• Tuesday, July 28, 2015RSS Feed

    Evidence on Hamstring Rehab Supports Exercise; Platelet-Rich Plasma Found Ineffective

    Results of a new systematic review and meta-analysis point to stronger evidence that when it comes to acute hamstring injuries, rehabilitation exercises work—and platelet-rich plasma (PRP) injections don't.

    The study, which updated an earlier review published in 2012, analyzed 10 randomized clinical trials—6 of which were new since the previous publication—that focused on conservative interventions for acute hamstring injuries. A total of 526 participants were included in the trials (mean of 65 per study) with an average age of 20. All participants had some connection to sports, and most (86%) were male.

    The interventions used in the trials included lengthening and loading exercises, stretching and strengthening (STST) exercises, progressive agility and trunk stabilization (PATS), and PRP injections. Authors of the systematic review compared the interventions by way of return-to-play (RTP) times and re-injury rates. Results were e-published ahead of print in July 21 online edition of the British Journal of Sports Medicine (abstract only available for free).

    The analysis showed that in terms of reducing RTP times, evidence supports the addition of lengthening exercises. Authors also found a link between PATS exercises and reduced re-injury rates, although evidence supporting that relationship was described as "limited." Researchers weren't able to identify any evidence that supported PATS as a way to speed up RTP, nor were they able to point to evidence that lengthening exercises reduced re-injury rates. Studies of STST exercises did not produce evidence supporting their effectiveness in RTP, and showed what authors described as a "remarkably high" re-injury rate, at 70%.

    What the evidence definitely doesn't support, according to the authors, is the use of PRP injections.

    "Our meta-analysis and descriptive synthesis show that there is no superior efficacy for PRP injections," authors write. "Considering our quantitative and qualitative findings, higher levels of evidence are now available to discourage the use of PRP injections in the rehabilitation of hamstring injuries."

    While authors believe that their new review helps to create a clearer intervention path, they cite the need for more studies or higher quality. Most current studies, they write, are weakened by a lack of blinding among patients and therapists, and poor comparability between trials (mostly due to variation in what was used as the "standard therapy" control). Another issue: RTP measures "varied greatly" between studies.

    Still, they write, evidence is sufficient to point to the positive role of both lengthening exercises and PATS "for daily practice" to treat acute hamstring injuries.

    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.

    Thursday, July 23, 2015RSS Feed

    PCORI Devotes Additional $142 Million to Expansion of Clinical Research Network

    The Patient Centered Outcomes Research Institute (PCORI) plans to invest $142.5 million to expand its clinical research network—another facet of a broad initiative that includes major grants supporting physical therapy research.

    According to a PCORI news release, the money will be used to establish a second-phase expansion of the National Patient Centered Clinical Research Network (PCORnet), a project that links various health data research networks. The funding will be used in part to expand the number of PCORnet participants from 27 to 34, and will include both clinical data and patient-powered research networks.

    The 34 PCORnet partner networks encompass more than 150 conditions, including Alzheimer’s disease and dementia, autism spectrum disorders, heart disease, obesity, Parkinson disease, behavioral health disparities among low-income populations, and health disparities among sexual and gender minorities, all drawn from a wide variety of population groups.

    "Having key stakeholders--researchers, patients, clinicians, and health systems—working together to co-create PCORnet has been a tremendous step forward in how we approach health research," PCORI Executive Director Joe Selby, MD, MPH, stated in the news release. "We're proud of the achievements of the participating individuals and organizations that have worked so diligently to prepare PCORnet to begin conducting robust and efficient patient-centered research."

    PCORI is an independent, nonprofit organization authorized by Congress in 2010. Besides creating PCORnet, PCORI is funding specific research projects. Earlier this year, the institute announced that it will devote $28 million to support 2 research efforts led by prominent physical therapy researchers Pamela Duncan PT, DPT, FAPTA, and Anthony Delitto , PT, PhD, FAPTA.

    Duncan’s project will look at treatment of patients poststroke to find out whether early discharge with ongoing support by physical therapists (PTs) and other providers results in better daily function outcomes than do longer hospital stays and standard transitional care. Delitto's research will focus on low back pain, comparing 2 approaches in the outpatient primary care physician (PCP) setting. One is the "usual"care approach, and the other teams PCPs with PTs to provide cognitive behavioral therapy.

