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  • From PTJ: PT, PTA Injuries Related to Patient Handling Still Common in LTC Settings

    Despite efforts by APTA and others to emphasize safety and the use of lifting devices, physical therapists (PTs) and physical therapist assistants (PTAs) working in long-term care (LTC) facilities continue to experience musculoskeletal disorders (MSDs) linked to patient handling incidents, say authors of a new study. Areas of injury most frequently cited by PTs, PTAs, and other "therapy personnel"—occupational therapists (OTs) and occupational therapy assistants (OTAs)—were the lower back, shoulder, and neck.

    For the study, published in the February issue of PTJ (Physical Therapy), researchers looked at a year's worth of workers compensation claims (WCCs) from a long-term care company with 202 skilled nursing facilities and 20 assisted living facilities, and compared those data with the results of confidential surveys completed by 2,642 employees of the company. While the primary aim of the study was to get a sense of the magnitude of musculoskeletal injuries experienced by employees, authors also were interested in how those injuries correlate to workers' perceptions of their job demands and whether they routinely used resident-lifting equipment.

    For the analysis, the authors divided the WCC claims into 4 categories related to the cause of injury: ergonomic (manual or patient handling, bodily reaction, repetition), workplace violence, acute incident (fall, slips, trips, being struck by an object), and other. The nature of the injury—acute, subacute, nonspecific, nonmusculoskeletal—and body region affected also were grouped into major areas. Employees were grouped into larger categories: therapy personnel, nursing aide, licensed practical nurse (LPN), registered nurse (RN), social/speech/respiratory service, technician, housekeeping/dietary maintenance, and office/administrative service.

    Among the findings:

    • According to WCC data, the most commonly injured body regions among all employees were upper extremities (37%), lower back/back and trunk (20%), and lower extremities (17%).
    • Therapy personnel had the lowest rate of claims for acute injury, at 2 claims per 1,000, but their average per-claim cost were the highest.
    • In terms of ergonomic injury among clinical staff, nursing aides reported the highest rate of injury, at 36 claims per 1,000. Therapy personnel were next, at 16 per 1,000—a rate similar to those of LPNs and RNs.
    • About 43% of subacute injuries (defined by the authors as "sprains, spasms, muscle contusions, carpal tunnel, tendinitis, disc hernias, and similar injuries") were related to patient handling incidents across all jobs, with nursing aides once again reporting the highest claims rate, at 58 per 1,000. Therapy personnel were next highest at 15 per 1,000.
    • Therapy personnel, RNs, and nursing aides reported low back pain at a similar rate—48.1%, 44%, and 47.5%, respectively. Therapy personnel registered higher rates of neck pain (24.4%) and shoulder pain (34.6%) than nursing personnel (14%-22% for neck pain and 25%-30% for shoulder pain).
    • In analyzing survey results among employee categories, researchers found that therapy personnel recorded the third highest "psychological demand score" (5.87 on a 2- to 8-point scale, behind RNs and LPNs), and the highest "physical demand score"(14.6 on a 5- to 20-point scale), followed by nursing aides (12.6).
    • Just over half of therapy personnel—53%—reported that they "never" or "rarely" use resident-lifting equipment. When asked to explain the use rates, "a majority of therapy personnel stated that treatment did not involve lifting because the goal was to make residents independent," authors write.

    "It is concerning that MSD symptoms and costs…for therapy personnel were higher than for nurses," the authors write. "Our finding on the low use of resident-handling equipment by therapy staff, and the rationale that equipment use interferes with therapy goals, are consistent with prior studies." This use pattern is common despite evidence of similar patient outcomes with and without the use of patient-handling equipment and safe patient-handling protocols, they add.

    APTA's Safe Patient Handling webpage offers resources for avoiding injury, including links to online courses, US Food and Drug Administration guidelines on proper use of patient lifts, and a bibliography of journal articles from multiple disciplines.

    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.

    Check Your QPP Status (Again)

    Beginning this year, Medicare's Quality Payment Program (QPP) applies to qualifying physical therapists (PTs). Does that mean you?

    The US Centers for Medicare and Medicaid Services (CMS) has recently updated its QPP participation lookup resource to reflect the rules for 2019. APTA recommends that even if you've checked on your participation status before, you should revisit the site to see if anything has changed.

    The QPP and its Merit-based Incentive Payment System (MIPS) represent some of the most sweeping changes to PT reporting and payment in years—and all indications are that the models will likely include more PTs in the future. Get up to speed with this major shift through resources available at APTA's QPP webpage.

