• Friday, May 22, 2015RSS Feed

    Meniscus Surgery All in Your Head, Says One Psychiatrist

    Apparently, even psychiatrists have issues—and sometimes these issues include feelings about the validity of arthroscopic surgery for meniscus tears.

    In an opinion piece for Psychiatric Times titled "Knee Surgery? Think Twice," psychiatrist Allen Frances, MD, explores not just the power of the placebo effect, but the role of exercise and physical therapy to lessen the pain associated with meniscus tears.

    To make his point, Frances mostly turns over the commentary to Teppo Jarvinen, the orthopedic surgeon who was the lead author a study that compared outcomes of patients who received arthroscopic surgery for a meniscus tear with patients who were provided sham surgery. The results showed that the sham surgery patients reported outcomes just as good as or better than their real-surgery counterparts. Findings of the study were reported in a January 2014 PT in Motion News article.

    In the Psychiatric Times article, Jarvinen says that knee surgery is sometimes recommended but that "without a true traumatic event … resulting in your knee filling up with blood ... if you're able to move your knee freely (even with some possible pain), there is no urgent need to have your knee 'scoped.'"

    "Rather, go and see your physiotherapist, start a good rehab program, and give it some 3-4 months to let nature take its course," Jarvinen says.

    Allen writes that Jarvinen's research "is one of those landmark studies that should change the world."

    "Patients beware before accepting the knife," Allen writes. "Insurance companies take note in establishing standards for reimbursement. Guideline makers insert watchful waiting and rehab before recommending surgery."


    Thursday, May 21, 2015RSS Feed

    New Postacute Care Webpage Makes an IMPACT

    Work in a postacute care setting? Brace yourself for IMPACT.

    New to the APTA website: a webpage exclusively devoted to providing you with everything you need to know about postacute care reform in Medicare, including information on how the Improving Post-Acute Care Transformation (IMPACT) Act will change the types and quantity of data provided to the Centers for Medicare and Medicaid Services (CMS).

    The new webpage provides a basic outline of the principles behind postacute care reforms, resources from CMS, summaries of proposed rules, and highlights of APTA's involvement in the process.

    The reach of IMPACT and other postacute care reforms extends to skilled nursing facilities, home health, inpatient rehabilitation facilities, and long-term care hospitals. APTA is a strong supporter of the reform initiatives, including the provisions of the IMPACT Act.


    Thursday, May 21, 2015RSS Feed

    BMJ Study Links Regular Physical Activity to Longer Life in Elderly Men

    Older men have yet another incentive to be physically active—they can extend their lifespan. At least this was the case for elderly men in an observational study recently published in the British Medical Journal (BMJ) (free full-text download) that linked regular physical activity to a lower risk of death.

    Boosting physical activity levels in this age group seems to be as good for health as giving up smoking, the findings suggested.

    The 5,738 men under observation had taken part in the Oslo I study of 1972-1973, at which time they would have been aged 40-49, and again in Oslo II 28 years later. In Oslo II they were monitored for almost 12 years to see if physical activity level over time was associated with a lowered risk of death from cardiovascular disease, or from any cause.

    The men were surveyed on, among other things, their weekly leisure time physical activities. Activities were classified as sedentary (watching TV or reading); light (walking or cycling, including to and from work for at least 4 hours a week); moderate (formal exercise, sporting activities, or heavy gardening for at least 4 hours a week); and vigorous (hard training or competitive sports several times a week).

    The analysis indicated that more than an hour of light physical activity was linked to a 32% to 56% lower risk of death from any cause. Less than an hour of vigorous physical activity was linked to a reduction in risk of between 23% and 37% for cardiovascular disease and death from any cause. The more time spent doing vigorous exercise, the lower the risk seemed to be, falling by between 36% and 49%. Men who regularly engaged in moderate to vigorous physical activity during their leisure time lived 5 years longer, on average, than those who were classified as sedentary.

    Factoring in the rising risk with age of death from heart disease and stroke made only a slight difference to the results, researchers said. Overall, these showed that 30 minutes of physical activity—of light or vigorous intensity—6 days a week was associated with a 40% lower risk of death from any cause.

    Being an observational study, no definitive conclusions can be drawn about cause and effect, the researchers pointed out, adding that only the healthiest participants in the first wave of the study took part in the second wave, which may have lowered overall absolute risk. But the differences in risk of death between those who were inactive and active were striking, even at the age of 73, they suggest.

