Graham-Cassidy."

    To underline its position, APTA is joining 2 patient/provider groups, the Coalition to Preserve Rehabilitation and the Disability and Rehabilitation Research Coalition, in letters opposing Graham-Cassidy. APTA also has enabled members to contact their senators via the Legislative Action Center and APTA Action app to urge caution before removing various patient protections provided in the ACA.

    "APTA is committed to working with Congress to improve health care, including potential reforms to the ACA, but not at the expense of decreasing access for millions of Americans," said Justin Elliott, APTA's vice president of governmental affairs.

    This is consistent with APTA's position dating back to March, when APTA raised concern that the House of Representatives' American Health Care Act legislation would "create unneeded barriers to care and reduce the access to care for millions of Americans." In May and July, APTA opposed the Senate's American Health Care Act and Better Care Reconciliation Act, respectively.

    Among APTA's concerns in these repeal-and-replace efforts has been the elimination of the ACA's essential health benefits, which include habilitation and rehabilitation services, and the potential to adversely affect millions of Americans who rely on Medicaid. APTA has long advocated for access to adequate, affordable, and quality health care services for all Americans, and the association says these repeal-and-replace bills challenge those principles (.pdf).

    The Graham-Cassidy legislation is expected to be brought to the Senate floor next week.

    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.

    Microchips That Reprogram Cells, 'Superglam' Physical Therapy, and Powow Sweat: Highlights From 'Making the Rounds'

    This year, PT in Motion News added a new section to the weekly news blast to members—"Making the Rounds," a collection of interesting reads for the profession from across the Internet. The collections tend to have a wide focus and include articles on everything from exercise to health care policy. Some articles are more technical; others shine a light on how exercise, mobility, and physical therapy are being portrayed in the popular media.

    In honor of "Listember" week at PT in Motion News, here's a collection of some of the more interesting stories that have been featured in "Making the Rounds" over the past few months:

    When the prescription is a recipe
    There's a growing trend among doctors and medical groups to move beyond simply recommending healthy diets and toward helping patients learn how to prepare meals.

    Everything we know about treating tendon injuries is wrong
    From Outside magazine: "After most MCL and ACL surgeries, doctors focus on treating and rehabbing the soft-tissue, while almost completely ignoring motor patterns and biomechanics.

    Islamic prayer has been found to reduce back pain and increase joint elasticity
    The postures used during prayer can be beneficial—but only if they're done properly.

    Pokemon Go players walk an extra 2,000 steps daily, study says
    The American Heart Association says the game is getting people moving.

    Scientists unveil a possible new way of healing wounds in the future
    A microchip placed on a wound delivers signals that reprogram living skin cells to convert them into specific kinds of cells that can aid in healing.

    Can patients make recordings of medical encounters? What does the law say?
    It's complicated, according to the authors of this article in JAMA.

    Fitness pros have a dirty little secret: chronic pain
    Personal trainers are susceptible to overuse injuries.

    Teens get as much physical activity as 60-year-olds, study shows
    Researchers were expecting bad news, but not that bad.

    Knee patients spending millions on wasted treatments, study finds
    In an effort to avoid surgery, patients and their insurance companies are spending millions on ineffective treatments such as hyaluronic acid injections—and not seeking physical therapy, which actually does help.

    "Powow Sweat" promotes fitness through traditional dance
    The Coeur D'Akebe tribe has created an exercise routine—called "Powwow Sweat"—based on traditional dancing.

    How Hollywood is making physical therapy super glam
    From InStyle: "This once daunting pain management therapy reserved for those recovering from surgery or injury has shifted its place in the wellness space, becoming a hot new addition to celebrities’ workout routines, whether they are injured or not."

    She thought she’d pulled hip muscles, but six doctors couldn’t diagnose her pain
    It took a PT to figure out what was going on.

    PT, PTA Students Use 'Flash Action' Against the Therapy Cap

    A physical therapist (PT) and physical therapist assistant (PTA) student-led "flash action strategy" (FAS) held last week was all about stopping the Medicare therapy cap.

    And once again, students showed how enthusiasm for the profession can make a real difference.

    In the middle of packed semesters, students from dozens of schools across the country participated in a nationwide effort to press for repeal of the therapy cap. Primarily using social media, participants concentrated their efforts during a 48-hour window of intense messaging, September 12-13. Between an early alert on September 11 and some final action the morning of September 14, more than 10,000 emails, letters, faxes, and phone calls went out to members of Congress via APTA's Legislative Action Center and Patient Action Center. The latter, where consumers can contact their members of Congress, saw a nice uptick in registrations during the FAS, largely thanks to APTA members encouraging nonmember colleagues, family, friends, and patients to participate.

