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  • Zika Virus Effects Go Beyond Microcephaly, Guillain-Barré, Say Researchers

    Medical experts have long known of the link between microcephaly and Zika virus infections in expectant mothers. But new research is shedding light on the extent of virus' effects—both on fetal and adult brains.

    A cranial imaging study in the journal Radiologyhas found other severe brain abnormalities in Brazilian babies with congenital Zika virus infection, even in those with typical head circumference at birth.

    Radiologists identified ventriculomegaly in 43 out of 45 infants with confirmed or presumed Zika infections. Authors hypothesize that these larger-than-normal fluid-filled structures in the brain, as well as cerebral atrophy, are responsible for the often unusual skull shape in these infants; essentially, the baby’s soft skull collapses as the brain shrinks.

    Researchers also observed calcium deposits in most cases. In 38 of the infants, the corpus callosum, which connects the 2 sides of the brain, was thin, malformed, underdeveloped, or completely absent. Several of the infants had incomplete or atrophied brainstems, and in all but 1 case had abnormal migration of neurons in the cerebral cortex.

    Co-author Deborah Levine, MD, told the Washington Post, “The likelihood the babies in our series are going to have normal development because of so many abnormalities — the prognosis is not good.”

    Public health officials continue to focus on warning pregnant women to avoid exposure to the virus. However, a new study in Cell Stem Cell indicates the potential for the virus to affect adult brain cells as well. Study authors examined the 2 areas of the adult brain that still contain neural stem cells. Adult mice injected with Zika virus experienced nerve cell death and generated fewer new nerve cells compared with the control group.

    While researchers don’t know the exact ramifications yet, it's already understood that cognitive decline, Alzheimer’s disease, and other neurological conditions are associated with deficits in new nerve cells. Co-author Sujan Shresta also suggests that “infection of adult neural progenitor cells could be the mechanism behind” the development of Guillain-Barré syndrome in adults who have previously been infected with Zika virus.

    The Centers for Disease Control and Prevention (CDC) have issued an advisory for people living in or traveling to South Florida, as Miami-Dade County has experienced 29 locally acquired cases. Officials worry that Zika will spread to Texas and Louisiana, due to the standing water from massive storms and flooding. The CDC awarded $6.8 million to a number of national public health organizations to help with mosquito surveillance and public awareness efforts.

    For the most up-to-date Zika research, see the World Health Organization open access studies, and the Pan American Health Organization list of published research, and the BMJ free access content.

    Surgeon General Letter Urges Action on Opioids, Recommends CDC Treatment Guideline That Includes Physical Therapy

    Physicians across the United States can expect something in their mailboxes soon—a letter from the Office of the US Surgeon General urging them to take part in the battle against the opioid epidemic, accompanied by a card that specifically mentions physical therapy as one of the preferred first-line approaches for treatment of chronic pain.

    "Everywhere I travel, I see communities devastated by opioid overdoses," writes Surgeon General Vivek Murthy, MD. "I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure."

    In the letter, Murthy asks physicians to sign a pledge at www.TurnTheTideRx.org, the surgeon general's initiative to stem the opioid abuse epidemic.

    Murthy also asks doctors to review an enclosed pocket card that contains the basics of the US Centers for Disease Control and Prevention (CDC) opioid prescription guideline. That guideline lists physical therapy as among the preferred options for the treatment of chronic pain without the use of opioids. Murthy calls the CDC guideline a "good place to start" toward better physician education on how to treat pain "safely and effectively."

    A CNN report on the letter includes Murthy's remarks during a speaking engagement, in which he described how many physicians were taught that opioids are not addictive. Some continue to believe that false information, Murthy told the audience, including 1 of his own physician friends—until Murthy informed him otherwise. He was taught that opioids aren't addictive so long as a patient is "truly in pain," Murthy said.