    Wednesday, July 22, 2015RSS Feed

    Study: Early Supervised Exercise Reduces Fatigue, Improves Strength for Women After Breast Cancer Diagnosis

    A new study from the Netherlands is lending more support to the value of exercise during the early stages of adjuvant treatment for breast cancer. Researchers say that a combination of supervised strength and aerobic training not only reduces fatigue, but helps patients actually increase muscle fitness during the first 18 weeks of treatment.

    For the project, 204 breast cancer patients were divided into 2 groups of 102—one receiving usual care and the other participating in physical therapist-supervised resistance and aerobic exercise as soon as possible after diagnosis. By design, all participants received chemotherapy at some point between baseline and by an 18-week assessment.

    The exercise program was conducted at the patient's treating hospital, and consisted of 2 aerobic and 2 resistance exercise sessions per week, with each type of session lasting 25 minutes. Muscle training was targeted at all major muscle groups and designed to reach 1 set of 10 repetitions at 75% of 1-repetition maximum by the end of the 18-week period. Results were published in a recent issue of BMC Medicine (.pdf).

    Although the intervention and control groups both reported fatigue, at 18 weeks, the exercise group reported levels of fatigue 1.3 times lower than the control group, though no significant differences were noted at the 36-week assessment. Other measures related to quality of life showed no differences between groups, with the exception of the exercise group's perception of a positive "change in health" at 18 weeks.

    While researchers had anticipated that fatigue levels would drop for the exercise group, they were surprised to find that the exercise program not only offset the deconditioning effect of chemotherapy and other adjuvant treatments, but actually increased muscle strength. Authors write that most of the noted strength improvements at the 18-week point occurred at the submaximal level, an important improvement "since most daily activities are performed at the submaximal level."

    Researchers believe that engaging in exercise early in the breast cancer treatment process helps to change physical and emotional dynamics at a critical time, both by breaking the "vicious cycle" of "a self-perpetuating detraining state" that induces fatigue, and by increasing feelings of "general self-efficacy and mastery" among patients in treatment.

    The findings echo APTA's understanding of the important role that activity should play in the lives of cancer survivors. The association offers continuing education on physical therapy for cancer survivors, and visitors to APTA's website can view a video on collaborative care and breast cancer rehabilitation. Additionally, the role of the physical therapist in cancer survivorship was the focus of an article in the July 2013 edition of PT in Motion magazine.

    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.

    Friday, July 17, 2015RSS Feed

    Meta-Analysis Backs Use of Electrical Stimulation on Patients Posttroke

    Editor's note: this republication corrects an earlier version of this story that identified pulse duration in minutes instead of milliseconds.

     Authors of a review and analysis of studies on neuromuscular electric stimulation (NMES) in the treatment of patients poststroke say they've taken a step toward settling some of the debate about the technique's effectiveness. Bottom line: it's an option that they recommend to reduce spasticity and increase range of motion.

    The study, which appears in the August edition of Stroke (abstract only available for free), examined 29 randomized clinical trials that were focused on the use of NMES either alone or in combination with other treatment techniques, compared with a control group that did not receive NMES. Application sites were limited to lower or upper extremities, but researchers did not put upper or lower limits on NMES dosage. A total of 940 individuals were included in the combined trials.

    Authors of the analysis evaluated pre- and posttreatment spasticity by looking at participant scores on the Modified Ashworth Scale (MAS). Range of motion (ROM) was analyzed through Goniometer data. Treatment time varied (although studies that involved fewer than 3 days of intervention were excluded), as did the amount of time that passed between stroke and first treatment—from 1.5 months to more than 1 year.

    Despite the variation, what they found was that on average, use of NMES resulted in a significant .30 improvement on the MAS (14 of the 29 studies reviewed), and a 2.87 average increase in ROM (15 of the 29 studies reviewed). The most notable improvements came when NMES was used in conjunction with other interventions.

    "NMES combined with other intervention modalities is a treatment option that provides improvements in spasticity and range of motion in stroke patients," authors write. "This data provides support for further NMES use as an additional therapy technique," though they note more study is needed.

    In terms of actual frequencies used in the studies, in 22 trials, NMES frequencies ranged from 18 to 50 Hz, and pulse duration from .1 to .4 milliseconds; 3 studies used frequencies from 80 to 100 Hz with durations of .1 to .3 milliseconds; 4 of the studies did not describe the frequencies and durations. Intervention time across the studies was averaged to 3038.7 minutes, with all but 1 study occurring in an outpatient environment.