    Researchers: Physical Therapy-Related Cochrane Reviews Largely Inconclusive

    The Cochrane Database of Systematic Reviews is widely considered the “gold standard” for health care professionals who want to know what current, high-quality research says about the efficacy of various interventions. But when it comes to physical therapy, a “researcher or clinician would not necessarily be able to turn to [Cochrane reviews] for a definitive answer” on a treatment strategy, write authors of an article in the International Journal of Rehabilitation Research (abstract only available for free).

    Reviewers for the Cochrane Collaboration—an international network of subject-matter groups that produces evidence-based resources—are known for their systematic analysis of evidence obtained from randomized clinical trials and provide recommendations for specific interventions. Like any systematic review, Cochrane reviews (CRs) are based on the existing research, and randomized controlled trials vary in quality.

    For the Rehabilitation Research study, a multidisciplinary group of researchers in Japan turned to physical therapy to find out what CRs had to say about various interventions. They examined 283 CRs to evaluate just how conclusive the evidence is with regard to physical therapy, as well as what factors influence the degree of conclusiveness.

    Authors classified a CR as “conclusive” if it identified a particular intervention as “superior to another” or found that interventions are “equivalent.” Inconclusive reviews concluded that “no decision can be made.”

    While the authors acknowledge that CRs “often show a lack of strong evidence for the efficacy of a particular treatment or strategy,” they found that an overwhelming majority of reviews related to physical therapy—94.3%—were inconclusive and recommended further study, a rate higher than in many other areas of study. Reviews that evaluated a larger number of trials or included greater total numbers of patients were more likely to list conclusive results; still, even among CRs with conclusive results, 68.8% recommended further study.

    According to the authors, many factors were associated with recommendations for further research, including low-quality study design, small sample sizes, too few available studies, and not enough data on participant subgroups or on adverse effects.

    “The low proportion of conclusive studies may be attributable to the poor quality of evidence” in physical therapy, the authors write, noting, however, that, unlike other areas of study, blinded randomized controlled trials are “often hard to achieve” in physical therapy research.

    Authors emphasized that although inconclusive reviews cannot assist in clinical decision making, “high-quality inconclusive reviews…are of great value” to identify gaps in the literature and areas for further study.

    And while there's much work to be done to increase the number of physical therapy-related CRs with conclusive recommendations, authors think the effort is worthwhile—and timely.

    “Trials in physiotherapy are worth conducting, as the field is positioned as a new frontier and is receiving much attention," they write. "Future research in physiotherapy and further development of the [Cochrane Collaboration] are eagerly awaited.”

    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.

    Study: More Evidence for Early Post-TKR Exercise Interventions 'Urgently Needed'

    With the number of total knee replacements (TKRs) on the rise and average hospital lengths-of-stay (LOS) for the procedure dropping, you might naturally assume that the most effective early postoperative exercise interventions for TKR have been pretty well established by now.

    You'd be wrong, say authors of a new systematic review.

    They write that their review, which scoured more than 1,200 potentially useful studies, reveals a "paucity" of research that "makes it challenging for clinicians to deliver high-quality evidence-based exercise programs in the early postoperative period." They add that the prevalence of TKR and ever-decreasing hospital stays underscore the fact that more high-quality randomized clinical trials are "urgently needed."

    Authors of the review, published in BMC Musculoskeletal Disorders, had an inkling of what they were up against: they were aware that there were "limited studies" that demonstrated the effectiveness or best approach to early postoperative interventions, and they recognized that "large variations between institutions and individual clinicians exist as to what active inpatient therapy is prescribed." Still, they wanted to evaluate existing research to see if some of those gaps could be filled in.

    Focusing on studies that investigated supervised exercise therapy after TKR in the acute hospital setting, the researchers were able to find 1,296 possibly useful articles, of which 77 were reviewed in full text. Of those, only 4 articles were considered eligible for systematic review, and just 3 of the 4 met the criteria for meta-analysis. Reviewers excluded studies that used electrical stimulation, acupuncture, cryotherapy, and "electrical modalities" such as continuous passive motion, "as these were considered...an adjunct to physiotherapist-led exercise-based interventions."