    "Years from now, I want us to look back and know that, in the face of a crises that threatened our nation, it was our profession that stepped up and led the way," Murthy writes in the letter.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    Stem Cell-Protein Combination Reverses Poststroke Brain Damage in Mice

    Could brain damage poststroke be reversed? Researchers in a National Institutes of Health (NIH)-funded study say they have found a combination of human stem cells and a protein that created new, functional neurons in the brains of stroke-induced mice.

    In the August 22 edition of Nature Medicine (abstract only available for free), researchers from the University of Southern California outline how they combined 2 methods that individually have demonstrated limited success as treatments for neurologic injury poststroke: surgical grafting of human neural stem cells in the damaged area and administration of the 3KL3A-APC protein, which is derived from the human-activated protein-C.

    When the researchers combined these approaches in stroke-induced mice, they found that the grafted stem cells developed into neurons that made "functional and structural connections with the host's nervous system," explained lead researcher Berislav Zlokovic in an interview with Science Daily. Use of the protein compound resulted in mice with 16 times more human stem cell-derived neurons than mice that received the stem cells and a placebo, Science Daily reports.

    When the mice were tested a month after their stroke, researchers found significant improvement in motor and sensory function compared with that of mice administered neither or only 1 of the 2 components.

    "Functional deficit after 5 weeks of stroke were minimized, and the mice were almost back to normal in terms of motor and sensorimotor functions," Zlokovic told Science Daily. "Synapses formed between transplanted cells and host cells, so there is functional activation and cooperation of transplanted cells in the host circuitry."

    Researchers plan to begin testing whether the improvements can be replicated in human patients. If so, Zlokovic and his team will test the treatment on other neurological conditions, such as spinal cord injuries.

    TIME Article: US Must Rethink Pain Treatment, Become 'Insistent' on Physical Therapy

    A recent opinion piece in TIME magazine says that when it comes to pain treatment, unless a "fundamental mindset" is changed—a change that includes being "insistent" on the use of physical therapy in pain management—no real progress will be made in the fight to end the opioid abuse epidemic in the United States.

    In "We're All Responsible For Our Opioid Reliance—Even Patients," Andre Machado, chairman of the Neurological Institute at the Cleveland Clinic, describes how opioids are little more than a "quick fix" for pain that miss what should be the true goal of pain treatment, which he describes as "recovery of function, not complete resolution of pain."

    "This crisis is a failure of our health care ecosystem and our quick-fix culture," Machado writes. "We can all share the blame: physicians who feel anxious to meet patients’ expectations, pharma companies that oversell opioid benefits (and downplay the risks), insurers that fail to flag patients receiving high volumes of opioid prescriptions (and not properly reimbursing therapy) and patients who demand passive treatment."

    Machado argues that to truly change outcomes, "we all need to first change the metric of success" from focusing solely on the elimination of pain to helping patients better understand and manage their pain. Part of that shift, he writes, must include becoming "insistent on the use of physical therapy as an integral treatment component."

    As part of his own efforts to make that shift, Machado describes his participation in a Cleveland Clinic pilot program to treat more than 1,000 patients with chronic leg and back pain with physical therapy and counseling as a first-line response. The key metric of success, he writes, will be "restoration of function."

    "Ultimately, this methodology should serve to lessen the community's reliance on opioids and improve the utilization—and timing—of invasive procedures," Machado writes.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    NYT: Racial Disparities in Pain Treatment

    As if the national conversation over how pain is treated isn't already complex enough, The New York Times (NYT) points out another important facet of the problem: regardless of where approaches may be heading in the future, pain treatment as it stands now is far from equal among racial minorities and whites.