    Even though the FAS is over, APTA still needs members' efforts toward repeal of the therapy cap by year-end. That's when the latest extension of the exceptions processes expires, and the hard cap on Medicare payment for outpatient physical therapy services will be implemented. The Medicare Therapy Cap webpage explains how to email and meet with legislators, download the APTA Action app, and join the APTA PTeam to receive updates and alerts.

    PT and PTA students will bring their energy and excitement to the upcoming APTA National Student Conclave , set for October 19-21 in Portland, Oregon.

    Funding Opportunity for Chapters, Practices to Encourage Activity for People With Arthritis

    APTA chapters and individual physical therapy practices have a new incentive to start or enhance programs that encourage people with arthritis to be more active—but time is short to take advantage of it. APTA is collaborating with the National Association of Chronic Disease Directors (NACDD) and the Centers for Disease Control and Prevention (CDC) in a program that will award 6 grants of about $4,100 each to selected applicants. The grants specifically are for activities to increase consumer access to the Arthritis Foundation’s Walk With Ease (WWE) self-directed program.

    Applicants must propose how they will use the funds to implement the WWE self-directed program, either alone or in collaboration with community partners or state arthritis programs. Funds can be used to purchase participant WWE guidebooks and marketing materials, and to cover administrative costs. Grant recipients are expected to enroll 400 participants during the 9-month project period, which begins in November 2017.

    Applications are due Friday, September 29, 2017, at 11:59 pm EST. More information, including program requirements, application instructions, and links to download the application (in Word and fillable PDF formats), is available on the NACDD website.

    APTA’s Arthritis Management Through Community-Based Programs  webpage includes a link to the Walk With Ease program along with a wealth of other resources.

    7 Cool Things That Happened at APTA Over the Summer (And 1 Cool Thing for the Foundation)

    Ah, the summer of 2017: vacations and cookouts, kids' camps and carnivals, softball and sweet corn, with an entire season of "Game of Thrones" dumped into the mix. It's therefore understandable if you missed some of the cool stuff that happened at APTA during the past few months.

    Just like a good sunscreen, we've got you covered. As part of "Listember" week at PT in Motion News, here are 7 good things that happened at APTA over the summer—and 1 extremely good thing that happened at the Foundation for Physical Therapy.

    1. We're 100,000 strong.
      Over the summer, APTA reached this membership milestone. The growing numbers help the physical therapy profession give even stronger voice to its commitment to patient-centered care.
        
    2. We testified on Capitol Hill.
      APTA Chief Executive Officer Justin Moore, PT, DPT, was offered an opportunity to testify on repeal of the Medicare therapy cap before a House of Representatives subcommittee on July 20. He cut right to the chase.
        
    3. We developed an online toolkit on utilization management.
      Utilization management is by no means a perfect system, but it doesn't look as if it'll be going away. Physical therapists (PTs) and physical therapist assistants (PTAs) need to understand how it all works and develop success strategies.
        
    4. We're now offering insight on the role of PTs in nutrition.
      There's a role for the PT in helping patients understand how nutrition affects function, but there are nuances to be considered and no shortage of factors that could affect just how to fulfill that role. Fortunately, a new APTA webpage helps you navigate the issues.
        
    5. PTJ published an online-only "greatest hits" issue.
      Over the summer, Physical Therapy offered up a collection of some of its very best articles on back and neck pain in a special digital issue. The issue is packed with solid research and great insights on a topic familiar to just about every PT and PTA—and it's all open-access.
        
    6. #ChoosePT was named a top campaign.
      The association's opioid awareness campaign earned a prestigious “Power of A” award by the American Society of Association Executives.
        
    7. We can help you make the case for employer-based population health initiatives.
      APTA's new  "Working With Employers Toward Population Health" webpage helps PTs and PTAs make the case to employers that preventing noncommunicable diseases among employees—or addressing them before they become symptomatic, disabling, and costly—is a smart move and one that the physical therapy profession is poised to lead in collaboration with other disciplines.
        
    8. The Foundation received its largest-ever single donation.
      The $3 million gift from Stanley Paris, PT, PhD, and his wife Catherine Patla, PT, DHSc, MS, will be used to create an endowment for clinical research funding.