    More effort should go into encouraging elderly men to become more physically active, the researchers concluded, emphasizing the wide range of ill health that could be warded off as a result. PT in Motion News reported in 2014 on 2 other studies touting the benefits of physical activity for older adults: JAMA reported that a physical activity program can reduce the risk of losing the ability to walk without assistance; and the Journal of Physical Activity & Health reported that each hour of sedentary behavior increases the odds of disability in activities of daily living.

    APTA offers educational resources that address the role of the physical therapist in health and wellness in older adults and provide insight into older adults and exercise adherence. Additionally, APTA's consumer-focused MoveForwardPT.com website includes a webpage featuring videos addressing the importance of fitness across the lifespan. The association also offers a prevention and wellness webpage that includes videos, podcasts, and educational resources.


    Wednesday, May 20, 2015RSS Feed

    Last Chance to Test ICD-10 Reporting System

    With no further delays on the horizon, the shift to the new International Classification of Diseases, 10th Revision (ICD-10) is set for October 1. Physical therapists (PTs) have one more chance to capitalize on an opportunity to test the new system before actual implementation, but only if they act quickly.

    The last of 3 ICD-10 test programs that the Centers for Medicare and Medicaid Services (CMS) has conducted for health care providers is scheduled for July 20-24, and the deadline to apply is May 22. APTA is encouraging members to sign up for the program to gauge their own practice's readiness for the change.

    Bonus for any PTs who already participated in the January or April end-to-end tests: you can participate again in July without reapplying.

    The testing program will allow a sample group of providers to work with Medicare administrative contractors (MACs) and Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes, from submission to remittance advice. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.

    CMS is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by May 22. The MACs and CEDI will notify the volunteers selected by June 12 with information needed for the testing.

    More information on the testing process is available online (.pdf).

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.


    Wednesday, May 20, 2015RSS Feed

    Hospital 'Preferred Provider' Lists Put Pressure on SNFs

    A recent article in Modern Healthcare says that with increasing frequency skilled nursing facilities (SNFs) are being forced to compete for a coveted place on a hospital's list of "preferred facilities" that will receive the bulk of the hospital's referrals. According to the article, the results seem to be paying off—both in terms of improved patient outcomes and lower costs.

    Reporter Melanie Evans tracks trend by focusing on several hospitals that have adopted an "aggressive new strategy" of creating a shortlist of SNFs that will be recommended to patients after discharge. These preferred facilities are accepted based on a host of outcome data from state health reports and Medicare quality measures, including length of stay and readmission rates, in addition to questionnaires and interviews from the hospital.

    And those approval lists can be fairly exclusive. For example, Phoenix, Arizona-based Banner Health accepted 34 SNFs from among 90 applications; Partners Healthcare in Massachusetts included 47 of 140 potential SNFs in its preferred provider list.

    Evans writes that data gained since the switch to a preferred facilities system bears out the underlying assumptions—average lengths of stay are dropping, along with 30-day readmission rates. One Lincoln, Nebraska, hospital saw readmission rates drop from 15% to 11% in 7 months.

    While the SNFs that make the cut are experiencing increased business, the facilities that aren't on the lists may be in for tough times ahead, according to James Michel of the American Health Care Association. "For many providers, it could be life or death," he said in the article.


    Wednesday, May 20, 2015RSS Feed

    Patients With Colorectal Cancer Heed Physical Activity Advice – If They Get It

    The good news: a large-scale British study has found that individuals with colorectal cancer (CRC) who can recall a clinician giving them advice to stay as physically active as possible tend to do just that.

    The bad news: less than a third of CRC patients remember getting any such advice in the first place.

    In a study in the May issue of BMJ Open (.pdf), researchers presented findings based on a 2013 survey of 15,254 individuals in the United Kingdom who had received a CRC diagnosis in 2010-2011. The survey gathered demographic and other data—including rates of physical activity—and asked the question, "Did you receive any advice or information on physical activity or exercise?"

    Only 31% answered yes. And what makes this number particularly powerful is that receiving advice on physical activity (PA) seems to make a difference with patients.

    Researchers found that among the patients who recalled receiving PA advice, 51% were engaged in brisk physical activity for at least 30 minutes 1-4 days a week, with 25% participating in PA for at least 30 minutes 5-7 days a week. Those numbers dropped to 42% and 20%, respectively, among patients who didn't remember receiving PA advice.