    In the end, the 4 studies included in the review involved 323 participants and 373 individual knees (1 study with 50 participants studied both knees of each individual). Total study-versus-control group sizes were roughly equal, and, overall, most participants (78.5%) were female. The review focused on outcomes from 4 interventions: modified quadriceps setting, flexion splinting, passive flexion ranging, and a drop-and-dangle flexion protocol. As for assessment of outcomes, those varied depending on the study—not only did baselines differ, but follow-up times ranged from 4 weeks postsurgery to as much as 1 year afterward.

    Though not conclusive, researchers noted a few characteristics related to the various interventions: patients receiving the drop-and-dangle protocol had better flexion in the first 2 days after TKR and at discharge; flexion splint patients tended to be discharged earlier and had greater flexion at 6 weeks after TKR; and the modified quadriceps-setting patients tended to have greater hamstring and gluteal muscle strength. However, a meta-analysis of 3 of the 4 studies found no differences in flexion or knee society scores at 6 weeks' post-TKR.

    The real bottom line to be gleaned from the analysis, according to authors, is that the lack of solid evidence "precludes the formulation of clinical guidelines as to the optimum type, frequency, or duration of early exercise therapy after TKR."

    "Given the cost of providing these inpatient services, it is surprising that such a large deficit exists in the literature," authors write. "There is a need for further studies of high-quality design into supervised exercise therapy programs to provide greater functional outcomes and patient-reported satisfaction following TKR surgery, particularly in the early post-operative period."

    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.

    Systematic Review: LBP Studies Make the Case for Early Physical Therapy

    Authors of a new systematic review of 11 studies on low back pain (LBP) have found that despite sometimes-wide variation in research design, a picture of the value of early physical therapy for the condition is emerging—and the results are encouraging.

    According to the review, e-published ahead of print in the Archives of Physical Medicine and Rehabilitation (abstract only available for free), evidence supports the cost-effectiveness and better patient outcomes of early physical therapy over later physical therapy for LBP, and even points to a correlation between early physical therapy and lower rates of opioid prescription overall. As for utilization and costs associated with early physical therapy versus so-called "usual care" (UC)? Early treatment by a physical therapist (PT) adhering to APTA guidelines could make a positive difference there as well, authors say, but that's a harder question to answer definitively until studies become more uniform in terminology and design.

    The review synthesized data from 11 studies narrowed down from an initial pool of 1,146 articles. Authors aimed not only to compare early versus late physical therapy for LBP, but also to assess early physical therapy against UC that didn't include physical therapy (at least not initially, for some of the studies). Four of the studies were randomized controlled trials (RCTs), 6 were retrospective cohort studies, and 1 was a prospective cohort study. Study sizes ranged from 60 to 753,450 individuals. The studies were focused on new episodes of LBP, and did not address physical therapy as prevention.

    It didn't take long for authors of the review to realize they were up against some challenges in synthesizing the studies' results, mostly because of the variation in ways the individual projects were set up and conducted. Variation included the timeframes researchers used to define "early," "delayed," and "late" physical therapy, the inclusion of an option for later physical therapy in UC groups in some studies, and the variability of "education" components that were sometimes included in the UC groups, which in 2 RCTs included advice to remain physically active.

    Still, authors of the review were able to identify at least 1 common pattern: in the 6 studies that compared early physical therapy with late physical therapy for LBP, 5 "demonstrated significant reductions in HSU [health services utilization]." Those reductions ranged from an estimated savings of $1,209 after 24 months to $2,991 after 1 year (for a study that compared late physical therapy with "immediate" physical therapy). Early physical therapy also reduced the likelihood of later opioid use, spine injection, and spine surgery compared with late physical therapy.

    When it came to early physical therapy versus UC for LBP, the results were inconclusive, the authors write—2 out of 3 studies that assessed cost found a higher price tag associated with early physical therapy. What makes these results inconclusive, according to the researchers, is that there are simply too many unexplored variables related to "patient characteristics, care-seeking patterns, and physician decision-making."

    "Patients who participate in early [physical therapy] may also be fundamentally different from patients who follow the usual care pathway," the authors write. "Additionally, not all people with LBP go on to seek medical care. Estimates of the proportion of individuals experiencing LBP who seek care is highly variable…with percentages ranging from 9.19% in some geographic locations to 44.5% in others."

    As for the patients who seek physical therapy versus usual care, authors say the patients are more likely female, have higher educational levels, and have higher income compared with those who seek UC. "Therefore, patients who participate in early PT…may be part of a care-seeking group that is more active in seeking treatment than those who receive usual care, who may take a more passive approach," the authors write. "These traits may lead the early PT group to utilize more health services compared to the usual group."