    "Finding Good Pain Treatment Is Hard. If You're Not White, It's Even Harder" combines interviews with research findings to highlight what NYT describes as a "persistent" problem: "Minorities tend to receive less treatment for pain than whites, and suffer more disability as well." Among the findings reported in the story:

    • Blacks have been affected by the prescription opioid epidemic at "much lower rates" than whites.
    • Blacks are 34% less likely than whites to be prescribed opioids for back pain, abdominal pain, and migraines, and 14% less likely to be prescribed opioids for pain from traumatic injuries or surgery.
    • Pharmacies in poor but majority-white neighborhoods are 54 times as likely as pharmacies in poor minority neighborhoods to have "adequate supplies" of opioids.
    • In Alabama (the state used as an example in the NYT report because of its high opioid prescription rate), Medicare data show that "in all but 1 of Alabama's majority-black counties, the rate of opioid prescribing is below the state average," with 4 of the 5 counties at the low end of prescription rates being majority-black.
    • Workers' compensation programs in 2004 spent less to treat blacks with low back injuries, with shorter treatments, regardless of income level.
    • In 2014, 71 out of every 1 million white Americans died of prescription opioid overdose, compared with 33 out of every 1 million black Americans.

    NYT reporter Abby Goodnough interviewed several physicians and pain researchers on possible causes for the disparities, including some who believe the differences are at least partially rooted in false stereotypes and "a tendency for doctors to empathize less with patients whose race is different than their own—perhaps subconsciously—and to underestimate the severity of their pain."

    As for what the NYT describes as the "silver lining" argument—that the disparities have spared blacks from being as severely affected by the opioid abuse epidemic as whites—1 pain researcher discounted the sentiment.

    "We may agree that opioids can be harmful and that fewer of them may be a good thing," pain researcher Adam Hirsh told NYT, "But we should not ignore that black and white patients are getting treated differently."

    The article also mentions nondrug approaches to pain treatment, tracking the progress of Roslyn Lewis, who suffered a back injury for which she was able to receive little treatment. Eventually, she was enrolled in a study that used cognitive behavioral therapy to address pain—an approach she found helpful. Not long after that study ended, she was able to qualify for Medicaid, which allowed her to begin physical therapy.

    "I feel proud of myself that I finally got something to go for," Lewis told NYT.

    How do health disparities affect physical therapist practice, and what are some of the driving forces behind them? Check out APTA's health disparities webpage for more insight.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    From Business Insider: Insurance Companies 'Increasingly' Cutting Payments for Nondrug Pain Treatments

    The United States may be in the throes of an opioid abuse epidemic, much of it linked to a health care system that has relied too heavily on the drugs for the treatment of pain, but that doesn't mean insurance companies are doing much about it, according to a recent article in Business Insider (BI).

    In an article that appeared online on August 6, BI reporter Harrison Jacobs looks at the seeming disconnect between physicians' attempts to treat pain through nondrug approaches and the private insurers' unwillingness to pay for those treatments—including physical therapy. The situation has left patients with a difficult choice, Jacobs writes: "pay for expensive alternative treatments out-of-pocket, use opioids and possibly suffer a myriad of side effects and risk opioid addiction, or choose to do nothing and live with debilitating pain."

    According to physicians interviewed for the article, the situation has gotten worse over time, even with an increased understanding of the dangers presented by opioids, and evidence of their limited long-term effectiveness. The physicians tell BI that nondrug alternatives increasingly are being rejected.

    Why? Shalini Shah, MD, director of pediatric-pain management at UC Irvine Health, tells BI the reason is "simple. [Alternative treatments] cost more. It costs more for insurance companies for a physician to do a procedure on a patient or to do physical therapy. It is far cheaper for us to write a prescription for a 30-day supply of morphine. That's the only reason."

    The article also describes how insurance companies make payment decisions based on "the available medical evidence," and how obtaining evidence on pain treatment is problematic, due to the "inherently subjective" nature of a patient's pain experience, a "limited number of high-quality clinical studies on pain treatments," and the difficulty in creating studies that might require a study participant experiencing debilitating pain to take a placebo rather than receive treatment.

    The BI article echoes a June story inThe New York Times that described "resistance" among insurers toward paying for pain treatments that include nondrug approaches.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    United Healthcare Files Protest After Loss of 2017 Tricare Contract

    The US Department of Defense (DOD) may be aiming to shift its Tricare contracts away from United Healthcare, but it looks like the company isn't going without a fight.

