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  • Researchers Find 'Only Positive Effects' From PTs in Primary Care Role

    Get thee to a physical therapist (PT): according to a new study from Sweden, patients seeking primary care for musculoskeletal disorders (MSDs) who are triaged to a PT fare just as well—and in some respects, better—than those who are seen by a physician general practitioner (GP). It's a finding consistent with APTA's own investigations into the PT's role in primary care settings.

    Authors of the study, published in Therapeutic Advances in Musculoskeletal Disease, concede that, at 55 participants, their study was small. But they assert that their findings indicate that directing patients to PTs for primary assessment in primary care results in slightly better patient-reported outcomes related to pain, disability, and health-related quality of life (HRQoL) at follow-up, from 2 weeks to a year after initial visit. "Only positive effects were notable, and no adverse events regarding the triaging process were reported," they write.

    Researchers worked with 3 primary care health centers (PHCCs) in Gothenberg, Sweden, each serving a slightly different socioeconomic population (one serving patients experiencing generally lower socioeconomic conditions; one in a more affluent area; and one serving a more mixed population). PHCCs are the usual route taken by patients in Sweden seeking primary care, where patients are first assessed by a nurse, who determines a treatment pathway—including which provider the patient sees next.

    [Editor's note: want to learn more about how PTs are deepening their footprint in primary care? This 2018 article from PT in Motion magazine explores how the landscape is changing and offers links to APTA resources on issues related to primary care.]

    For the study, it wasn't a question of whether PTs should be delivering primary care—they were already doing that at the 3 participating PHCCs—but of how PT primary care affected outcomes. To make this assessment, researchers worked with nurses to randomly assign patients who normally would be referred to a PT to a control group that received "treatment as usual" (TAU) from a GP. The researchers then compared patient-reported outcomes from the PT and TAU groups at various points.

    Patients participating in the study were "working age" (16-67 years old) individuals seeking help for a new musculoskeletal condition; patients were excluded from the study if they required home visits, were receiving ongoing treatment for the current MSD, were seeking help for a chronic condition unchanged for 3 months or more, or possessed insufficient English or Swedish language skills to complete patient questionnaires.

    Both groups were asked to complete patient questionnaires on pain (0-10 rating scale), disability (Disability Rating Index), HRQoL (EuroQol 5), and risk for developing chronic musculoskeletal pain (Orebro Musculoskeletal Pain Questionnaire). Researchers also sought to determine whether the PT patient group developed different attitudes about responsibility for their MSDs, shifting more of that sense of responsibility to the patient and away from employers and/or medical professionals. Researchers asked patients to complete the questionnaires at initial consultation and 2, 12, 26, and 52 weeks later.

    Analysis revealed that while all patients improved at roughly similar rates, the PT group reported consistently better—albeit just slightly better—outcomes. The exception to that trend was in HRQoL scores, which improved for the PT group over the TAU group by a statistically significant margin.

    As for patient attitudes about responsibility for MSDs, the PT group tended to reduce what authors call "externalization" of the condition to health care providers, but a slight drift to greater externalization focused on employers after 1 year. However, researchers found that the changes in attitudes were slight.

    "This study indicates that early contact with both GPs and [PTs] can reduce the risk for patients developing chronic conditions with subsequent need for more comprehensive treatment," authors write. "As the effects of [PT] treatment were at least as good as TAU, it is clearly feasible to impose management modifications which can free medical competence for other patient groups. It is important to take care of even the group of patients with short-term or low-intensive musculoskeletal conditions to prevent development of chronic disorders."

    The researchers acknowledge that besides the small study population, the project also experienced patient dropout over time—particularly among younger patients in the PT group. Still, they contend, the findings support the role of PTs in primary care.

    "While it cannot be irrevocably concluded that initiation treatment by a [PT] is better for all patients with [MSDs] than [is] medical advice and treatment by a GP, there is nothing to indicate that this triage model for managing patients with [MSDs] in primary care is, in any way, detrimental to the patient health or worse than standard care," they write. "Triaging to [PTs] for primary assessment in primary care seems to lead to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with MSDs."

    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.

    The Good Stuff: Members and the Profession in the Media, March 2019

    "The Good Stuff" is an occasional series that highlights recent 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!