    Authors see the control of spasticity as a precursor to the application of any therapies that target motor control, and recognize NMES as an effective way of meeting that challenge.

    "From our findings, the application of NMES to reduce spasticity in these patients can be recommended," authors write. "It would lead to a bigger benefit from the motor control programs and a better improvement in the functional activity. The use of NMES could not inhibit the use of the unaffected hand, but it could enhance and facilitate the patient to use the affected hand for day-to-day tasks, resulting in improvements in [ROM]."

    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.  

    Wednesday, July 15, 2015RSS Feed

    Study: Concussed College Athletes Almost Twice as Likely to Experience Later Lower Extremity Injuries

    A study of Division I college athletes has reinforced the idea that there's a connection between concussion and later musculoskeletal injury, with an estimate that for as much as a year after the initial head injury, concussed athletes are nearly twice as likely to suffer an acute lower extremity injury than they were prior to the concussion.

    Researchers analyzed electronic medical records of 44 concussed and 58 nonconcussed college athletes for a 2-year period that extended 1 year before and after the concussion (the nonconcussed athletes were matched with the concussed athletes over the same time period). Records were retrieved at 365 days, 180 days, and 90 days before and after the concussion, with researchers focusing on reports of acute lower extremity musculoskeletal injury that included sprains, strains, contusions, and fractures, but didn't include chronic and overuse injuries.

    Authors found no differences in injury rates between the concussed and control groups prior to concussion events, but things changed significantly after that. The study was e-published ahead of print in Medicine and Science in Sports and Exercise (abstract only available for free).

    While injury rates for the concussed players at the 90-day mark were not significantly different from average rates, by 180 days the group reported an injury rate 2 times higher than average. A year later, the concussed group was reporting an injury rate 1.97 times higher than average, and 1.64 times higher than the control group.

    Authors cite several potential explanations for the increased injury rate but lean toward the idea that disrupted cortical pathways after a concussion may be among the most plausible.

    "While still a hypothesis, reduced cortical excitability observed following concussion may contribute to overall reductions in function ability," authors write. "The brain's ability to effectively control and coordinate movement following concussion may be impaired. In a dynamic athletic setting, any disruption of the cortical pathways to the musculoskeletal system has the potential to negatively affect movement."

    Researchers acknowledge several limitations to the study, including small sample size, the potential unreliability of electronic medical records, and the possibility that some concussions may have gone unreported. Among the study's strengths, according to authors, is the fact that all the athletes were from the same university, which operates under a uniform concussion management policy.

    Authors believe that their study points out the need for more refined measures of neuromuscular control deficits after concussion.

    "Importantly, the underlying causes for these lingering balance deficits must be explored further," they write. "If our current measures of balance following concussion are not sensitive enough to detect deficits, more functional balance assessments should be identified."

    APTA offers multiple resources on concussion, which include a Traumatic Brain Injury webpage, and a clinical summary on concussion available for free to members on PTNow. The association also offers a patient-focused Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website. Continuing education offerings from APTA include the prerecorded webinar "Managing Concussions with an Interprofessional Team," as well as the online courses "Concussion and the Postconcussive Syndrome," and "Sports-Related Mild Traumatic Brain Injury," all available through the APTA Learning Center.

    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.

    Wednesday, July 08, 2015RSS Feed

    Study: Rates of Aging Differ—Even in Young Adults

    Do you look older than you are? If so, some researchers think that biologically speaking, you may be—and you may be already showing an increased rate of decline in physical and cognitive abilities.

    A new study published July 8 in the Proceedings of the National Academy of Sciences (.pdf) analyzed biomarkers of 954 healthy individuals beginning at age 26 over a 12-year period to establish a "pace of aging" during that time, and then conducted tests that allowed them to establish a "biological age" of each participant at age 38. They found that the people who were biologically older at 38 had been aging at a more rapid pace throughout the study period—some as rapidly as 3 years for every 1 chronological year.

    According to study authors, these faster-aging individuals were already demonstrating the effects of aging, performing less well on tests of balance, strength, and motor coordination; and reporting greater limitations on physical functioning. Researchers also noted elements of cognitive decline, particularly in "fluid abilities" to solve problems without the use of acquired knowledge.

    And the faster-aging individuals even looked the part. When researchers shared head shots of the participants to a group of undergraduate students who were unaware of the study, the students consistently rated the biologically advanced participants as being older than their biologically younger peers. Those differences were also reflected in participants' own perceptions of facial age and overall well-being.