    Last week, United Healthcare filed a formal bid protest with the Government Accountability Office (GAO) that challenges recently announced 2017 contracts awarded to Humana and Health Net Federal. Those contracts reflect a reorganization of the regional management system used by Tricare, which will reduce its coverage regions from 3 to 2. United Healthcare currently manages the West region, with Humana managing the South and Health Net overseeing the East region. The new system will be divided into East and West regions only, with Humana taking over the East region and Health Net handling the West region—leaving United Healthcare out of the picture.

    This isn't the first time United Healthcare has protested a Tricare decision. The company was awarded the West contract after a protest in 2012. The Military Times reports that a staff email sent to United Healthcare employees describes the protest as "a very normal part of the federal procurement process."

    The Military Times article also cites a Pentagon spokesperson who told the Times that the protest would not affect services to Tricare beneficiaries, and that current contracts will remain in place while the protest is adjudicated. GAO has 100 days to respond to United Healthcare's protest.

    According to the Wall Street Journal, United Healthcare earned $650 million through its Tricare West contract in 2015, serving approximately 3 million members.

    NYT Article Looks at 'Useless' Surgeries

    A recent online article in The New York Times (NYT) touches on a subject physical therapists and physical therapist assistants know all too well: the prevalence of certain back and knee surgeries whose effectiveness has been called into question.

    In "Why 'Useless' Surgery Is Still Popular," NYT reporter Gina Kolata looks at the continued popularity of spinal fusion and meniscus surgeries, even in the face of clinical trials and meta-analyses that dispute the usefulness of the procedures. She writes that unlike the process used to achieve federal approval for the use of certain drugs, surgeries can continue even after being proven ineffective through research.

    With no clear way to regulate which surgeries are permitted, "it looks as if the onus is on patients to ask what evidence, if any, shows that surgery is better than other options," Kolata writes.

    The article quotes Jeffrey Katz, a professor of medicine and orthopedic surgery at Harvard Medical School, who conducted a clinical trial comparing meniscus surgery with physical therapy. The results from Katz's research echoed other work that found no clear benefit to surgery. Kolata writes that Katz believes "patients should be told that physical therapy is a good first-line therapy for pain relief," but should also be reminded "surgery also relieves pain" and that relief can take longer with physical therapy.

    "At the end of the day, patients ought to choose," Katz tells NYT.

    Opioid Dependence Claims Up by More Than 3,000% Since 2007

    A new report on the opioid crisis—this one focused on private insurance data--presents yet another litany of chilling statistics on the reach of the epidemic, this time including a startling 3,203% increase in claims related to opioid dependence from 2007 to 2014.

    The latest report, conducted by the nonprofit FAIR Health, is the result of an analysis of the organization's collection of more than 20 billion privately billed health care claims. Like previous research, the FAIR Health report points to a public health crisis that has ballooned rapidly, and is affecting certain age groups and regions disproportionately.

    In addition to the 3,000% leap in opioid dependence diagnoses, the FAIR Health report also includes other alarming statistics. Among them:

    • While "opioid dependence" claims rose by more than 3,000%, claims of "opioid abuse" rose by 317% between 2007 and 2014. (The distinction between opioid "dependence" and "abuse" may no longer be relevant in the wake of a 2014 revision to the primary diagnosis guidelines, which now describe a single continuum labelled "substance use disorder.")
    • Claims listing pregnancy drug dependence diagnoses rose 511% between 2007 and 2014; the number of babies born with neonatal abstinence syndrome—the condition caused by opioid abuse by the mother during pregnancy—rose by nearly 300% between 2000 and 2009.
    • Between 2007 and 2014, 69% of the claim lines for opioid dependence were for individuals aged 19-35, a disproportionate share that FAIR Health believes may be related to the fact that the rate of controlled substance prescriptions written for adolescents and young adults nearly doubled from 1994 to 2007.
    • The 19-35-year-old group accounted for 78% of diagnosed heroin overdoses between 2009 and 2014.
    • From 2002-2004 to 2011-2013, heroin use grew by 100% among females, compared with 50% among males. "Women are more likely than men to experience chronic pain, be prescribed pain relievers, and be given higher doses," write report authors. "They are likely to use the medications for longer periods and become dependent more quickly."
    • Between 2007 and 2014, 67% of the opioid dependence claims in the 19-35 age group were for men and 33% for women; in the 46-55 age group, that share shifted to 55% for men, 45% for women.
    • The states that reported the opioid dependence diagnoses at the highest rates compared with other substance abuse and dependence diagnoses were: California, Texas, Florida, Georgia, South Carolina, Tennessee, Pennsylvania, and Connecticut.