    Authors write that while some clinicians may be waiting for the results of an ongoing clinical trial focused on the relationship of PA rates to CRC survival rates before considering giving PA advice, "in light of strong evidence for a number of other important outcomes, such as reductions in cancer-related fatigue and improved quality of life, it is important for clinicians to be advising their patients with CRC to be physically active."

    Other findings from the study:

    • Men (35%) were more likely than women (25%) to recall being given PA advice.
    • Patients 55 and younger recalled receiving advice more often than older patients (37% vs 20%).
    • Patients with higher socioeconomic status (SES) remembered getting advised on PA with more frequency than patients at lower SES levels (32% vs 28%).
    • Among patients in remission, 32% recalled receiving advice, compared with 27% of nonremission patients.

    Authors acknowledge that "giving PA advice may not always be easy for health care professionals" because of a "lack of appropriate support," uncertainty about what to recommend, or perceived time constraints.

    But these barriers must be overcome, they argue.

    "Our results strengthen the case for clinicians to recommend PA to their patients with cancer," authors write, citing the differences reported in the survey. "This difference is potential of real practical significance."

    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, May 19, 2015RSS Feed

    Wheelchair, Robotic Advances Show Promise

    Need an antidote to the nagging feeling that personal health technology is turning us into walking databases and little else? Maybe it's time to check out some cutting-edge technologies that are less about quantifying people and more about empowering people.

    In a recent Disability Blog, guest blogger Kathy Pretz, editor of the Institute of Electrical and Electronics Engineers (IEEE) member newspaper, touches on some projects now in development that could make mobility and communication easier for individuals with disabilities.

    Pretz's post focuses on 3 cool new projects: an upgraded version of Stephen Hawking's communication system, made open source to allow for wider access for individuals with ALS; a smart powered wheelchair that can adjust its tracking to account for a sidewalk's sideways ("center to street") grade and keep itself going straight; and "quality of life robots" that can perform household chores or assist a user outside the home—either under the user's direct control or remotely by a caregiver.

    IEEE is a professional association "dedicated to advancing technological innovation and excellence for the benefit of humanity."


    Monday, May 18, 2015RSS Feed

    Survey: Your Boss Is Concerned About Your Retirement—To a Point

    Health care employers understand the importance of offering a retirement plan to employees, and they may even be concerned that their employees are financially prepared to leave work, but taking steps to foster that kind of retirement readiness? That's a trickier question.

    A Modern Healthcare survey of 523 health care executives looked at how health care employers think about retirement plans, and how they go about shaping them. The results show a strong sense of appreciation of a retirement plan as a benefit but more scattered views on whether the employer has a responsibility to do more than simply offer a plan.

    When it comes to helping their employees reach retirement readiness—defined by most respondents as "when employees understand how their savings translate to income to support them through retirement"—the executives were sensitive to the role of the employer, with 87% responding that their organizations "feel responsible for helping employees become retirement ready."

    But that's where opinions start to diverge. The survey showed that while nearly half (49%) of those who feel responsible take steps to provide guidance and encourage employee savings, about 31% do nothing, and the remaining 24% leave it to the benefit providers.

    In terms of how these executives measure the success of their plans—something that only 25% say they do—retirement readiness came in fourth out of 6 possible measures. The top 3 measures were employee satisfaction, meeting compliance requirements, and achieving targeted levels of participation.

    According to Modern Healthcare, the results show that employers haven't quite connected operations with intent.

    "Respondents indicate that retirement readiness matters a great deal to a plan's success," authors write, "while other survey data reveals that health care organizations have an opportunity to do significantly more to ensure retirement readiness is a plan priority."

    Among other findings in the survey:

    • Respondents listed the top reasons for offering a retirement plan as a way to attract and retain talent, to encourage employees to save for retirement, and because it's "simply the right thing to do." Few of the executives surveyed ticked off tax savings or "to help employees retire sooner" as important reasons.
    • Employer match plans were used by 70% of the respondents, with 45% using some form of employer contribution.
    • Just over one third of respondents said their organizations used automatic enrollment plans in which employees must opt out (rather than opt in); even fewer (14%) used systems that employed automatic increases in employee contributions at certain points—low numbers that Modern Healthcare described as "surprising since they are proven to enhance saving."

    Friday, May 15, 2015RSS Feed

    9 of 10 Parents of Overweight Children Don't See the Problem

    Nearly 95% of parents of overweight children in America don't perceive their child as overweight, according to a new study that underscores a phenomenon one editorial writer describes as "oblviobesity."

