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  • 2017 Slate of Candidates Posted

    The 2017 Slate of Candidates for APTA national office is now posted on the APTA website. The candidate webpage, including candidate pictures, statements, and biographical information, will be posted on March 13, 2017.

    Elections for national office will be held at the 2017 House of Delegates on June 19, 2017. Please contact Cheryl Robinson in APTA’s Governance and Leadership Department for additional information.

    From Move Forward Radio: A Journey Out of Pain and Away From Painkillers, Thanks to Physical Therapy

    Morgan Hay had been down with the flu for about a week and was starting to get bored. So she turned on a horror movie to break up the monotony. It worked: not long into the movie, she jumped off the couch and attempted to run upstairs, away from all the scariness, only to slam her right big toe into a stair. The resultant pain was intense.

    That's when she entered what turned out to be a real-life nightmare that took her from specialist to specialist, and subjected her to multiple painkillers that made her feel "like a zombie." The pain was so overwhelming that it caused her to lose consciousness nearly 2 months after the initial injury.

    It was a nightmare that only ended after extensive work with a physical therapist (PT). Hay recounts her story in the latest edition of "Move Forward Radio," APTA's twice-monthly podcast series that educates the public about the benefits of physical therapist treatment.

    Initially, Hay thought she had badly stubbed her toe. But when she woke up the next day still in excruciating pain, she went to the local hospital emergency department to find out that she had sustained multiple fractures in her toe. She was put in a cast, but 11 days later, her orthopedist removed it due to the intense pain Hay was still experiencing.

    A neurologist diagnosed Hay with reflex sympathetic dystrophy, and then the pain medications started rolling in: at one point Hay says, she was taking Cymbalta, Lyrica, and methadone for the pain, and some doctors she visited were even pressing her to begin taking additional antidepressants.

    Hay understood that the current course of treatment wasn't really addressing the pain, but merely masking it. Finally, in desperation, the 23-year-old made an appointment at the Cincinnati Children's Hospital Medical Center, where she was seen by a team of providers, including Nancy Durban, PT, DPT, MS.

    That's when things began turn around for Hay. She was diagnosed with complex regional pain syndrome, and prescribed intensive physical therapy, accompanied by pain medications, which would be gradually reduced and finally eliminated.

    "Nancy understood everything I was going through," Hay says. "She knew exactly what to say and what to do to make me feel like I was heard—and it helped my pain."

    It took nearly a year of physical therapy, sometimes at 4 or 5 sessions a day, before Hay was fully recovered. But the process helped Hay understand how pain was a signal that something needs to be addressed, and not simply a sensation that needs to be blocked or dulled through drugs.

    "I felt like I was going to be on pain medication forever," Hay says. "I couldn't really see a light before I went to physical therapy," but once she did, "I was actually doing something to help me. I didn't have to rely on medicine to heal my pain."

    APTA is raising public awareness about the risks of opioids and the benefits of physical therapy via its #ChoosePT campaign, which includes TV and radio public service announcements, national advertising, and free resources at MoveForwardPT.com/ChoosePT.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org.

    Tim Flynn, PT, PhD, Wants Physical Therapists to Take the Lead in Pain Education

    Tim Flynn, PT, PhD, has left medicine.

    For Flynn, a featured speaker at this year's conference of the American Academy of Manual Physical Therapists (AAOMPT), and part of the APTA Innovation 2.0 initiative, it wasn't exactly a unilateral decision. He says that in many instances, it's medicine that did the leaving, moving away from what he believes should be the central focus of health care: the needs of the whole patient.

    "I left medicine because medicine left health care," Flynn says. "I cannot be a part of a system based on the medical model of doing-to people and selling sickness." Flynn thinks the most dramatic departures are around pain treatment, the use of imaging, and reliance on surgeries.

    Flynn took that message to the AAOMPT conference, where he delivered the Distinguished Lecturer Presentation, titled "Why I Left Medicine in America: Stay Wild and Mischievous." The presentation was, if nothing else, provocative in the truest sense of the word, with slides asserting that "the modern US medical-industrial complex has created, promoted, and sustained" epidemics in pain, imaging, and surgical management of low back ache. At times Flynn went even further, asking, among other things, whether spinal fusion surgery is "the lobotomy of our time."