    APTA has added its voice to the effort to curb opioid abuse through its national #ChoosePT campaign, an initiative to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. APTA is also a member of the White House’s working group addressing the opioid epidemic.

    Research Roundup: Physical Inactivity Pandemic Takes Center Stage

    You don't need to tell physical therapists (PTs) and physical therapist assistants (PTAs) that physical activity is key to a healthy life and lower overall health care costs, but now a new batch of studies shines a light on that concept in ways that are grabbing the broader public's attention.

    Over the last week, 4 studies emerged—3 published in the Lancet, and a fourth in the European Journal of Preventive Cardiology—that show a direct connection between physical activity (PA) and mortality risk, and begin to quantify the global costs of low levels of PA. The results, some based on long-term studies with large participant numbers, are unequivocal in their conclusions about the very direct effect PA has on living longer.

    Here's what the 4 studies found:

    Engaging in 60-75 minutes of moderate-intensity physical activity for every 8 hours spent sitting virtually erases the mortality risk associated with sitting—and every little bit of PA helps help to offset the risk somewhat. This Lancet study (abstract) gained the widest attention, and was featured in major media outlets including CNN, US News and World Report, and National Public Radio.

    To reach their conclusions, authors conducted a meta-analysis of 16 studies that included 1 million participants in research that compared all-cause, cardiovascular-related, and cancer-related mortality with time spent sitting, watching television, and engaging in moderate-to-high PA. Bottom line: researchers found "a clear dose-response association" with "an almost curvilinear augmented risk for all-cause mortality with increased sitting time in combination with lower levels of activity."

    Using the most active (60-75 minutes per day of moderate intensity PA) and least sedentary (less than 4 hours per day sitting) group as a referent, researchers found mortality rates at 2-18 years 12% to 59% higher for individuals who sat more than 8 hours per day and engaged in minimal PA. The hazard ratios sloped neatly down as activity increased, with the group engaging in 25-35 minutes of moderate intensity PA per day—amounts more in line with national recommendations—receiving nearly the same benefit as the most active group. Those general patterns were also reflected in analyses of mortality related to cardiovascular conditions and cancer.

    Researchers also conducted a similar analysis of studies that focused on television-watching time and PA, and found that the relationship between television-watching time and all-cause mortality "seemed to be stronger in magnitude" but followed the same basic pattern.

    A long-term study of middle-aged men finds that low aerobic capacity is second only to smoking in its association with all-cause mortality. In a study that spanned 50 years, researchers from Sweden concluded that low aerobic capacity has a very solid link to increased risk of death—and not just from cardiovascular-related conditions, but from nearly every noncommunicable disease-related cause of death, save gastrointestinal conditions.

    The study, featured on Fox News, the Huffington Post, and Today online, was based on an analysis of 792 men born in 1913 in Gothenberg, Sweden. As part of a 50-year study of health, researchers analyzed the aerobic capacity (VO2 max) of the men in 1963 and again in 1967, and authors of the most recent study analyzed those results with mortality through 2012. After grouping the men into low, medium, and high VO2 max categories, researchers found that the low group had a 21% higher risk of dying prematurely than the middle group, and a 42% higher risk than the men in the top VO2 max category.