    Finally, authors write, earlier studies "support the idea that not only does adherence to APTA guidelines for acute LBP decrease risk of later HSU, but nonadherence to APTA guidelines and ineffective [physical therapy] treatments could potentially increase future use of health services." The problem is that most of the studies included in the review were unclear about whether or how often the physical therapy interventions adhered to the guidelines.

    Despite the mixed results, the authors believe their findings "support early access to [physical therapy] as a cost-effective intervention for acute LBP that reduces HSU," adding that "receiving early [physical therapy] for acute LBP could not only reduce health care costs, but it may also help combat the opioid crisis

    "Early [physical therapy] for acute LBP…may prevent the potential for recurrences and chronic pain, leading downstream cost savings and better outcomes for individuals," the authors write. "Even if recurrences do occur, which is fairly likely, early [physical therapy] can give people with new episodes of LBP strategies to manage their condition independently in the future, preventing unnecessary overuse of resources."

    APTA members Elizabeth Arnold, SPT; Janna La Barie, SPT; Lisely Da Silva, SPT; Meagan Patti, SPT; Adam Goode, PT, DPT, PhD; and Derek Clewley, DPT, PhD, co-authored the study.

    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.

    Foundation Has a New Name, Logo, and Website

    What's in a name? For the organization formerly known as The Foundation for Physical Therapy (Foundation), just about everything.

    Earlier this month, the Foundation announced a name change for the organization, from the Foundation for Physical Therapy to the Foundation for Physical Therapy Research. It's a subtle change, but an important one, according to Foundation President Edelle Field-Fote, PT, PhD, FAPTA.

    "After much consideration, the board of trustees concluded that this addition to our name would more clearly define what we do," Field-Fote said in a Foundation news release. "Research has always been the core of our identity. Now it's a part of our name."

    The name change, adopted in the Foundation's 40th anniversary year, was accompanied by a new logo and redesigned website. The shifts were the result of a nearly 2-year communications assessment.

    Rather than an attempt to capture a new direction, the name change is intended to make the Foundation's focus as clear as possible. According to Field-Fote, the work of the Foundation will continue unaltered.

    "Although our name and logo have changed…our everyday work and enduring commitment to the profession remain unwavering," Field-Fote said.

    Since its establishment with the financial support of APTA in 1979, the Foundation has become an independent 501(c)(3) organization that has awarded more than $17 million in grants, scholarships, and fellowships. In addition, the Foundation established the Center on Health Services Training and Research (CoHSTAR), a multi-institutional research and training program. APTA is a Foundation Pinnacle Partner in Research and was a lead donor to the establishment of CoHSTAR.

    Study: Physical Activity and Higher Motor Skills Create a 'Cognitive Reserve' Even When Brain Pathologies Are Present

    New research combining postmortem examination of brain tissue with testing during life has revealed what researchers believe to be an as-yet unexplained connection: higher levels of physical activity (PA) and motor skills seem to create a "cognitive reserve" that buoys cognitive performance during life, even in the presence of Alzheimer's disease (AD), Lewy body disease, and other brain pathologies associated with dementia.

    For the study, published ahead of print in Neurology (abstract only available for free), researchers examined brain tissue from 454 participants involved in the Rush Memory and Aging Project (MAP). The subjects participated in a battery of annual clinical assessments and agreed to brain donation at the time of death. The clinical tests included 21 cognitive assessments, an analysis of 10 motor abilities, and an estimation of total daily PA drawn from accelerometers worn constantly for 10 days (researchers in this study used only the first 7 days' data).

    After death, brain tissue was analyzed for AD, Lewy body disease, nigral neuronal loss, hippocampal sclerosis, and several other pathologies—10 in all. Researchers then compared the presence of these pathologies with PA, motor skills, and cognitive testing scores obtained during the participants' last MAP visit—typically about 2 years before death.

    Researchers weren't particularly surprised that participants who recorded higher levels of PA and motor skills during their last assessment also tended to score higher on cognitive tests than did those with lower PA and motor skills. What was more intriguing was that this association held up even in the presence of brain pathologies later revealed through tissue analysis. It wasn't that higher activity and mobility decreased the risk of the diseases themselves (although other studies have explored that possibility); it's that increased PA and mobility created what authors call a "cognitive reserve" that lowered the odds for and severity of dementia, even in the presence of AD or other degenerative brain conditions.