    Biomarkers studied during the 12-year period included measures of the cardiovascular, metabolic, and immune systems, as well as DNA, dental health, and kidney, liver, and lung function.

    Participants in the research were drawn from the Dunedin Study, a project from New Zealand that has been closely following the health and development of 954 individuals since birth. All participants are from the same area, and lacked minority populations—one of the main limitations of the study, according to authors.

    Despite that limitation and others—including a lack of data on biomarkers before age 26 and after 38—authors believe that the study opens up possibilities for more research that could lead to both preventive and antiaging therapies.

    "If aging can be measured in free-living humans early in their lifespans, there are new scientific opportunities," authors write. "These include testing the fetal programming of accelerated aging … testing the effects of early-life adversity (e.g., does child maltreatment accelerate aging in the decades before treatment is developed?); testing social gradients in health … and searching for genetic regulators of aging processes."

    Knowledge of the role of these factors on aging could help health care providers introduce effective preventive measures against chronic disease before the diseases become established, they write, and "allow for testing the effectiveness of antiaging therapies (e.g., caloric restriction) without waiting for participants to complete their lifespans."

    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.

    Monday, July 06, 2015RSS Feed

    'Real-Time' Data From Nursing Home EMRs Could Aid in Falls Prevention

    According to a new study, nursing home electronic medical records (EMRs) could contain predictive "real time" data that can shed light on resident falls risk, and make identifying those most at risk for falls more precise. The result? Fewer falls, of course, but also cost savings that could pay for the expansion of EMR use in those facilities.

    Researchers analyzed data from 26 nursing homes that are part of a large California-based chain that uses a centralized EMR system, 13 of which participated in a program that combined standard data collected as part of the minimum data sets (MDS) required by the Centers for Medicare and Medicaid Services (CMS) with pre-identified risk factors obtained on an ongoing basis through the residents' EMRs. Authors reviewed data from 5,129 residents (133,781 observations) between 2011 and 2014. Results were e-published ahead of print in the Journal of the American Medical Informatics Association (abstract only available for free).

    According to the authors, the main differences between the data collected for the MDS and EMRs have to do with frequency and the risks associated with certain medications. While more risk factors are collected in the MDS than in the EMR, EMR data is collected in real time rather than at regular (often quarterly) intervals; additionally, the EMRs used for this study collected data on resident use of opioid analgesics, anticonvulsants, antihypertensive medications, and psychotropic medications—drugs that have been associated with higher falls risk. The EMR also recorded room changes, another factor linked to higher falls risk.

    To get a sense of whether—and exactly how—EMRs led to better predictive results, researchers looked at how risk estimates were affected by various combinations of MDS and EMR data. Because some of the data collected for the MDS and EMRs overlap, authors of the study were able to not only look at the elements exclusive to each collection method, but also evaluate which system seemed to produce more accurate predictive results in those common areas.

    In the end, what they found was that the additional data available through the EMRs did not significantly improve the precision of falls risk; however, substituting the EMR data that overlapped with MDS data made a big difference in who was assessed as most at risk for falls.

    Specifically, researchers found that when using the MDS model alone, the top 10% of at-risk residents were shown to account for 28.6% of observed falls. When MDS variables were replaced with EMR variables, the top 10% were linked to 32.3% of falls. "Together, these results imply that the replacement of MDS risk factor measures with more frequently-updated EMR measures substantially improves identification of residents at highest risk for falls, but that the addition of risk factors available in the EMR yields little or no improvement," authors write.

    In terms of real-world application, authors use an "average" 100-bed nursing home that experiences an "average" rate of 150 falls per year as an example. If the facility could prevent falls among the top 10% of residents most at-risk for falls using MDS data, they write, it could expect to prevent about 43 falls. With the use of EMR data, that number climbs to about 49 prevented falls. Based on an estimated cost-per-fall of $7,307, that 6-falls change would amount to a savings of $43,842 per year.

    Even if a facility could only prevent 33% of the falls in the most at-risk decile, authors write, the resultant $14,000 in savings "would readily justify the additional incremental cost of incorporating EMR information into targeted clinical decision support systems."

    As encouraging as this may be, authors say that the real problem is that nursing homes have been slow adopters of EMR systems, and the EMRs themselves aren't always well-suited to use data in this way.

    "Standard EMR systems currently provide no easy way to synthesize and summarize information on the changing risk factors recorded in disparate parts of the EMR to support clinical decision-making," authors write. "Further development of such application, focused both on falls and other avoidable adverse events … should be a key priority as nursing homes expand their adoption of EMRs in the coming years."