    Other parts of Flynn's presentation focused on the ways imaging is being used to create a culture that characterizes problems associated with normal aging—things like disc degeneration, knee meniscal tears, wrist arthritis, and shoulder abnormalities—as dire conditions that need to be identified through excessive imaging, and then somehow "fixed" through surgery. Flynn calls many of these conditions "wrinkles on the inside," and just a normal part of aging.

    The AAOMPT presentation was also about exhorting physical therapists (PTs) to recognize the unique power they have to move patients away from the assumptions that play into the medical-industrial model, Flynn said.

    "I believe that the term 'medicine' is no longer applicable to what we are as physical therapists," Flynn says. "We’re in the health care business—the medical-pharmaceutical interventions are just a small component of health care."

    This, according to Flynn, represents a real opportunity for PTs—but it may require them to get out of their comfort zone.

    "My call to PTs is that we are at the forefront on educating people about pain, but we have not been aggressive enough about that education," Flynn says. "We can't wait. We have to be going to clients and consumers now, and really educating them. And it may push us into areas where we probably didn't get enough training, but tough: it has to be done."

    Flynn's efforts to that end also include a video, "Keep the Wolves and Opioids Away," now making the rounds on YouTube and social media. The 4-minute video combines interview comments from Flynn with images and text that provide stark, often startling facts about the seriousness of the opioid epidemic, and the ways in which big pharma sold the US health care system on an unsustainable and dangerous approach to pain treatment.

    Like his AAOMPT lecture, the video includes a call for PTs to live out the full potential of their profession.

    "As PTs, we've always been the optimists of the health care system," Flynn says. "But we've undersold that optimism, and now it's time to change that. That's what consumers desperately need."

    And Flynn believes that much-needed optimism is borne out in nearly everything PTs do.

    "At the end of the day we listen, we put our hands on people, we educate, we motivate, and we bring people back to where they want to be," he says. "That's who we are. We've always been that way. We empower people."

    APTA is raising public awareness about the risks of opioids and the benefits of physical therapy via its #ChoosePT campaign, which includes TV and radio public service announcements, national advertising, and free resources at MoveForwardPT.com/ChoosePT.


    From PTJ: Selecting the Right SCI Outcome Measure Sometimes a Matter of Clinical Judgment

    A new report on outcome measure (OM) recommendations for treatment of people with spinal cord injury (SCI) finds that, yes, there are strong tests and measures for this population, but physical therapists (PTs) still need to rely on their clinical judgment when the measures are weak on evidence.

    Appearing in the November 2016 issue of Physical Therapy (PTJ), APTA’s scientific journal, the report comes from the Spinal Cord Injury EDGE (Evaluation Database to Guide Effectiveness) Task Force led by the APTA Academy of Neurologic Physical Therapy. In addition to the recommendations, the task force’s efforts illuminated areas of strength and weakness in outcomes tools for specific areas.

    After evaluating psychometric data for 133 outcomes measures used in treating people with SCI, task force members narrowed down the initial list to 63. Reviewers were paying particular attention to each measure’s reliability, validity, sensitivity to change, minimal detectable change, and minimal clinically important difference.

    Experts then peer reviewed each of the 63 measures and rated them from 1 (do not recommend) to 4 (highly recommend), for level of acuity, incomplete vs complete SCI, and appropriateness for research, clinical practice, or entry-level PT education.

    Some highlights:

    • 20 measures were recommended or highly recommended for both complete and incomplete SCI.
    • 14 measures were recommended or highly recommended for at least 2 levels of acuity.
    • 23 measures were recommended for use in PT education.
    • 32 measures were recommended for use in research.
    • Of the 63 measures, 35 were performance-based, 27 were self-report, and 1 contained elements of both.

    Unfortunately, some key areas for measurement had limited supporting data. “There were constructs that the [task force] felt were priorities for measurement in SCI, but that did not have any OMs receiving ‘Recommended’ or ‘Highly Recommended’ rating across all [International Classification of Functioning, Disability, and Health] categories,” authors write, citing examples such as muscle tone and cardiovascular function in the domain of body structure and function.

