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  • Foundation Funding Opportunities Available for 2018

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

    Eligibility and application information for the postprofessional 2018 Promotion of Doctoral Studies (PODS) Scholarship and the New Investigator Fellowship Training Initiative (NIFTI) (a $100,000 award over a 2-year period) is posted on the Foundation website. The deadline to apply is January 10, 2018, 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.

    Study: CMS Should Pay Closer Attention to Chronic Wounds

    In its push toward outcomes-based models, the US Centers for Medicare and Medicaid Services (CMS) needs to take a closer look at wound care, say authors of a new study that estimates nearly 15% of all Medicare beneficiaries experience chronic nonhealing wounds at an annual cost of nearly $32 billion. And the researchers believe those numbers are on the conservative side.

    The study, recently published in Value in Health, analyzed data from Medicare’s 5% Limited Data Set during 2014 for details on claims in which wounds were the primary or secondary diagnosis. Researchers looked at costs, both in aggregate and by care setting, for 12 types of wounds: arterial ulcers, diabetic foot ulcers, diabetic infection, chronic ulcer, pressure ulcer, skin disorders, skin infection, surgical wounds, surgical infection, traumatic wound, venous ulcers, and venous infection. Here’s what they found:

    • In 2014, approximately 14.5% of Medicare beneficiaries were diagnosed with at least 1 type of wound or wound infection—that’s about 8.2 million patients.
    • Surgical wound infections were the largest category, at 4% of beneficiaries, followed by diabetic wound infections (3.4%) and nonhealing surgical wounds (3%). Pressure ulcers were associated with 1.8% of beneficiaries; venous ulcers were present in 0.9% of Medicare patients.
    • Although Medicare’s episode-of-care payment system makes it hard to tease out exactly how much is spent on care associated with each of various conditions a patient may have experienced, authors were able to generate a 3-tier set of estimates based on whether the wound was a primary or secondary diagnosis. Overall costs were estimated at $28.1 billion annually under the most conservative model and up to $96.8 billion under a model that assumed the wound “was always the underlying cause of the service.” Mid-range cost estimate was $31.7 billion.
    • In terms of wound type, the highest costs were associated with surgical wounds ($11.7 billion, $13.1 billion, and $38.3 billion in the 3-tier model), followed by diabetic foot ulcers ($6.2 billion, $6.9 billion, and $18.7 billion).
    • Mean Medicare spending per wound was $3,415, $3,859, or $11,781 depending on the estimate models, with arterial ulcers and pressure ulcers registering the highest rates of spending per wound.
    • Spending on wound care for hospital outpatients was nearly twice as high as inpatient spending, with estimate models at $9.9 billion, $11.3 billion, and $35.8 billion.

    Authors believe that that data point to the need for CMS to question assumptions that have played into how it establishes episode-based measures that do not encompass wound care and are rooted in inpatient models.

    “The construction of these episode groups reveals 2 important misconceptions,” authors write. “The first is that chronic nonhealing wounds represent a less significant burden [than] other conditions, and the second is that the primary driver of cost is the hospital inpatient stay. Our data dispute both assertions. Not only does chronic wound care represent a large portion of the Medicare budget, but our data suggest there has been a major shift of costs from hospital inpatient to hospital outpatient settings.”

    Authors acknowledge that more analysis is needed to arrive at clearer estimates of costs associated with wounds, but they believe the study’s results could be the basis for the development of “more appropriate quality measures and reimbursement models, which are needed for better health outcomes and smarter spending for this growing population.”

    The study was funded by the Alliance of Wound Care Stakeholders. APTA is a member of the alliance.

    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.

    Rates of Cancer Associated With Overweight and Obesity Register Significant Increases from 2005 to 2015, Says CDC

    America's obesity and overweight problem is also a cancer problem. According to the US Centers for Disease Control and Prevention (CDC), the US has witnessed a 7% increase in overweight- and obesity-related cancers (other than colorectal cancer) over 10 years, with some types of overweight- and obesity-related cancer rates increasing from 26% to 40%.