    Learn how predictive analytics could shape the future of physical therapy practice: check out "The Power of Prediction" from the June issue of PT in Motion magazine. The article is open-access. Also available from APTA: a recorded webinar titled "Using Data Analytics to Work Smarter in Your Health Care Setting," presented by Michael Weinper, PT, DPT, MPH, and Nancy Rothenberg.

    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.

    Tuesday, June 30, 2015RSS Feed

    Girls' High School Sports Post Highest Incidence of Overuse Injuries

    Larger numbers of girls participating in high school sports and the growing range of sports offerings available to them are very good things, with a not-so-good side-effect—an increase in overuse injuries.

    According to a recent study of 2,834 overuse injuries (.pdf) between 2006 and 2012, girls' track and field and field hockey have come to top the list of high school sports linked to higher rates of overuse injuries in a set of 20 boys' and girls' sports. While the all-sports average injury rate was 1.50 per 10,000 athletic "exposures," girls' track and field registered a 3.82 rate, while girls' field hockey reported a 2.93 rate. The highest overuse injury among boys' sports was in track and field, at 2.24 injuries per 10,000 exposures.

    Overall, overuse injuries represented 7.7% of all injuries, but rates among girls and boys differed significantly, with overuse representing 13.3% of all injuries for girls, and only 5.5% among boys.

    The study, which appeared this spring in the journal Pediatrics, was based on data submitted by school athletic trainers through the National High School Sports-Related Injury Surveillance System, which randomly selected 100 high schools from an even distribution of geographic regions and school sizes. The injury statistics were drawn from 18,889,141 "athletic exposures," defined as 1 athlete participating in 1 practice or competition.

    Among other findings in the study:

    • Of the 20 sports studied, overuse injuries were more likely to occur in practice than in competition in all sports except boys' baseball, boys' ice hockey, and cheerleading. Girls' lacrosse and girls' field hockey reported the greatest increased risk of injury at practice vs competition.
    • Of 2,832 overuse injuries, 79.9% were reported as new.
    • Among sex-comparable sports, girls had an overall injury rate of 2.08; the injury rate for boys was 1.44.
    • Although overall injury rates were fairly evenly distributed across athletes' year in school, girls' rates decreased as they advanced, while boys' rates increased.
    • The lower leg was the most frequently injured body site (21.8%), followed by knee (15.9%), shoulder (11.5%), and foot (11.3%).
    • Boys' volleyball (.18), boys' ice hockey (.32), cheerleading (.35), and boys' wrestling (.57) reported the lowest overuse injury rates.
    • Sports with the highest percentage of injuries related to overuse were boys' swimming (55.7%), girls' swimming (47.7%), girls' track and field (36.8%) and boys' track and field (28.5%).

    In a video produced by Ohio State University, where lead author Thomas Best, MD, teaches and practices, Best links the intensity of practice and focus on a single sport as potential areas to be watched.

    "Many of these youngsters are playing a single sport, and that may in fact be a major risk factor for these overuse injuries because their bodies are seeing the same repetitive blows with one sport," Best said.

    In the study, authors write that their work could inform the development of sport-specific preventive measures to avoid a potentially worsening problem.

    "As the popularity of high school sports continues to increase, the number of high school athletes sustaining overuse injuries may also increase unless effective prevention programs are developed," authors write. "The body sites affected with overuse injuries were sport specific. Identifying high school athletes at risk of overuse injuries is the first step in working to prevent these injuries."

    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.

    Also available from APTA:  a recorded webinar on repetitive stress injury in youth sports, presented by Jeff Taylor-Hass, PT, DPT, OCS, CSCS, and Chad Cherny, PT, DPT, MS, SCS, CSCS.

    Monday, June 29, 2015RSS Feed

    Study: Location Differences, Disproportionate Burdens Among PT Copay Problems

    The amount of out-of-pocket (OOP) expenses a patient may be expected to pay for an episode of physical therapy is likely to vary not only depending on where the patient lives, but on a number of demographic factors, according to a new study. In addition to these variations, the study says, the payment burden is not equally distributed, with 25% of patients who incurred OOP expenses accounting for 75% of all expenditures.

    The analysis, e-published ahead of print in APTA's journal PTJ (.pdf), looked at datasets from the Medical Expenditures Panel Survey (MEPs) in 2-year increments beginning in 2008 and ending in 2012. Researchers drew from expenditure records of 2,189 patients who received physical therapy treatment (identified in the article as "PT").