    "A more active lifestyle and better motor abilities proximate to death were independently associated with better cognitive function and reduced odds of dementia when controlling for AD and 9 other common age-related pathologies," authors write. "Moreover, there was also no evidence that a more active lifestyle or better motor abilities modified the associations of these brain pathologies with cognitive function prior to death." Authors believe that, together, these concepts point to the possibility that the cognitive reserve associated with PA and better motor skills are related to "molecular mechanisms…that remain to be identified."

    The researchers believe their study should be followed up with more work on the biological mechanisms that resulted in their findings, as well as explorations of which interventions might help to bolster cognitive reserve.

    Authors acknowledge several study limitations, including the lack of data on how active participants were prior to joining the MAP, no examination of other brain pathologies including white matter integrity, and the inability of the accelerometers to identify what kinds of PA were taking place. Still, they argue, the study's findings are important.

    "These findings suggest that a more active lifestyle may provide cognitive reserve or resilience for adults," the authors write, adding that the results "may have important public health implications because they suggest that resilience factors such as more cognitive activities or physical activity might mitigate late-life cognitive impairment even in the absence of effective therapies to reduce AD and other common brain pathologies."

    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.

    JAMA Study: 'Multicomponent' Exercise Interventions During Hospital Stay Can Reverse Functional Decline Among Patients 75 and Older

    The potential for hospitalization to have damaging, long-term effects on function and mobility among patients who are elderly is well-known. But does functional decline have to be a given? New research from Spain says no, and points to the possibility that those effects can be blunted—and even reversed—through the addition of an exercise intervention that goes beyond ambulation-only.

    The study, published in JAMA Internal Medicine (abstract only available for free), focused on a single hospital and tracked 370 patients in who were hospitalized between 2015 and 2017, all of whom were 75 years or older (mean age, 87.3). Most participants were admitted for acute illnesses by way of the hospital's accident and emergency department; all wound up in the facility's Acute Care of Elderly (ACE) unit. Median length-of-stay was 8 days.

    Over the 2-year study period, researchers divided participants into 2 groups: the control group received "usual care" consisting of "standard physiotherapy focused on walking exercises for restoring the functionality conditioned by potentially reversible abnormalities," while a second group received twice-daily exercise interventions that included progressive resistance, balance, and walking training exercises adapted from the Vivfrail exercise program. Researchers then compared patient scores on several tests administered at admission to the ACE unit and again at discharge. Tests included the Barthel Index of independence, the Short Physical Performance Battery (SPPB), the Mini-Mental Status Examination, and a quality of life (QoL) scale.

    Researchers found that not only did the exercise group register better scores than the control group on the Barthel index (a 6.9 difference on the 100-point scale), they tended to record improvements over their own baseline scores. The control group, meanwhile, lost ground, averaging a 5 point drop from baseline. The same basic pattern was found in the SPPB scores, as well as scores that assessed cognitive function, QoL, and depression.

    "Our study shows that an individualized, multicomponent exercise intervention including low-intensity resistance training…can help reverse the functional decline associated with acute hospitalization in older adults," authors write. "Acute hospitalization per se led to impairment in patients' functional ability during [activities of daily living], whereas the exercise intervention reversed this trend."

    The exercise intervention itself consisted of 2 daily 20-minute sessions through the duration of the patient's stay in the ACE unit. The first session, in the morning, included individualized supervised progressive resistance, balance, and walking exercises. The resistance exercises centered around 2 to 3 sets of 8 to 10 repetitions of a load equivalent to 30%-60% of the patient's maximum; walking and balance exercises progressed in difficulty, and included semi-tandem foot standing, line walking, stepping practice, walking with small obstacles, exercises on unstable surfaces, and weight transfer. The 20-minute evening session consisted of "unsupervised exercises using light loads" such as anklets and handgrip balls, and daily walking in facility corridors.

    While authors note that the study focused on patients who possessed "a high level of functional reserve and cognitive capacity high enough to allow them to perform the programmed exercise interventions," the research did not automatically exclude patients with dementia or an inability to walk unassisted. Moreover, the entire population was markedly older than most previous studies on the effects of hospitalization, with about 30% of the study group being 90 or older.

    "Our results indicate that, despite its short duration, a multicomponent exercise approach is effective in improving the functional status … of very old adults," authors write, describing their findings as results that "open the possibility for a shift from the traditional disease-focused approach in hospital acute care units for elders to one that recognizes functional status as a clinical vital sign that can be impaired by traditional (bed rest-based) hospitalization but effectively reversed with specific in-hospital exercises."