    5 Examples of Why You Should be Reading the APTA Student Pulse Blog

    Given that physical therapy students represent a significant portion of APTA membership, you can't really call the APTA Student Assembly's "Pulse" blog a "best-kept secret" or "hidden gem." Still, because the blog series is targeted at students, it can be easy for practicing physical therapists (PTs) and physical therapist assistants (PTAs) to overlook.

    That would be a mistake. Turns out the Pulse blog series is home to energized, engaging content worthy of checking out no matter how long it's been since you've earned that sheepskin (and if you've ever heard it called "sheepskin," it's been a while). Here's a list of the 5 most popular posts from 2017, with links to the original posts.

    • 5. Develop Your Patient Care, Not Your Social Network
      "Presumably, in hopes of avoiding it, students and new grads [often ask me] what I think is the biggest mistake folks make in the early years of their careers. Unlike many other questions, I’m confident on my answer: They spend far too much time networking on social media, which significantly handicaps their clinical skills development."
    • 4. Jealousy, a Well-Known But Unspoken Part of Physical Therapy School
      "Comparing grades, clinical experiences, and overall knowledge is not how we're going to be the best student or best clinician; to be honest, those things will hold us back. Not only that, but it will hold our profession back."
    • 3. My Biggest Takeaways From Physical Therapy School
      "I finally made it to #FreshPT status! It was a long, intense 3 years, but I made it! At this point, I thought I'd share my biggest takeaways from the journey that is physical therapy school in hopes that it will ease the minds of current physical therapy students."
    • 2. Three Things I Wish I Knew Before I Started My Clinical Rotations
      "It's a really interesting transition from student to clinician, even though every impressive clinician whom I've shadowed has maintained a student-like curiosity that blurs the line between these roles."
    • 1. My Biggest Challenge in Physical Therapy School? Imposter Syndrome
      "When I got to physical therapy school, I didn’t feel so successful anymore; I had never been challenged like that before. I was around the smartest people—fellow students, faculty, and mentors—that I had ever met. From the start, my professors would ask a question and someone was always there with the answer, as I sat next to them feeling clueless."

    8 APTA Collections That Could Make You a Better Therapist

    "Archives." The very word sounds old and dusty, like there will be a lot of scrolls involved, and giant books on chains, and solemn reading rooms that will make you very, very sleepy, right?

    Maybe what you better dust off is your attitude.

    The APTA website is home to some fascinating archives devoted to a variety of topics. Some put you in touch with the thought leaders of the physical therapy profession; others help you keep up with the latest research; still others help to remind you why you chose the physical therapy profession. Here are 8 of the best collections offered by APTA.

    Move Forward Radio
    The Move Forward Radio podcast series explores the impact of physical therapy from a consumer-focused perspective. Guests on the interview program have ranged from a survivor of the Boston marathon bombing to the physical therapist (PT) for the Washington Redskins and Nationals—and that was just this year. Past years' podcasts have touched on blood flow restriction training, sedentary behaviors in children, and patient journeys out of pain through physical therapy.

    McMillan and Maley lecture videos
    Need a little inspiration? Settle in with some of the thought leaders of the profession as they take on some of the biggest issues not just in physical therapy, but in health care as a whole. The lectures, delivered annually at the NEXT Conference and Exposition, could challenge you, surprise you, or stir up emotion, but they're sure to recharge you.

    Ethics in Practice
    A regular (and popular) column in PT in Motion magazine, "Ethics in Practice" uses vignettes developed and written by Nancy R. Kirsch, PT, DPT, PhD, FAPTA, to explore how professional values and ethics are applied in real-world situations. What makes this archive so useful is the way it's arranged: you can track down articles according to the code of ethics principle(s) they explore, specific standards of ethical conduct addressed, and by ethical issue (for example, confidentiality, improper conduct, and suspected impairment).

    PTJ podcasts
    For some time now, Physical Therapy, APTA's research journal, has been supplementing its regular articles with podcasts featuring conversations between authors and PTJ Editor-in-Chief Alan Jette, PT, PhD, FAPTA. The podcasts are a good way to gain perspective on the articles themselves: if you've already read the article, you get more context; if you haven't read the article, the podcasts serve as a great introduction.

    Well To Do
    There's a lot of talk in the physical therapy profession about the role PTs and physical therapist assistants (PTAs) can play in prevention, wellness, and fitness. PT in Motion magazine's longtime contributor Brad Cooper, PT, MSPT, MBA, ATC, has been providing insightful columns on these topics for the magazine since 2014.   