    Among the findings of the study:

    • The average episode of care for physical therapy was 9.9 visits, with a mean total expenditure of $1,708. OOP expenditures were required in 54% of episodes, a lower rate than in general medical care.
    • The average OOP expenditure for physical therapy was $351.
    • OOP expenditures averaged 19.5% of the total expenditure for care, or about $44.73 in OOP costs per visit.
    • Being female, non-Hispanic, and of a higher income correlated with higher odds of incurring OOP expenses; being in worse general health, 65 or older, having public funding, and being nonwhite were factors associated with lower odds of having an OOP expenditure.
    • Among geographic regions, the Northeast fared the best in terms of lowest average OOP costs. Rates for the South were 44% greater than for the Northeast; rates for the West about 29% higher than for the Northeast, results that authors write " are consistent with current APTA lobbying efforts at limiting patient expenditures through the fair copays model legislation, which are focused in these same geographic regions."
    • Urban areas registered OOP expenditures that were, on average, 72% higher than rural areas.
    • The top 1% of those with an OOP expenditure accounted for 14.6% of all OOP payments; the top 5% accounted for 38.2%. Overall, about one-quarter of patients with any OOP expense account for three-quarters of all expenditures.

    Authors point to this lopsided distribution of OOP expenditures as an area for further policy work, writing that "we believe that if there is a desire to reduce the level of OOP expenditures, attention to the small proportion of higher expenditure episodes could result in the largest reduction of OOP expenditures for PT."

    They also cite overall average cost as a matter of concern, writing that while the average $351 OOP expenditure for physical therapy "may not appear excessive," when this amount is compared with another study that estimated an average annual OOP expenditures rate of $703 for health care in general, the average for physical therapy expenditures takes a disproportionate bite.

    "We believe that for some individuals the OOP expenditure could be a barrier to obtaining PT care and that the policy implications could include advocacy for a limit on OOP expenditures for physical therapy services as a small proportion of annual OOP health spending," authors write. "In the least our findings indicate that the profession should continue to monitor the proportion of those who have OOP expenditures and the amount incurred."

    Fair physical therapy copay policies are a major focus of APTA advocacy efforts, particularly at the state legislative level. Visit the APTA webpage on copays for resources, background, and model legislation, as well as a new interactive copay map that lets you find out how your state is handling the issue.

    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.

    Thursday, June 25, 2015RSS Feed

    Health Care Worker Injuries Due to Patient Handling Continue to Rise

    According to a new report from the US Centers for Disease Control and Prevention (CDC), health care workers are still number 1 when it comes to on-the-job injuries, accounting for 20% of all nonfatal occupational injuries across the country.

    And the most prevalent source of health care worker injury? Patient handling.

    In a report that reviews Occupational Health Safety Network (OHSN) data from 112 health care facilities with a total of 162,535 full-time employees, the CDC found that patient handling injuries occurred at an average rate of 11.3 per 10,000 worker-months; with slips, trips, and falls occurring at a 9.6 rate, and workplace violence from patients at 4.9 per 10,000 worker-months. All 3 categories have been on the rise over the past 2 years.

    The report cited nurses and nurse assistants as the most frequently injured health care staff, with nurse assistants recording a patient handling injury rate of just over 35 per 10,000 worker-days, and nurses reporting a rate of 16. According the report, upping the risk factors for nurses are a growing number of obese/overweight patients, high patient-to-nurse ratios, long shifts, and increased efforts to mobilize patients as soon as possible after a medical procedure.

    Although the report did not include physical therapists (PTs) or physical therapist assistants (PTAs) as a separate category, research that appeared in a 2014 issue of PTJ estimated the 1-year work-related injury rate for PTs at 20.7%.

    "Similar to findings from other studies, OHSN data indicate that [the use of lifting equipment and other interventions] could potentially reduce patient-handling injuries, particularly for activities involving positioning, transferring, or lifting a patient," the CDC writes. "Additionally, to prevent patient-handling injuries, health care institutions might establish a safety culture emphasizing continuous improvement and … provide resources such as training in safe patient handling."

    APTA provides multiple resources on safe patient handing for physical therapists and physical therapist assistants through an association webpage devoted to the topic. In 2012, APTA joined a broad-based effort by the American Nurses Association to establish national standards on safe patient handling.