• Tuesday, December 01, 2015RSS Feed

    This Month in PT in Motion Magazine: Helping Patients Think About Misbeliefs

    Everyone's entitled to his or her beliefs, so they say. But what happens when those beliefs get in the way of getting better?

    This month's issue of PT in Motion magazine takes on the subject of how physical therapists (PTs) and physical therapist assistants (PTAs) can help their patients and clients overcome misbeliefs that can interfere with achieving optimal outcomes. The feature-length article includes plenty of real-life examples of patients attached to ideas that were barriers to their understanding of their condition and how physical therapy can help—everything from believing that exercising makes multiple sclerosis worse, to a theory that wearing wet jeans causes arthritis.

    Keeping in mind that patient values and beliefs are a factor in evidence-based practice, how should a PT or PTA handle off-target patient beliefs? According to the article, there simply isn't a single best way—it's all about nuance, about understanding the kind and source of the misinformation the patient holds, and about approaching the issue with genuine sensitivity to the patient's belief system, culture, personality, and learning style.

    "Overcoming Patient Misbeliefs" features advice from PTs who have engaged in sometimes-significant patient education efforts. Approaches differ, but each PT interviewed underscores the need to be patient and avoid making the patient feel ignorant or defensive—or lectured-to. The article also recognizes the value of honoring patients’ belief systems and respecting the knowledge they have of their own bodies and experiences.

    "As a physical therapist, you have to be a great listener," says Chuck Gulas, PT, PhD, in the article. "You need to ask questions and show patients they have a key role in their own treatment."

    "Overcoming Patient Misbeliefs" is featured in the December issue of PT in Motion . Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Monday, November 30, 2015RSS Feed

    Think You'll Avoid a Work-Related Musculoskeletal Disorder? Don't Bet On It

    If you're a physical therapist (PT) hoping to avoid a work-related musculoskeletal disorder (WMSD), the odds are definitely not in your favor: according to a new systematic review, the chance of PTs experiencing a WMSD at some point in their careers could be as high as 90%, with most of those disorders occurring in the first 5 years of practice.

    In a review e-published ahead of print in the Journal of Back and Musculoskeletal Rehabilitation (abstract only available for free) researchers zeroed in on 32 studies that focused specifically on PTs and WMSDs. The studies examined prevalence of and triggering factors for the risk associated with various specialties, and differences in WMSD among male and female PTs. Here's what they found:

    Prevalence is high.
    In terms of how many PTs experience WMSD during their careers, studies varied from 53% to 91%, with researchers estimating that half of the WMSDs occur during the first 5 years of a PT's career. Authors of the study suspect that the higher rates for earlier-career PTs may have something to do with older PTs' use of "self-protecting strategies such as treatment modifications, requesting assistance with strenuous tasks, and performing less demanding therapies to minimize WMSD risk." In most of the studies, female PTs had a higher rate of WMSDs than male PTs—as wide as a 73% to 57% difference in 1 study.

    Certain parts of the body are more likely than others to be affected by WMSDs, with certain activities more likely to result in WMSDs.
    The low back was the most prevalent area reported, followed by WMSDs affecting the thumb and/or hand. Studies pointed to transferring and handling patients as the most common risk factor for a low back WMSD (1 study estimated that patient handling accounted for 83% of the low back WMSDs), with PTs who frequently deal with dependent patients nearly twice as likely to experience a low back WMSD as those who rarely work with dependent patients, according to 1 study. As for hand, wrist, and thumb WMSDs, manual therapy and "treating an excessive amount of patients per day" were the risk factors most strongly associated with injury.

    There's a relationship between a PT's specialty area and the kinds of WMSDs experienced.
    Hospital- and acute care-based PTs have not only the highest overall prevalence of WMSDs, but the highest rates associated with WMSDs of the low back, ankle, and feet. PTs who specialize in outpatient orthopedic treatment are more likely to experience WMSDs of the thumb; PTs who focus on manual physical therapy are linked to higher WMSDs of the elbow, wrist, and hand (especially among those who performed manual therapy on more than 10 patients at day); WMSDs of the upper back, low back, and knee are most strongly associated with PTs in neurologic rehabilitation; and pediatric PTs (especially those in school systems) are linked to neck, knee, hip, and thigh WMSDs.