    Insider Intel
    APTA’s periodic call-in webinars invite members to hear about the most pressing payment and regulatory issues, and pose questions to staff experts. All are recorded so you can catch up on proposed and final payment rules, new methodologies and models, MIPS reporting, and more. BTW, the next Insider Intel is September 20, with topics to include 2018 IRF and SNF final rules, the 2018 home health proposed rule, and Medicare’s new emergency preparedness requirements.

    Defining Moment
    Formerly known as "This Is Why," this award-winning column in PT in Motion magazine shares the real stories of PTs and PTAs as they describe touchstone events in their careers, the inspirations for their decision join the profession, or just the moments that make them realize they've chosen the right path for themselves.

    #XChangeSA
    APTA students participate in this monthly live chat on Twitter and YouTube to discuss topics ranging from mentorship to population health. But all PTs and PTAs will find value in the archive of discussions, which includes video and podcast versions.

    The Good Stuff: Members and the Profession in Local News, September 2017

    "The Good Stuff," is an occasional series that highlights recent, mostly local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual physical therapists (PTs) and physical therapist assistants (PTAs) are transforming health care and society every day. Enjoy!

    PT student with a lot of harp: Elise Krueger, SPT, is making a name for herself as a harpist. (Findlay, Ohio, Courier)

    Helping dental students understand patients with mobility issues: Kim Dunleavey, PT, PhD, teamed up with the University of Florida College of Dentistry in a unique program. (University of Florida Alligator News)

    Neonatal abstinence syndrome: Karen Speropulos, PT, talks about the role of PTs in responding to NAS. (Bristol, Tennessee, Herald-Courier)

    Hip exercise tips: Karen Joubert, PT, DPT, provides pointers on how to keep hips healthy. (ABC News7, Los Angeles)

    "National Founder of the Year": Heidi Jannenga, PT, DPT, has been recognized by the Arizona State University W. P. Carey School of Business for the establishment of WebPT. (Phoenix Business Journal)

    Treatment poststroke: McHaley Haeflinger, PT, explains the importance of physical therapy after a stroke. (News4 Tucson, Arizona)

    PTA—and artist: Kevin Schmoldt, PTA, has his paintings featured at a local arts center. (Waupaca County, Wisconsin, News)

    Advice on urinary incontinence: Julie Wiebe, PT, MPT, BSc, shares recommendations for women who experience UI. There's also a link to APTA's Section on Women's Health. (MSN network)

    Virtual reality (VR) for rehab: Emily Keshner, PT, EdD, discusses the advantages of VR in treating patients post stroke. (News4 Tucson, Arizona)

    "There has been research and more support medically for post concussion symptom treatment being physical therapy—using aerobic exercise as treatment, as well as cognitive behavioral therapy." – Kristine Keane, PsyD, neuroscience physician. (USA Today app.com)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    Ready for Falls Prevention Awareness Day? PTNow Can Help

    Falls Prevention Awareness Day is coming September 22, making now a great time to check out falls-related resources on APTA's recently expanded PTNow evidence-based practice center.

    Here's a quick take on just some of the falls-related resources available at PTNow.

    In addition to PTNow, APTA also offers information on falls at its Balance and Falls webpage. Resources include continuing education courses, tips on developing consumer events on falls, and links to other organizations.

    PTJ: Preterm Infants Less Able to Explore, May Lead to Delays

    Infants born preterm may be less able to perform certain motor and exploratory behaviors, which could lead to future cognitive and developmental delays, suggests a study in the September issue of PTJ. According to the study's authors, physical therapists in early-intervention programs should target behaviors such as head control and ability to make a fist.

    Non-object-oriented exploration, wrote the authors, "is not only critical for infants to learn how to engage in social interactions and to learn about objects; it is also key for infants to learn to control their own bodies so they can perform perceptual-motor behaviors like lifting their heads against gravity, reaching, or moving their hands into midline.”

    Researchers followed the development of 24 healthy full-term infants (37–42 weeks gestational age), 24 infants born preterm, and 6 preterm infants who were born with brain injury.

    Authors recorded the infants in their home environments just after expected date of birth, and at 1.5, 3, 4, 6, 9, 12, 18, and 24 months of age. Through 9 months, they assessed the infants in lying on their backs and on their stomachs. From 3 months through 24 months, they assessed the infants in sitting, supported in an infant seat.

    Some of the findings include:

    Holding up the head. Through the age of 9 months, all infants improved their ability to hold up their heads while lying on their stomachs, but those born preterm were less able.