    Another important point, according to authors: lower overall ratings don't necessarily mean that a particular measure isn't worth consideration. "A score of 2 on the SCI EDGE recommendations does not mean [it] should be dismissed,” they write, but that PTs should exercise clinical judgment.

    The full recommendations can be found on the academy’s website.

    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.

    Prepare for MIPS: CMS Is Looking for PT Volunteers to Shape the Future of Payment

    It's not often that the Centers for Medicare and Medicaid Services (CMS) allows providers to try out a new system for a couple years before they're required to participate, but that's exactly the opportunity being presented to physical therapists (PTs) under the final 2017 Medicare and CHIP Reauthorization Act (MACRA) released last month.

    In other words, carpe MIPS.

    MIPS, which stands for the Merit-Based Incentive Payment System, is the program most physicians, physician assistants, nurse practitioners, certified registered nurse anesthetists, and groups that include these providers will be required to participate in beginning January 2017. MIPS is a provision of MACRA, the value-based payment system that was put in place after the demise of the flawed sustainable growth rate (SGR), and one that represents a fundamental shift in the way CMS looks at valuation of care. MIPS replaces the physician quality reporting system (PQRS), the value-based modifier program (VBM), and the electronic health records (EHR) "meaningful use" program.

    And according to APTA Director of Regulatory Affairs Roshunda Drummond-Dye, JD, it will almost certainly be the system required of PTs beginning as early as 2019.

    "MACRA is the beginning of the end of CMS reliance on the fee-for-service model," Drummond-Dye said. "These comprehensive efforts will be extended beyond the first wave of providers in 2017, and CMS has definitely not left physical therapy out of its plans for expansion."

    While the move toward value-based care has been long-supported by APTA, there's even better news for members of the physical therapy profession: PTs will be able to voluntarily report to MIPS beginning in January, an opportunity that will not only help them understand the new payment landscape, but will provide CMS with data it can use to structure the program to better position physical therapy when MIPS does become a requirement for PTs. The agency has created a webpage specifically devoted to learning more about participating in MIPS.

    Drummond-Dye says that now is the time to get involved in MIPS, and offers 3 tips that will help make that involvement more successful:

    1. Implement an EHR. "If you don't use an EHR, now's the time to start," said Drummond-Dye. But make sure your EHR is certified by the Office of the National Coordinator—a critical step to ensure that it will be able to work with Medicare and MIPS. "There are only a small number of certified EHRs used by the physical therapy profession, so choose carefully," she adds. The CMS MIPs participation information page includes resources for finding an EHR.
    2. Subscribe to a registry. "Registry participation isn't mandatory, but it's a great way to gain valuable information about your practice and the value of services you provide," Drummond-Dye said. And beginning in early 2017, you can do that by participating in APTA's Physical Therapy Outcomes Registry. It's a resource that does double-duty: not only providing information for individual practices, but stockpiling data that will be used to create robust quality measures that can help the profession position itself well in the future.
    3. Educate your staff, and stay on top of compliance. "It is crucial that each PT understands the importance of quality measurement, and incorporates that understanding into their daily activities," Drummond-Dye said.

    MIPS isn't the only avenue for voluntary participation in the new systems. According to Drummond-Dye, PTs may also be able to participate in the Medicare Quality Payment Program through participation in advanced alternative payment models (APMs). The most applicable models for PTs: the Medicare Shared Savings Program, and the Next Generation Accountable Care Organizations (ACOs). APTA offers background and resources on ACOs on its webpage devoted to the topic.

    "PTs should take a look at area hospitals and physician groups establishing these models, and actively look for ways to take part," Drummond-Dye said. "Participation will not only satisfy MIPS reporting requirements but will also increase the importance of the role PTs play in interdisciplinary teams that are working to improve the quality of care for populations."

    Preparation for the coming changes is also important at the facility level, Drummond-Dye added.

    "Facility-based settings that bill under the Medicare Physician Fee Schedule—rehab agencies, outpatient hospitals, and skilled nursing facilities, for example—need to prepare now," Drummond-Dye said. "CMS hasn't set out a clear path for how these settings will participate in MIPS, but they're working on it," and that’s another move supported by APTA. "To have a strong quality payment program for physical therapy under Medicare, that program must encompass the entire continuum of care," said Drummond-Dye.