    The research, which appears in the June issue of Childhood Obesity (.pdf) analyzed data from National Health and Nutrition Examination Surveys (NHANES) administered between 1988 and 1994, and again between 2007 and 2012.

    Researchers compared an individual child's BMI with his or her parent's answer to the questions, "Do you consider [child's name] to be overweight, underweight, just about the right weight, or don't know?" (earlier survey) and "How do you consider [child's name] weight?—overweight, underweight, about the right weight, or don't know," (later survey). The comparison allowed authors of the study to gauge just how far parent perceptions veered from reality.

    They veered a lot. In the later survey 94.9% of parents of overweight children described their child's weight as "just about right," a slight decline from the 96.6% of parents who provided that response in the earlier survey.

    That perceived improvement, however, was offset by an increase in the number of parents who perceived their obese child's weight to be "just about right"—about 79% of parents of obese boys, and 68% of obese girls, numbers that increased from 69% and 59%, respectively. What that means, according to researchers, is that that probability of a parent appropriately perceiving his or her child as overweight or obese dropped by 30% between the surveys.

    Other findings:

    • Overall, the children sampled in the latest survey were "significantly heavier" than their counterparts in the earlier survey, with mean BMI increasing from .23 to .37.
    • The declining tendency to misperceive the weight of an obese or overweight child was most pronounced among black parents.
    • The apparent threshold for a parental perception of overweight shifted: in the earlier study, the majority of perceived overweight children were overweight; in the most recent study, the majority of children perceived as overweight were obese or severely obese.

    In an editorial that appeared in the same issue as the study, author David L. Katz, MD, described a number of earlier studies that produced similar results—both in terms of parental perceptions of a child's weight, and the perceptions of children themselves. He dubbed the phenomenon "oblivobesity."

    For their part, researchers point to several possible causes for the increasing misperceptions, including growing overall obesity rates that may prompt parents to look at peers for standards, poor communication between parents and the medical community, a belief that weight will be "outgrown," and an unwillingness "to label their child as overweight owing to societal pressures of maintaining a lower weight and/or the stigma often attached to obesity."

    Authors cite public health initiatives to decrease childhood obesity rates, but write that "the opportunity has not yet been fully realized and pediatricians' commitment may need revitalizing."

    In his editorial, Katz frames the problem in dire terms.

    "If parental inattention fosters a rising mean BMI among children globally, and a rising mean BMI fosters acclimation among parents to that ever-higher norm, then obesity in our children becomes the new normal," he writes.

    APTA offers extensive resources on the PT's role in prevention and wellness, as well as on behavior change in the patient and client.

    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, May 14, 2015RSS Feed

    ACA Data: Newly Insured Have 'Pent-Up Demand' for TKA, LBP Surgery

    A new study from the Society of Actuaries (.pdf) (SOA) reveals what may not be a huge surprise: previously uninsured individuals who became insured through the Affordable Care Act (ACA) tended to pursue so-called "preference-sensitive" treatment—health care that can be delayed without a crisis—at a significantly higher rate than the continuously insured.

    Topping the list of preference-sensitive treatment? Total knee arthroplasty (TKA) and surgery for low back pain (LBP).

    According to SOA, the use of these treatments "exceeded the expectation of differences due to demographics alone, such as those used in actuarial rating calculations."

    Among the preference-sensitive treatments reviewed, TKA showed the most marked difference in use, with new enrollees showing an estimated member month use rate per-1,000 that is 6.19 times that of the continuously enrolled. That rate was significantly above the next-highest treatment differential, surgery for LBP, which showed an estimated use rate of 2.14 times the rate of the continuously enrolled.

    The SOA study was focused on usage in the first quarter of 2014, and limited to 87,000 individuals in Kansas—17,000 newly insured and 70,000 continuously insured. Actual numbers of procedures performed were small.

    Still, according to an article in the National Journal, the SOA study could offer "a glimpse into where the pent-up demand is within the health care system."

    The SOA report states that these data are similar to studies conducted after Medicaid expansions, "which show that there is an initial high use of services that tapers off over the year," but that a definitive pattern can't be established until all 2014 data are in.

    In the National Journal article, Kaiser Family Foundation Vice President Larry Levitt described the rates as a temporary spike.

    "Just because new enrollees used more services initially doesn't mean that will necessarily be true looking ahead," he told the National Journal. "This study may give insurance regulators some evidence to push back on insurers that are proposing big rate increases for 2016 based on how much enrollees used in 2014."


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