    Holding the head in midline. In the prone position, all infants improved, but full-term infants showed the greatest ability and preterm infants with brain injury the least. Full-term infants also were best able to hold their heads in midline while lying on their backs, but there was no significant difference between preterm infants with and without brain injury. There was no significant difference among the groups in ability to hold the head in midline while sitting.

    Holding 1 hand in midline. While lying on their backs, there was no significant difference among the groups. Full-term infants did so more frequently in prone or sitting position, with no significant differences between preterm infants with and without brain injury.

    Holding both hands in midline. In supine position, there was no significant difference among the groups. While prone, preterm infants with brain injury exhibited difficulty. In sitting position, full-term infants showed greater ability than all preterm infants.

    Holding hands fisted. The amount of time spent holding 1 or both hands fisted decreased for all infants over time. However, through 9 months, infants with brain injury demonstrated more 1-handed fisting while lying down; all preterm babies showed more 1-handed fisting while sitting than did the full-term infants. Full-term infants in prone position spent more time with both hands fisted over the first 6 months than did the other 2 groups.

    Hand mouthing. Preterm infants with brain injury showed more hand mouthing than the other groups while prone but less while supine. There was no difference while sitting.

    Touching the body or surfaces. Touching the body decreased for all infants over 9 months, but preterm infants with brain injury did so much less frequently than the other groups. Touching surfaces increased over 9 months for all infants in prone and supine. While there were no differences among the groups for touching surfaces in prone position, full-term infants did so the least frequently, and infants with brain injury the most frequently. While sitting, the trajectory was the same for all groups over 24 months.

    Bouts of exploration per minute. At 6 months of age, infants without brain injury performed 7% more bouts of exploration per minute while sitting than did preterm infants with brain injury; this difference increased to 74.6% by 18 months of age.

    Variety of separate and combined behaviors. Full-term infants performed a greater variety of both separate and combined behaviors while prone. There were no differences among the groups while supine. In sitting, full-term infants performed a greater variety of combined behaviors, and all infants without brain injury demonstrated a greater variety of separate behaviors.

    The authors wrote that these non-object-oriented exploratory behaviors can "provide proprioceptive and haptic feedback, increase their body awareness, and are believed to be the precursors of future reaching and grasping behaviors.” Impairments in this area, they concluded, "are likely to cascade into delays in reaching and object exploration, which in turn will result in future motor and cognitive delays,” which proper early intervention could address.

    PTNow Expands Resources, Offers New Search Experience

    If you haven't checked out PTNow lately, you haven't checked out PTNow.

    APTA's online evidence-based practice resource has been updated and expanded significantly. Just how significantly? Additions include:

    • 92 new clinical practice guidelines (and more than 80 updates to existing ones)
    • More than 50 new tests and measures, including new resources on pain and cognitive impairment
    • 22 new clinical summaries
    • 20 new Cochrane reviews

    And getting at those resources is now easier than ever, thanks to a  retooled search function that's both user-friendly and expansive, providing members with easy access to journals and other resources relevant to clinical practice. The PTNow site has also simplified its access to its CPG+ collection, which provides expert appraisal of selected CPGs.

    "The new resources at PTNow enrich offerings to clinicians in some truly meaningful ways," said Anne Reicherter, PT, DPT, PhD, a board-certified orthopaedic clinical specialist and APTA’s senior practice specialist overseeing the PTNow expansion. "And it's not just about the new material—updates to earlier clinical summaries on subjects such as total knee arthroplasty, falls, traumatic brain injury, and unilateral vestibular dysfunction will connect members with some of the latest and best evidence out there."

    Comments on Home Health Due to CMS by September 25; HH Webinar Recording Now Available

    There's still time to submit your comments on the US Centers for Medicare and Medicaid Services' (CMS) plan to dramatically change payment for home health services beginning in 2019. And if you feel like you need to get up to speed on just what those changes entail, APTA has you covered.

    September 25 is the deadline for comments to CMS on its proposal to shift from 60- to 30-day episodes of care and to launch a new case-mix adjustment model that removes physical therapy visit thresholds, among other changes. Combined, the fully implemented proposal could result in a $950 million payment reduction, according to CMS.

    To make it as easy as possible for physical therapists and physical therapist assistants to share their concerns with CMS, APTA has created a customizable template letter that allows individual authors to included details of their own practice circumstances while delivering a shared message: that the proposal "severely devalues the clinical importance of physical therapy." APTA will submit comments to CMS by the September 25 deadline.