    Authors of the review write that while it may not be possible to completely eliminate WMSDs among PTs, certain steps can be taken to minimize exposure to risk factors. They suggest that given the connection between WMSDs and patient handling, increased use of patient transfer devices may make a difference. However, they argue, other changes need occur, too, including altering the load—both literal and figurative—often taken on by PTs.

    "To reduce the risk of developing WMSD during activities such as manual therapy, manually resisted exercises, and assisted stretches, adequate body mechanics as well as other strategies are needed to minimize load," authors write. "For example, physical therapists could take break/recovery time between patients, and alternate between more and less physically demanding patients."

    APTA offers a webpage devoted to safe patient handling, with resources that include an extensive bibliography and a continuing education course that can help you learn to identify threats to health care provider safety.

    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, November 24, 2015RSS Feed

    Human Movement System Roundtable Podcast Now Available

    If you ever wondered if APTA has taken a firm position on the human movement system, wonder no more: according to the guiding principles of the association's vision statement, it's nothing less than "the core of physical therapist practice, education, and research."

    But saying it doesn't make it so. The question is, has the physical therapy profession embraced the movement system, and what still needs to be done to truly integrate the idea throughout the profession?

    Those issues were front and center at the 2015 Rothstein Roundtable held during APTA NEXT Conference and Exposition in June, and now a recording of that roundtable is available to members for free, courtesy of APTA's journal Physical Therapy.

    Called "Putting All of Our Eggs in One Basket," the nearly 90-minute conversation features panelists Stephen J. Hunter, PT, DPT, OCS, Barbara J. Norton, PT, PhD, FAPTA, Christopher M. Powers, PT, PhD, FAPTA, and Lisa K. Saladin, PT, PhD, FASAHP, who address early gains, challenges to come, and possible barriers. Moderator for the roundtable is Anthony Delitto, PT, PhD, FAPTA.

    Listen in, and get the latest on what some of the profession's leaders in research, education, and practice have to say about one of the key guiding principles in the profession's vision of "transforming society by optimizing movement to improve the human experience."

    Need a little more context before diving into the podcast? Check out these resources on the human movement system, and read about how the system relates to the APTA's vision statement for the profession.

    Tuesday, November 24, 2015RSS Feed

    Patients, PTs Generally Agree on LBP Triggers

    While patient education can be an important part of treatment for low back pain (LBP), physical therapists (PTs) and physical therapist assistants (PTAs) may not have as much educating to do when it comes to triggers for the condition. According to a new study from Australia, patients' understanding of what causes sudden-onset acute LBP is fairly consistent with PTs' views.

    For the study, e-published ahead of print in Spine (abstract only available for free), researchers surveyed 102 PTs and 999 patients with sudden onset acute LBP to find out perceptions around common triggers. The groups were asked slightly different questions: patients were asked what they thought caused their own LBP episode, while the PTs were asked to list "the 5 most likely factors involving short-term exposure that are triggers for a sudden episode of LBP."

    Though the questions were different, the answers showed "remarkably similar" perceptions among both groups, according to the study's authors.

    In terms of broad categories—"individual," "biomechanical," "psychological/psychosocial," "genetic," and "other"—biomechanical was the clear winner, with 87.7% of patients and 89.4% of PTs citing that broad area as the most important risk factor. When it came to kinds of biomechanical events that are triggers, PTs and patients further agreed in citing lifting, bending, and prolonged sitting the most important triggers (lifting was most common).

    Though agreement was significant, patients and PTs did part ways with a few trigger subcategories, with patients more often pointing to awkward posture (31.4% of patients vs 1.2% of PTs) and sports injury (15.9% of patients vs 4.7% of PTs) as a trigger. PTs, on the other hand, more often cited physical trauma (9.2% of PTs vs 3.4% of patients) and unaccustomed activity (7.3% of PTs vs 2.3% of patients) as triggers.

    Other findings from the study:

    • Even though psychological and psychosocial factors have been linked to increased risk for LBP, neither group in this study cited these triggers in significant numbers. Authors described this discrepency as something that "warrants further investigation."
    • Authors noted that while prolonged sitting was one of the most-frequently cited triggers, "there is little to no evidence that prolonged sitting is an independent risk factor for LBP."
    • Researchers believe that some of the differences between the groups may be related to how the question itself was read and understood. For example, they assert, patients may interpret a "sports injury" as any injury that occurs while playing a sport, while PTs are more likely to pinpoint the biomechanical cause of the injury.