    The relationship was second only to smoking as a predictor of early mortality, according to authors. Interestingly, researchers found no significant association with death from certain kinds of conditions, including cardiovascular issues. Instead, they identified a relationship between low VO2 max and a wide range of mortality causes, from cancer to urinary tract disease, with the only exception being death related to gastrointestinal conditions. "This … suggests that cardiovascular fitness might be an advantage in most illnesses that can lead to death, and thus a benefit for general health and not only for cardiovascular health," authors write.

    Physical inactivity is costing the world at least $67.5 billion a year, and that burden falls in disproportionate ways. The Lancet published an article from researchers from the University of Sydney in Australia (abstract) who analyzed 2013 health data from 142 countries—representing 93% of the world's population—to estimate the costs of physical inactivity in terms of health care costs, productivity losses, and disability-adjusted life-years (DALYs), and to establish how those costs were borne out around the globe.

    The answer: physical inactivity's costs equal the total gross domestic product of Costa Rica, and the burden falls more heavily on individuals in developing countries, even though prevalence of physical inactivity is lower than that of more developed countries—for now.

    As reported in CBS news and elsewhere, authors of the study estimate that the $67 billion in costs represents payments of $31.2 billion from the public sector, $12.9 billion from the private sector, and $9.7 billion by households, accompanied by $13.7 billion in productivity losses. According to authors, physical inactivity was responsible for 13.4 million DALYs worldwide in 2013.

    Excluding productivity losses, physical inactivity was responsible for more than $600 million in health care costs in Africa, $3.2 billion in Latin American and the Caribbean, $25.7 billion in North America, $2.4 billion in the eastern Mediterranean region, $11.7 billion in Europe, $900 million in southeast Asia, and $9.2 billion in the Western Pacific region.

    Although individual households were linked to the smallest amounts paid in relation to physical inactivity, that $9.7 billion amount fell disproportionately to less developed regions, particularly in southeast Asia where nearly half of the physical inactivity-related health care costs were paid out-of-pocket. Authors believe that disproportionate impact is further reflected in DALYs rates, with southeast Asia accounting for 20% of the DALYs globally but only 1.7% of the direct costs.

    "We show that although inactivity is more prevalent in high-income countries, most of the health burden is in low-to-middle income countries," authors write. "As such countries develop economically, so will the consequent economic burden, if the pandemic of physical inactivity spreads as expected."

    Globally, we're getting better at tracking physical inactivity rates—but we're not doing enough to actually fight the pandemic. In the second in a series of inactivity report cards timed to coincide with the Summer Olympics games, the Lancet follows up on its 2012 look into how the world is responding to increasing rates of physical inactivity (abstract). The results? As reported in Science Daily and other outlets, authors say we know more now than we did in 2012—but that doesn't mean we're doing much about it.

    According to the authors of the series, while the number of countries tracking physical inactivity is higher than in 2012 (142 countries in 2016, compared with 118 in 2012), and 80% of countries have national physical activity policies or plans, only 56% reported operational policies or plans, and many of those are insufficient. Meanwhile, the global prevalence of physical inactivity is estimated to be 23% for adults and 80% for school-going adolescents.

    The lack of progress is most distressing in what authors describe as low-to-middle-income countries (LMICs), where population and physical inactivity rates are both increasing. Researchers note that the increased documentation is pointing out a problem that many LMICs simply aren't prepared to fix.

    "Progress on physical activity has been far from proportionate to the documented burden of disease from physical inactivity in countries of all income levels," authors write. "LMICs are laying the groundwork for effective public health action on physical activity, but it is not clear where the resources will be round to scale up effective interventions, build a physical activity workforce in public health, expand research in LMICs, and take bold initiatives that will increase physical activity in all countries."

    APTA offers multiple resources on the role physical therapists (PTs) and physical therapist assistants play in addressing prevention and wellness, including a 2-part podcast on the inactivity epidemic (part 1, part 2), and a recorded presentation on physical activity and the PT.

    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.