    APTA also has made it easy to learn more about the details of both the CMS proposal for 2019 as well as the proposed 2018 payment system, by way of a recorded webinar now available for viewing. The session includes a question-and-answer session with participants in the live session, and viewers of the recorded session also can see text comments that were entered at the time. To view the webinar, visit the APTA webpage on Medicare home health policies, and click on "Recorded Webinar 'Overview of CY 2018 Home Health PPS Proposed Rule.'"

    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.

    IOC Recommends 'Multi-Faceted' Approach to Pain Management in Elite Athletes

    Citing a lack of evidence-based guidelines for managing acute and chronic pain in elite athletes, the International Olympic Committee (IOC) issued a consensus statement (abstract only available for free) recommending a comprehensive, multidisciplinary team approach to address “biomechanics and the kinetic chain continuum, and psychosocial and contextual domains" among elite athletes. It's an approach that recognizes physical therapists (PTs) as "front-line clinicians who … address conceptualizations of pain and injury."

    While experts suggest nonpharmacologic interventions as first-line treatment, IOC authors acknowledge that “when an athlete has severe acute pain, relief of pain is not only humane but may be necessary to facilitate early mobilization.” Drugs, they state, should be used only as “one component” of a broader plan that could include physical therapy, psychosocial interventions, and, if necessary, surgery.

    PTs should provide interventions such as strength training and conditioning, as well as all types of exercise, to treat pain and fear of reinjury, according to authors. According to the statement, evidence has shown many passive PT interventions such as electrical stimulation to be ineffective for pain associated with musculoskeletal injury.

    The statement also encourages clinicians to educate athletes about the role of the central nervous system in pain. “In addition to physical therapy targeted at increasing strength, stamina, and endurance, and at correcting biomechanical contributors to pain and injury, trained and informed [PTs] can act as front-line clinicians who identify and address inaccurate conceptualizations of pain and injury plus psychosocial and contextual influences on pain,” authors write. Working in concert with behavioral health providers, PTs can offer “psychologically informed physical therapy” such as cognitive behavioral therapy to address fear-avoidance.

    The statement supports improved quality of sleep as playing an important role in decreasing pain, but it backs away from a full endorsement of nutritional interventions, with authors asserting that, so far, there isn't enough evidence of effectiveness.

    Because of the complex nature of chronic pain, “an informed and well-documented discussion should occur between the clinician, the broader health care team, and the athlete when considering approaches to the management of chronic pain,” authors write.

    If pharmacologic therapy is needed, paracetamol, NSAIDs, and topical analgesics are preferred for acute pain for lesser injuries, according to the statement. For injuries that do not allow for same-day return-to-play, the recommendations do allow for morphine, fentanyl, and nitrous oxide—but for no longer than 5 days and “at the lowest effective dose.” In addition to the risks for addiction, opioids can impair an athlete’s performance due to their effects on cognition.

    Authors note that “pain management and injury management are not necessarily identical,” and, as such, “managing pain in elite athletes must account for the tension between ignoring or masking pain versus understanding the protective role of pain in the presence of injury.”

    APTA Awards Now Open for Nominations, Including New Awards for Humanitarian, Societal Impact Efforts

    Members of the physical therapy profession do amazing things for people every day and not just inside the walls of a clinic: that's the idea behind 2 new awards from APTA that focus on humanitarian efforts and contributions that make an impact on society.

    The APTA Honors & Awards program is now accepting nominations for the 2018 awards cycle, and the program has added a Humanitarian Award and Societal Impact Award to APTA's distinctive collection of accolades. Those honors include awards for excellence in education, practice, research, and publications.

    The APTA Humanitarian Award recognizes association members "who exemplify the compassionate nature of the physical therapy profession by actively expressing a commitment to humanity and exhibiting admirable degrees of selflessness in addressing key health concerns," according to the award webpage. Nominees must be active APTA members in good standing at the time of nomination and selection, and must have a record of humanitarian service for at least a year prior to nomination.

    Also for APTA members with at least 1 year of relevant activity, the APTA Societal Impact Award is aimed at individuals who embody the compassionate nature of the profession "by exhibiting a distinguished commitment toward philanthropic initiatives, raising public awareness on key societal issues, and demonstrating how physical therapy can be applied to address these issues."

    Detailed award descriptions, eligibility information, and nomination instructions for these and the many other awards and honors in the program are available on the APTA Honors & Awards webpage. Deadline for nominations is December 1.

    Award winners will be recognized by the APTA Board of Directors at the 2018 NEXT Conference and Exhibition, set for June 27-30 in Orlando. For more information, email Alissa Patanarut.