    Ultimately, the findings produced a kind of "no news is good news" result for researchers, who were particularly interested in defining the scope of triggers perceived by the groups and uncovering any "novel triggers" that may be overlooked by PTs or patients. According to the study's authors, high levels of agreement around a particular condition contribute to greater patient satisfaction and compliance with treatment.

    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, November 23, 2015RSS Feed

    Deadline Extended on PQRS Penalty Letter Requests

    Editor’s note: After this story posted, the Centers for Medicaid and Medicare Services again extended the deadline to submit review requests. The new deadline is December 16, 2015.

    The Centers for Medicare and Medicaid Services (CMS) announced that it is extending the deadline for providers to question Physician Quality Reporting System (PQRS)-related penalty notices they may have received. Instead of a November 23 deadline, CMS will accept "informal review" requests until midnight on Wednesday, December 16.

    APTA is aware that some members have received letters related to PQRS performance during 2014. If you believe you have received a penalty notice letter in error, be sure to submit an informal review request through the CMS "QualityNet" website by the December 16 deadline.

    CMS has informed APTA that providers have been experiencing problems in reaching QualityNet over the past several days, and says that it's attempting to fix the problem. APTA is also working with CMS to ensure that physical therapists are not unduly penalized for 2014 PQRS performance.

    Questions? Problems with filing an informal review? Contact the APTA advocacy staff.

    Want more on PQRS? A recording of APTA's recent webinar, "Physical Therapy and PQRS in 2016: How to Report Successfully," will be available in the coming weeks.

    Monday, November 23, 2015RSS Feed

    THA, TKA Readmission Rates Drop Across the Board—and Dramatically, for Some

    It isn't news that the number of total knee and total hip replacements is rising across the country. But what may be news is that efforts to reduce hospital readmissions associated with the surgeries may be working, albeit in different ways for different age groups.

    A study released by the American Association of Retired Persons (AARP) looked at over 142,000 insurance claims from individuals 50 and older enrolled with a "large insurance carrier" to calculate the prevalence of the replacement surgeries—and rates of 30-day readmissions—from 2009 to 2013. What they found was that while both total hip arthroplasty (THA) and total knee arthroplasty (TKA) numbers rose dramatically, readmission rates fell nearly as dramatically, particularly among the 65- to 84-year-old age group.

    Overall, THA rates jumped by 73% between 2009 and 2013, with TKA rates rising by 46% during the same period. THA rates for the 65-84 age group increased by 113%, while the 50-64 group saw a 58% rise. For TKA procedures, the older group once again outpaced the younger group, with the 65-84 group registering an 80% increase in procedures, compared with the 50-64 group's 23% increase.

    During that same period, unplanned 30-day hospital readmission rates fell significantly, according to the study. Overall rates for THA-related readmissions fell by 20% across age groups, while TKA readmission rates dropped by 23%.

    Like the rates of increase for the procedures themselves, the drops in readmission rates were also different between the age groups—sometimes dramatically so.

    THA-related readmission rates registered the most significant differences, with the 65-84 age group reporting a 38% drop in readmission rates (from 5.5% to 3.4%), while the younger group saw a drop of only 3% (from 3.5% to 3.4%). Similarly, TKA readmission rates dropped by 36% for the older group (from 5.2% to 3.2%), and 12% for the younger group (from 4% to 3.5%).

    The bottom line: by the end of 2013, 30-day THA and TKA readmission rates were virtually identical among all adults age 50-84.

    As for causes of readmission, device complications and complications from surgery led the list throughout the study period. "Rehabilitation/device adjustment" registered as a cause in 2009 for the older group only (11% of THA readmissions, and 9% of TKA readmissions), but fell off the list of top 3 causes by 2013.

    The AARP study authors called the results "promising," but wrote that the relatively slower reduction in readmissions for the younger group "raises concerns that hospitals could be focusing their readmission reduction efforts on Medicare beneficiaries rather than the broader population."

    In an online article on the AARP report in Forbes magazine, author Bob Rosenblatt offers up another theory on what's responsible for the drop: an increased use of "observation status" designations among hospitals. The Forbes article cites an AARP analysis of Medicare data that found the top 10% of hospitals with the largest drop in 30-day readmissions between 2011 and 2012 increased their use of observation status for returning patients by an average of 25%.