    APTA is developing a series of fact sheets on MACRA and will offer a comprehensive plan to help PTs participate in the voluntary reporting program in MIPS. In the meantime, programs such as APTA's Innovation 2.0 initiative are helping to better acquaint the profession with alternative payment models that include significant involvement from PTs.

    From PT in Motion: I Love Rock 'n' Roll (And My PT)

    You know those faces rock guitarists make during those solos? How, in the middle of the most intense passages, they look like they're grimacing in pain?

    Well, maybe they are.

    This month, PT in Motion magazine takes a look at physical therapists (PTs) who work with musicians—mostly of the rock variety. From singers who repeatedly curve their spines to look into the audience, to guitarists with focal hand dystonia, keyboardists with tendinitis, and drummers with epicondylitis, the article makes the case that the life of a musician can be downright brutal on the body.

    Through interviews with several PTs who work with both big names and the lesser-knowns, to comments from stars Mat Kearney and former Genesis guitarist Steve Hackett, "Keeping in Tune" touches on the ways that repetitive motion, hours spent in a slouch, and the often un-ergonomic nature of some instruments can lead to problems that affect a musician's ability to continue to ply her or his trade. Fortunately, some musicians turn to physical therapy, with a few PTs even traveling with a band on tour.

    "A musician is more like an athlete than people understand," says Kearny, who begin noticing neck, back, and shoulder pain while on tour. He connected with a PT, who helped him work on his onstage posture, and even the way he held his guitar. "Once I learned some proper techniques and the PT showed me what I could do better onstage, things improved tremendously."

    "Keeping in Tune" is featured in the November issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one 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.

     Also newly opened for public access: "Making the Most of International Volunteer and Learning Opportunities." Check it out!

    Access to Accountable Care Organizations Is Focus of Third Innovation 2.0 Learning Lab

    Continuing its successful Learning Lab series based on the Innovation 2.0 initiative, APTA will host its third of 4 labs on November 15, 1:00 pm–4:00 pm ET.

    Like the first 2 labs, the November 15 event will enable participating APTA members to hear firsthand from the physical therapist (PT) innovators who were selected to pursue new, creative models of care. The third lab will focus on how PTs can facilitate access and provide value as integral participants in an accountable care organization (ACO).

    This project was conducted with private physical therapy practices in Northern Colorado participating in the Medicare Shared Savings Program through the Mountain and Plains Division of Central US Accountable Care Organizations and led by Tim Flynn, PT, PhD. It evaluates the role of early access to PTservices for patients with musculoskeletal complaints, specifically lower back pain (LBP). In this model, PTs are working collaboratively with ACO primary care physicians to optimize management of LBP in the outpatient setting.

    The Learning Lab is a free online event intended as an advanced experience for providers who are currently active in innovative programs or ready to explore them. Because the event has limited attendance, members interested in participating are required to answer a series of questions on the registration form to help APTA select participants who can gain—and later share with others—the most benefit from the lab. Participants will be expected to actively engage in the lab session, and materials will be provided beforehand to help them do so. If that’s you, visit the Innovation 2.0 webpage and scroll to the "Learning Lab" section to register.

    Registered participants will receive a template that will help them replicate the model presented in the lab. APTA will post a free recording of the event afterward, which will include the downloadable template and the presenter’s slide deck.

    Visit the Innovation 2.0 webpage to register for the Facilitating Access Improving Care—PTs as Integral ACO Members Learning Lab. For details on all of the projects selected for development, as well as projects that received honorable recognition, go to Innovation 2.0 Background. Profiles of each project were also featured in a September 2015 article in PT in Motion magazine.

    APTA Begins Research Fellowship Search; 2 Positions Available

    Looking for a postdoctoral or early investigator fellowship? APTA may have an opportunity for you.

    APTA has announced the creation of 2 new fellowships within the association: a visiting scholar postdoctoral fellowship set to begin in 2017, and a 2018 visiting scholar early investigator fellowship. Both positions seek a physical therapist "who will be able to add to or refine the body of knowledge on which physical therapy is based."