    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 PTJ: Could Impaired Physical Performance Predict Hospitalization Risk?

    Routine assessments of mobility level by a physical therapist (PT) can help better identify older adults at highest risk for hospitalization, according to a new study in the January issue of PTJ (Physical Therapy). Authors write that their findings "suggest a future role for [PTs] in designing effective screening and intervention programs for older adults participating in…community-based long-term care programs."

    A team of researchers at University of Colorado, led by APTA member Jennifer Stevens-Lapsley, PT, PhD, analyzed data from both electronic medical records and hospital claims for over 1,000 patients participating in the Program of All-Inclusive Care for the Elderly (PACE) in the Denver area. Sponsored by the US Centers for Medicare and Medicaid Services (CMS), PACE is designed for dual Medicare/Medicaid-eligible adults as a way to provide community-based long-term care services from an interdisciplinary team of health professionals, including PTs. The program brings participants to a community day facility, where they participate in social activities and receive health services.

    Authors hoped to identify relationships between physical performance scores, using the Short Physical Performance Battery (SPPB) conducted through PACE, and both all-cause and potentially avoidable hospitalizations. "All-cause" hospitalization covered conditions such as heart disease, fractures, and infections, while "potentially avoidable" hospitalizations included incidents such as falls, congestive heart failure, and poor glycemic control.

    Researchers found that lower SPPB scores were associated with higher rates of hospitalization. Patients with the lowest scores were 1.87 times as likely as those with the highest scores to experience all-cause hospitalization, and 2.27 times as likely to experience potentially avoidable hospitalization. Patients with scores in the middle range were 1.40 times and 1.76 times as likely as the high-score group to experience all-cause and potentially avoidable hospitalization, respectively.

    While having a greater number of chronic conditions also predicted hospitalization, impaired mobility was a significant and independent risk factor for hospitalization, according to the study. "It is likely that impairments in physical performance constitute a valuable biomarker to identify PACE participants that are vulnerable to hospitalization," authors write.

    The study's findings come in the wake of a CMS proposal to include potentially avoidable hospitalizations as a quality metric for postacute and long-term care facilities. Authors of the study note that despite the emphasis on avoidable hospitalizations, there has been little research that looks at the relationship between impaired physical performance and a later hospital visit.

    "The results of this study illustrate the importance of routinely assessing mobility within long-term care settings," said APTA member and lead author Jason R. Falvey, PT, DPT, PhD, a board-certified clinical specialist in geriatric physical therapy. "The study also further supports the role of physical therapists as part of the primary care team for medically complex older adults."

    In addition to Falvey and Stevens-Lapsley, APTA member Allison Gustavson, PT, DPT, was a coauthor of the study.

    [Editor's note: for an in-depth look at PTs in primary care teams, check out "A Perspective: Exploring the Roles of Physical Therapists on Primary Care Teams," a paper produced by APTA. For more on this study, listen to a recent PTJ podcast featuring the study's lead author.]

    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.

    CoHSTAR Announces Fellowship Opportunities; Applications Due by February 15

    The Center on Health Services Training and Research (CoHSTAR) has opened its latest call for fellowship applicants for 4 research opportunities. All fellowships have a February 15, 2019, application deadline. The positions are:

    • Full-time postdoctoral fellowships: Trainees may focus their activities on a unique research focus area or craft an individual experience that involves activities at 2 or 3 collaborating sites.
    • Part-time faculty fellowship: Faculty fellows will retain their faculty appointments at their home institutions while using CoHSTAR support to maximize their protected time for research activities.
    • Part-time faculty fellowship at naviHealth: The selected faculty fellow will retain her or his faculty appointment at a home institution while using CoHSTAR support to maximize protected time to engage in research activities as a naviHealth faculty fellow. NaviHealth is a care transitions and postacute care management company serving both payer and provider marketplaces.
    • Postdoctoral fellowship at Vanderbilt University Medical Center: This 2-year postdoctoral fellowship will support an analysis of registry and trial data, particularly data related to spine surgery and associated outcomes. The fellowship is funded jointly with Vanderbilt University Medical Center's Department of Orthopaedics and Rehabilitation.

    CoHSTAR was established with a grant of $2.5 million from the Foundation for Physical Therapy. Funding for this initiative was made possible with a $1 million gift from APTA, gifts from 50 APTA components, and donations from physical therapists, foundations, and corporations with a shared passion for the field of physical therapy.