    Friday, November 20, 2015RSS Feed

    Study: Increased Leg Power Associated With Slower Cognitive Aging in Women

    Women who want to protect themselves against cognitive decline as they age could get a leg up through legwork, according to a new study that found "a striking protective relationship" between aging women's leg power and cognitive changes over 12 years.

    Researchers in England reached this conclusion after analyzing leg muscle power and cognitive performance among 324 healthy female twins at baseline (average age, 55; range 43-73) and then 12 years later. After controlling for health and demographic variables, they found that the women who had increased leg power at baseline scored better on tests of brain processing speed and visual memory 12 years later than the women with lower leg power at baseline. Overall differences were modest but consistent, with a 40-watt leg explosive power (LEP) increase correlated with an average 3.3 years' lower cognitive age.

    Authors of the study assert that the use of twins further strengthens their conclusions, because they were able to compare 10-year differences among "discordant" twins—twins with similar genetic traits and childhood environmental influences, but whose leg power was different at baseline. As with entire group comparisons, researchers found that the twin with the greater leg power tended to demonstrate slower cognitive decline than her sister. The strongest differences were noted in dizygotic (fraternal) twins; less so in monozygotic (identical) twins.

    The differences weren't just revealed in test scores—magnetic resonance imaging of the brains of a subset of participants revealed larger gray matter volume at 12 years after the baseline leg power assessment. Results were published online in the November 10 issue of Gerontology.

    Researchers chose LEP as a measurement of physical fitness because they felt that it was "sensitive to low-intensity [physical activity], " and that it is associated with functional ability "and declines with age earlier, and more dramatically, than physical strength." The baseline LEP scores were measured using the Leg Extensor Power Rig designed by the Nottingham University Medical School.

    Authors of the study write that their work stands out in at least 2 ways: it's the first study "linking a power of large leg muscular response to brain changes," and it's one of a very few studies that have tracked the effects of fitness on cognition and brain function over more than 10 years.

    While they acknowledge that the study does not itself prove causality between physical fitness and brain aging, authors argue that like earlier research, their work "support[s] the probability of a causal relationship."

    Exactly what that relationship might be is a matter for further research, however.

    Authors of the Gerontology study offer a couple of possible explanations. One option, they write, is that LEP itself could be related to cognitive aging "through a shared mechanism which is independent of genetic and many development factors and specific to lower limb and/or speed and coordination of muscle function, which affects lower limb power before cognition." If that's the case, they write, research should focus on "non-genetic mechanisms" such as cellular changes in brain and muscle tissue in response to the environment.

    But the simpler—and hence more likely—possibility is that leg power is a good marker of physical activity levels, which are correlated with slower brain aging.

    "The principle of parsimony would favor this latter explanation," they write. "If so, interventional trials aimed at improving leg power over the long term may be fruitful in the search for strategies to improve cognitive aging in the healthy population."

    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, November 19, 2015RSS Feed

    Game On: Recent Articles Focus on VR and Gamification in Physical Therapy

    When it comes to rehabilitation, many physical therapists (PTs) and physical therapist assistants (PTAs) don't play around.

    But maybe they should.

    The "gamification" of physical therapy may not be anything new, but it's been receiving attention from the media lately. Here's a quick roundup of some of the highlights published recently.

    The New Yorker looks at "a radical new approach to treating stroke patients"
    This feature-length article in the November 23 issue of the magazine looks at "Bandit Shark Showdown," a rehabilitative video game designed by a team of neuroscientists and game developers in the Brain, Learning, Animation, Movement (BLAM!) lab at Johns Hopkins University. Writer Karen Russell explores the game's development and BLAM! leader John Krakauer's thoughts on the relationship between the brain and the motor system.

    A new "virtual physical therapy" system gets FDA approval
    Medical Device and Diagnostic Industry Online looks at Vera, not exactly a game itself but a system that incorporates the Microsoft Kinect platform often used for gaming. Reflxion Health's "Vera" system includes 2-way video connection between patient and PT, as well as an avatar that monitors and evaluates patients' home exercises to facilitate rehabilitation from joint replacement.

    Inc. magazine declares virtual reality "will change physical therapy forever"
    "Recently, with the expansion of medical-related technology, a new type of physical therapy has arisen," Inc. announces in this article. The piece includes links to clinics providing physical therapy via virtual reality as well as to a 2002 article on virtual reality and stroke rehabilitation from APTA's journal Physical Therapy (proving that what's news to Inc. may not necessarily be news to PTs).