    A complete description of the fellowships, including responsibilities, requirements, terms, and application instructions, can be found on the APTA website (postdoctoral fellowship here, early-investigator fellowship here). The deadline for submission of applications is November 30, 2016, with in-person and virtual interviews conducted beginning in February 2017, during the APTA Combined Sections Meeting.

    Questions about the fellowship should be directed toward the APTA research department.

    Foundation Funding Opportunities Available for 2017

    The Foundation for Physical Therapy (Foundation) is now accepting applications for 2 major funding programs.

    Eligibility and application information for the postprofessional 2017 Promotion of Doctoral Studies (PODS) Scholarship and the New Investigator Fellowship Training Initiative (NIFTI) (now a $100,000 award over a 2-year period) is posted on the Foundation website. The deadline to apply is January 18, 2017, by 12:00 pm, ET.

    Applicants are encouraged to start the submission process early to allow for potential questions to be answered. Award recipients will be notified in June.

    Contact Jordan Rochon for more information, or call 800/875-1378, ext 3167.

    Important tip: thoroughly read through all instructions and funding mechanism deadlines before beginning your application. Want to stay on top of what's available? Sign up for the F4PT Alert and be first to know about Foundation funding opportunities.

    From Move Forward Radio: Transforming Society's Understanding of Pain

    Andre Machado, MD, chairman of the Neurological Institute at Cleveland Clinic, thinks opioids are remarkable.

    "But 'remarkable' can have 2 meanings," he says. "It can be a positive remarkable, or a negative remarkable. And the long-term use of opioids, when we use it chronically, is often remarkable in the wrong direction."

    Now available from APTA's Move Forward Radio: a conversation with Machado, who is leading an innovative pain treatment research project that puts a combination of physical therapy and behavioral therapy at the front lines of pain treatment, and takes a cautious approach to the use of opioids. Machado shared his thoughts on opioids and the need for a cultural shift on attitudes about pain in a recent TIME magazine opinion piece. His Move Forward Radio interview delves even deeper into his beliefs on what constitutes truly effective pain treatment.

    "When pain becomes chronic it is no longer necessarily signaling an injury to the body," Machado tells Move Forward Radio. "It's just there. It's telling us that there is injury when there is really no injury, and this is really the difference between hurt and harm. It is on us to learn that sometimes there is hurt, but there is really no harm. By rehabilitating the body, which is the job of the physical therapist, while rehabilitating the mind and the perception of pain, we believe that we will be able to rehabilitate people in going back to their work, to their self-care, and care of their loved ones."

    Machado is joined in the interview by Ian Stephens, PT, DPT, a board-certified clinical specialist in orthopaedic physical therapy. Stephens is a faculty member for Cleveland Clinic’s orthopaedic physical therapy residency program, and is a provider in the study.

    Stephens believes that Machado's approach leverages what PTs do best: empowering their patients and clients.

    "When [patients] understand pain, and they understand triggers and how to reduce the sensitivity of their nervous system, I think they become empowered, and I think you can see that translate directly to their function," Stephens told Move Forward Radio.

    Move Forward Radio is featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    Other recent episodes include:

    Success Story: A Young Woman's Journey With Complex Regional Pain Disorder
    Margaret’s experience with pain started with an accident when she was stepped on by a horse.

    Success Story: An Art Teacher's Journey to a Pain-Free Life
    Joanne was enjoying her life as an art teacher when she started experiencing hip pain. The pain increasingly intensified, making it hard to stand or walk, and ultimately forcing her into retirement.

    Tips for Track and Field Athletes
    Shannon Singletary, PT, DPT, directs the health and sports performance team that cares for all of the University of Mississippi’s varsity athletes. In this episode of Move Forward Radio, Singletary advises youth athletes who want to excel in the various disciplines of track and field, or any sport.

    Success Story: Physical Therapist Treatment Gives Woman Active Life After Restricted by Pelvic Pain
    Erin Jackson endured intense chronic pelvic pain through college and law school, and would persevere to graduate both. But the pain would ultimately become severe enough to cause her to postpone her wedding and withdraw from a postgraduation job opportunity.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be emailed to consumer@apta.org.