    The findings appear in an October 3 CDC report on a study of data from the United States Cancer Statistics (USCS) data set between 2005 and 2014. Researchers tracked incidence rates for 13 types of cancer associated with overweight and obesity: cancers of the esophagus, breast, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, thyroid, meningioma, plasma cells (myeloma), and colon/rectum. Researchers looked at overall rates as well as rates by age, sex, and race/ethnicity. Here's what they found:

    • Overall, the overweight/obesity-related (OOR) cancer rate declined by 2% between 2005 and 2014, but that doesn't tell the whole story. Researchers believe that the overall decrease was largely driven by a 23% decline in colorectal cancers, which have a high rate to begin with. Authors think that more widespread detection and removal of precancerous polyps are responsible for the drop in that cancer type.
    • When colorectal cancer is excluded from the data, OOR cancer rates show a 7% increase between 2005 and 2014, with thyroid cancer rates increasing by 40% and liver cancer rates increasing by 29%.
    • Besides the decline in rates for colorectal cancer, a few other cancers showed declines during the study period, including ovarian cancer (16% drop), and meningioma (29% drop); however, these declines weren't enough to offset the overall increase.
    • OOR cancers accounted for 40% of all cancers diagnosed in 2014.
    • OOR cancers accounted for 55% of cancers diagnosed in women and 24% of cancers diagnosed in men in 2014.
    • OOR cancer rates were higher among non-Hispanic blacks and non-Hispanic whites compared with other groups.

    Authors believe that growing rates of obesity and overweight in the US—now estimated at about 1 in 3 Americans—threatens to overwhelm efforts to reduce overall cancer rates, and that more needs to be done to promote healthy diet and increased physical activity.

    "Without intensified nationwide efforts to prevent and treat overweight and obesity, the high prevalence of excess weight might impede further declines in overall cancer incidence," authors write. "These efforts include investing in addressing both social and behavioral determinants of health."

    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: 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.

    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.

    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.

    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.

    CDC: Rates of Cardiac Rehab Use Among Heart Attack Survivors 'Suboptimal'

    Despite the fact that cardiac rehabilitation (CR) significantly reduces the likelihood that a heart attack survivor will die of a later cardiac-related cause, only about 1 in 3 heart attack survivors in the US receive CR, according to a new analysis from the US Centers of Disease Control and Prevention (CDC). That's a "suboptimal" rate that represents "missed opportunities to access an evidence-based intervention that has been documented to improve patient survival, quality of life, functional status, and cardiovascular risk," the CDC writes in its report on the findings.

    Using results of the Behavioral Risk Surveillance System, a telephone survey conducted annually, the CDC analyzed rates of CR use for 20 states and the District of Columbia in 2013, and 4 states in 2015 (Georgia, Iowa, Maine, and Oregon—also in the 2013 group). Researchers found that not much changed over the 2-year span, with the average use of CR estimated at 33.7% in 2013 and 35.5% in 2015.

    The report also breaks down the use of CR by demographic and other variables. Among the findings:

    • Based on the 2013 data, men received CR more often than did women (36.4% compared with 28.8%), and whites more often than non-Hispanic blacks (35.4% compared with 25.3%).
    • An estimated 46.6% of college graduates received CR, 2 times the rate among individuals with less than a high school degree (23.3%) in 2013.
    • Individuals with some form of insurance in 2013 received CR at a rate of 34.4%, compared with 25.2% of individuals with no insurance.
    • Minnesota was the state with the highest percentage of CR use in 2013, at 58.6%; Hawaii was lowest, with a 20.7% rate.
    • In 2015, among the 4 states studied, Georgia had the lowest CR use rate, at 27.9%. Iowa had the highest rate, with 57.5% of heart attack survivors interviewed reporting that they had received CR.

    Authors of the analysis acknowledge several limitations to their study, including the potential unreliability of the self-reported survey responses, the lack of information on why patients didn't participate in CR, and no details on follow-through among the individuals who did report participating in CR. Still, they argue, those weaknesses don't overshadow the core conclusion: CR is being underused.

    "Health system interventions to promote [CR] referral and use, supported by access to affordable rehab programs within the community, should be prioritized to improve outcomes and prevent recurrent events," authors write. "Some strategies that might improve use of [CR] include higher payments for rehab by insurers, eliminating or reducing copays for patients, and extending [CR] clinical hours to improve access, as well as providing standardized referrals coupled with linkage to [CR] staff member liaisons at hospital discharge or by primary care providers and cardiologists."

    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: Prevalence of Knee OA Today Twice What It Was 75 Years Ago

    Knee osteoarthritis (OA) has more than doubled among Americans since 1940, say researchers, and the increase can't be explained by longer lifespans or a higher prevalence of obesity and overweight in recent decades. Instead, the real culprit could be physical inactivity, which authors describe as "epidemic in the postindustrial era."

    The study, appearing in the Proceedings of the National Academy of Sciences, compared knee joints of 2,756 skeletons from 3 groups of individuals: those who lived in the 1800s and early 1900s ("early industrial," N=1,581), those who lived during the late 1900s through the early 2000s ("postindustrial," N=819), and prehistoric hunter-gatherers who lived between 6,000 and 300 BCE (“prehistoric,” N=176). Researchers were looking for knee joint eburnation—the ivory-like result of bone-on-bone contact that occurs after cartilage erodes—as the indicator for moderate to severe OA.