    Long-Term Living focuses on gamification
    This brief article explores the trend toward "turning physical therapy into a game," and focuses on the Medical Interactive Recovery Assistant (MIRA) technology developed by TED fellow Cosmin Mihaiu.

    New twists on virtual reality and gaming applications in physical therapy are developing constantly, but the basic concept is a familiar one to readers of PT in Motion, APTA's member magazine. The magazine covered virtual reality in 2012 and 2011, and published a feature article on gamification in physical therapy in 2014.

    Wednesday, November 18, 2015RSS Feed

    PQRS Penalty Letters Require Quick Action From PTs

    Editor's note: This story has been modified to reflect a recent announcement by the Centers for Medicare and Medicaid Services (CMS) that it is extending the deadline to submit review requests until December 16, 2015. (This is an additional extension from that of an earlier CMS announcement, which initially extended the deadline to December 11.)

    If you recently received a Physician Quality Reporting System (PQRS)-related penalty notice from the Centers for Medicare and Medicaid Services (CMS), you're not alone. But you need to take action before December 16, a deadline moved back by CMS from its original November 23 date.

    APTA is aware that some members have received letters related to PQRS performance during 2014. If you believe you have received a penalty notice letter in error, be sure to submit an informal review request through the CMS "QualityNet" website by Friday, December 16.

    CMS has informed APTA that providers have been experiencing problems in reaching QualityNet over the past several days, and says that it's attempting to fix the problem. APTA is also working with CMS to ensure that physical therapists are not unduly penalized for 2014 PQRS performance.

    Questions? Problems with filing an informal review? Contact the APTA advocacy staff.

    Want more on PQRS? A recording of APTA's  recent webinar, "Physical Therapy and PQRS in 2016: How to Report Successfully," will be available in the coming weeks.

    Wednesday, November 18, 2015RSS Feed

    The Good Stuff: Members and the Profession in Local News, November 2015

    "The Good Stuff," is an occasional series that highlights recent, mostly local media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    "Her physical therapist and occupational therapist are working so well with her but they are also great about being able to change pace when Amelia has a mind of her own." – Andie Musial, whose 18-month-old "miracle baby" daughter will celebrate her first Thanksgiving home, thanks to the work of PTs and OTs at the Cleveland Clinic's NICU follow-up clinic. (Fox 8, Cleveland)

    "Perhaps the first physical therapy scene ever in a musical" – Review of "On Your Feet," a new musical biography of Gloria Estefan. (Newsday)

    Karena Wu, PT, discusses the dangers of exercising without a sports bra. (Greatist.com)

    "In late September, Korbin, a 23-year-old physical therapy doctoral candidate at Gannon University in Erie, held the door of life open to someone he has never met and perhaps never will." – Feature story on PT student Korbin Keene's decision to become a bone marrow donor. (Wilkes-Barre, Pennsylvania, Times Leader)

    PT students at the University of South Florida participated in a Commitment to Professionalism ceremony that included remarks from APTA President Sharon Dunn, PT, PhD, OCS. (USF Health newsletter)

    Stephanie Combs Miller, PT, PhD, NCS, discusses a San Diego program that provides boxing training for individuals with Parkinson disease. (San Diego Union-Tribune)

    "It goes beyond just treating your patient's pain … To be able to provide such a service for the community, I think it means a lot." - University of Kentucky PT student Matt Williams on UK PT students' Global PT Day of Service project. (WYMT News, eastern Kentucky)

    Using physical therapy to recover after breast cancer surgery. (video report from KTVQ, Billings, Montana)

    "I hope it also encourages them to make a life career of helping people, not just for the income." – Highland, Illinois, Mayor Joe Michaelis on the scholarship program he created for local students hoping to pursue majors in PT, OT, SLP, or sports medicine. (Belleville, Illinois, News Democrat)

    Mark Kozuki, PT, MA, CSCS, OCS, points out why good balance and a strong core is important for everyone, not just athletes. (Wall Street Journal)

    "Welcome any physical and/or occupational therapy offered, even if it reminds you of what you can no longer do. The endorphins can provide an emotional lift." – Long-term care facility resident Elvin Marmol. (guest blog in Long Term Living magazine)

    "To me, they're miracle workers." – Shirley Zech, physical therapy patient, on the PTs who helped her regain her ability to walk. (Maryville, Missouri Daily Forum)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.