APTA member Mike Klonowski, PT, DPT, PCS, will attend the State of the Union
address as an invited guest of Sen Mark Kirk (R-IL).
Klonowski was the senator's primary physical therapist at the Rehabilitation
Institute of Chicago following a stroke in January 2012 that paralyzed the left
side of Kirk's body. Last month, Klonowski watched Kirk climb the steps to the Capitol on the first day of the 113th
for Klonowski's comments on tonight's event in an upcoming article in News Now.
APTA's issue brief on the final
settlement in the class action "Improvement Standard" lawsuit (Jimmo
vs Kathleen Sebelius), which upheld the right of patients to continue to
receive reasonable and necessary care to maintain their condition and prevent
or slow decline, contains key points for physical therapists regarding
compliance with this Medicare regulation.
In the brief, APTA notes that there is "clear and convincing evidence embedded within the
provisions of the current Medicare regulations that providers may use to
justify the current practice of providing skilled therapy to patients to
maintain their current level of function or to prevent decline or
deterioration." Thus, the final settlement seeks to clarify the
regulations; it does not expand the Medicare benefit.
"Therefore, we expect that only patients who were unfairly denied services
based on this arbitrary standard will now have access to care," says the
members can access the issue brief on the Medicare Coverage Issues webpage under the
subtitle Improvement Standard.
An article* published this
month in JAMA reports that in
patients with unilateral lateral epicondylalgia, corticosteroid injections were
associated with poorer long-term outcomes and higher recurrence rates than
other interventions 1 year after receiving the injection. Patients in the same
study who participated in 8 weeks of multimodal
physical therapy did not achieve long-term outcomes. However, physical therapy
was beneficial in the short term in the absence of corticosteroid injection. In
addition, significantly fewer patients receiving physical therapy consumed an
analgesic or anti-inflammatory medication.
randomized, injection-blinded, placebo-controlled
trial was conducted in Australia at a single university research center and 16
primary care settings. A total of 165 patients aged 18 years or older with
unilateral lateral epicondylalgia of longer than 6 weeks' duration were
enrolled between July 2008 and May 2010; 1-year follow-up was completed in May
Of the 165 patients, 43 received corticosteroid injection,
41 received placebo injection, 40 received corticosteroid injection plus
physical therapy, and 41 received placebo injection plus physical therapy. The
physical therapy intervention was standardized, based on current evidence, and
primarily included manual therapy and exercise. The exercise program included
twice daily sensorimotor retraining of gripping and concentric and eccentric
exercise to progressively load the wrist extensors using resistive elastic
latex bands. The patients' home program and exercise diaries were monitored to
facilitate program adherence.
The 2 primary
outcomes were 1-year global rating of change scores for complete recovery or
"much improvement" and 1-year recurrence (defined as complete
recovery or much improvement at 4 or 8 weeks but not later) analyzed on an
intention-to-treat basis. Secondary outcomes included complete recovery or much
improvement at 4 and 26 weeks.
At 1 year,
corticosteroid injection demonstrated lower complete recovery or much
improvement and greater recurrence compared with placebo injection. There were
no differences between physical therapy and no physical therapy for complete
recovery or much improvement or recurrence.
their analysis of secondary outcomes, the authors found that at 4 weeks there
was a significant interaction between corticosteroid injection and physical
therapy for complete recovery or much improvement. In particular, patients who
received the placebo injection plus physical therapy had greater complete
recovery or much improvement compared with patients who did not receive
physical therapy, and medium-sized benefits for worst pain, resting pain, and
pain and disability.
their finding that physical therapy did not provide a statistically significant
long-term effect on complete recovery compared with the other groups, the
authors say that physical therapy "should not be dismissed altogether,"
because in the absence of corticosteroid it provided short-term benefit across
all outcomes and had the highest percentage of participants reporting a
complete recovery or improvement at 1 year.
results of this study were widely reported in the mainstream media, including
articles by USA Today, The New York Times, ABC News, NPR, and CBS News.
full text of this study is available by subscription or purchase only.
Copyright protections prohibit APTA from disseminating the information. For
suggestions about obtaining literature, visit APTA's Finding Information in Physical Therapy Literature webpage.
APTA's photographer take a great photo of you or your colleagues at the
Combined Sections Meeting (CSM) last month in San Diego? You now can view and
purchase CSM 2013 photos. To order images and downloads, go to www.davidbraun.photoreflect.com and click on
Enter password "ribcage,"
click the "GO" button, select any day or event gallery link, and
click on thumbnails to view larger images. Use the drop-down menu on the upper
right to change between daily galleries. Prices for prints appear on the right
when viewing an image. To order file downloads, click on the "Digital
Products" link below the print prices.
American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782) | 800/999-2782 | 703/683-6748 (TDD) | 703/684-7343 (fax)
Contact Us | For Advertisers & Exhibitors | For Media | Follow APTA
All contents © 2014 American Physical Therapy Association. All Rights Reserved.