    Here's what they found:

    • The prevalence of knee OA in the postindustrial skeletons was about 16%, a rate 2.6 times higher than the early industrial group, which had a 6% incidence rate. Knee OA prevalence among the prehistoric sample was 8%.
    • After controlling for body mass index (BMI) and age when that information was available (1,859 of the 2,756 skeletons), researchers were unable to establish a correlation between these factors and prevalence of knee OA—instead, rates remained 2 times higher for the postindustrial group even when compared with early industrial skeletons with similar ages and BMIs. BMI for the prehistoric sample could not be estimated.
    • In the postindustrial individuals with knee OA, 42% had the disease in both knees. Bilateral occurrence was 30% among the early industrial samples with knee OA, and 17% among the prehistoric group.

    "Although knee OA prevalence has increased over time, today's high level of the disease is not, as commonly assumed, simply an inevitable consequence of people living longer and more often having a high BMI," authors write. "Instead, our analyses indicate the presence of additional independent risk factors that seem to be either unique to or amplified in the postindustrial era."

    The researchers believe that risk factor could have to do with "environmental changes"—namely, the reduced levels of physical activity associated with the postindustrial era, despite the human body's need for regular exercise. It's a phenomenon known as a "mismatch disease," when the human body can't easily or rapidly adapt to changes in the lived environment.

    "Although altered loads generated by walking more frequently on hard pavement … or with certain forms of footwear … might be factors, another possibility that merits more study is physical inactivity, which has become epidemic during the postindustrial era," authors write. "Less physically active individuals who load their joints less develop thinner cartilage with lower proteoglycan content … as well as weaker muscles responsible for protecting joints by stabilizing them and limiting joint reaction forces."

    The good news, according to the researchers, is that their findings point to the possibility that knee OA is a largely preventable condition—providing there's a widespread "reappraisal of potential risk factors that have emerged or intensified only very recently."

    "As with other mismatch diseases, it is likely that any effective prevention strategy will involve adjusting physical activity patterns and diets to approximate more closely the lifestyle conditions under which our species evolved," 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.

    Technological Possibilities, Practical Challenges: Report Looks at Assistive Technologies in the Workplace

    Assistive technologies to help individuals in the workplace are developing at a rapid rate, but if the promise of these technologies is to be fully realized then thinking around access, user training, reimbursement, and other barriers needs to catch up. That conclusion echoes throughout a new report from the National Academies of Science, Medicine, and Engineering.  Authors of the study include Physical Therapy (PTJ) Editor-in-Chief Alan Jette, PT, PhD, MPH, FAPTA, and Linda Resnik, PT, PhD, FAPTA, and executive director of the Center on Health Services Training and Research (CoHSTAR).

    "The Promise of Assistive Technology to Enhance Activity and Work Participation" is the result of an extensive review of the literature pertaining to assistive products and technologies, a series of public meetings on the topic, and a public teleconference that invited expert comment. The purpose: to develop an analysis of the adult use of assistive technologies including wheeled mobility devices, upper-extremity prostheses, and technologies designed to assist with hearing, speech, and communication.

    The report, available to download for free, isn't just an account of what's out there and how far assistive technology has come—it's also an examination of the challenges of putting these technologies to their most widespread and effective use.

    "The committee's review of the literature and the expert opinions of its members and others who provided input for this study made clear that appropriate-quality assistive products and technologies … may mitigate the impact of impairments sufficiently to allow people with disabilities to work," authors write. "In some cases, however, environmental and personal factors create barriers to employment despite the impairment-mitigating effects of these products and technologies. In addition, maximal user performance requires that individuals receive the appropriate devices for their needs, proper fitting of and training in the use of the devices, and appropriate follow-up care."

    That concept of barriers and training needs colored most the committee's conclusions, which include recommendations that point to the importance of proper fit, ongoing follow-up, better training for providers, and an understanding among employers and others that a device that may be useful to an employee today may become less useful over time.

    Authors also addressed the lag-time that can exist between effective technologies and a payer's willingness to provide reimbursement for those technologies.

    "The provision of assistive products and technologies … is contingent largely on reimbursement policy rather than patient need," authors write. "In some cases, the products and technologies that are covered by Medicare and other insurers as medically necessary are not those that would best meet the needs of users to enhance their participation in life roles."

    Funded by the Foundation for Physical Therapy , CoHSTAR is a multi-institutional, multi-disciplinary center dedicated to advancing health services and health policy research capacity in physical therapy.