    Grab the popcorn: Lauren Snowdon, PT, DPT, professor in the Seton Hall physical therapy program, served as a clinical consultant for The Upside, the recently released movie starring Bryan Cranston and Kevin Hart. (New Jersey Stage)

    Now hear this: Lisa Muratori, PT, is working with a music professor to create audio software that helps patients with neurological conditions sense gait fluctuations. (Wired)

    Waddle it be? Cara Berg-Carramusa PT, MSPT, has advice for minimizing slips on the ice: "You've got to walk like a penguin." (WKBN27 News, Youngstown, Ohio)

    Post-flight physical therapy: Air Force Capt Anna Adkins PT, DPT, is part of a new program aimed at keeping pilots healthy between missions. (Stars and Stripes)

    Rolling with it: Karena Wu PT, DPT, explains some of the advantages of using a foam roller to address muscle soreness. (Better magazine)

    Let's dance: Michelle Ritter McGuire, PT, helps run an innovative program for the Cincinnati Ballet to bring adaptive dance to children with motor disabilities. (Falmouth, Kentucky, Outlook)

    The PT as DJ: Creighton University physical therapy students Danny McAndrew, SPT, and Kelsey Biaggi, SPT, are helping conduct research on the effect of customized playlists that use songs with specific beats-per-minute to help runners adjust their stride to lessen pain. Creighton professor Terry Grindstaff PT, ATC, PhD, is advising on the project. (KMTV3 News Now, Omaha, Nebraska)

    Making tummy time easier to stomach: Kristy Johnson, SPT, explains why it's important for parents to ensure that their infants spend time on their stomachs—even it's not their favorite thing to do. (KXNET News, Bismarck, North Dakota)

    Triathlete, PT, and mom of 3: Delaine Fowler PT, DPT, describes her approach to training during and after pregnancy. (Salisbury, North Carolina, Post)

    You don't know the calf of it: Nicole Haas PT, DPT, shares her perspective on the importance of calf strength. (Outside)

    Exercise and PD: Michael Braitsch, PT, DPT, outlines the importance of exercise for individuals with Parkinson disease. (Parkinson's News Today)

    Quotable: "If you have been smart enough to get PT after a problem, never second-guess the therapist. If he or she tells you to ice it twice a day, do it. If there is a rehab program assigned for ‘homework,’ follow it as scheduled." – Wina Sturgeon, editor of Adventure Sports Weekly (Bristol, Virginia, Herald Courier)

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

    North Carolina PTs Get Decisive Dry Needling Win

    After a nearly 4-year battle, physical therapists (PTs) in North Carolina can finally claim victory in their fight to protect dry needling: last week, the state's acupuncture licensing board relented on its attempt to restrict the intervention, signing off on a settlement agreement in federal district court that acknowledges dry needling as a part of the PT scope of practice in the state. The settlement is a decisive win for APTA’s state chapter, the North Carolina Physical Therapy Association (NCPTA), as well as for APTA, which provided support for the chapter's efforts.

    The agreement effectively ends a lawsuit brought by 4 PTs and 2 patients against the North Carolina Acupuncture Licensing Board (NCALB) in October 2015. That lawsuit asserted the NCALB's efforts to prevent PTs from engaging in dry needling—efforts that included issuing "cease and desist" letters to PTs who perform dry needling and threats that they would be charged with a Class 1 misdemeanor for violating federal antitrust laws.

    The lawsuit continued in court for the next 3 years, surviving the NCALB's attempts to get the case thrown out. Dry needling was also at issue in a September 2015 suit filed against the state's physical therapy licensing board by the NCALB, which sought to have a county superior court declare that dry needling is outside the scope of PT practice. That suit eventually wound up in the state's Supreme Court, which upheld the lower court's ruling that dry needling was part of PT practice in the state. The agreement reached in the federal case applies to current and future acupuncture boards, and includes a monetary settlement to the plaintiffs.

    "The Acupuncture Board finally yielded to the NCPTA's demands," said NCPTA President J. Kyle Covington, PT, DPT, PhD, in an online statement. "This tremendous victory—including the monetary settlement—sends a powerful message to those would seek to prevent our patients from receiving the treatment they need: no matter how tough the fight, no matter how long it takes, NCPTA will always stand up for our patients' access to care."

    At the national level, APTA assisted the North Carolina Chapter during the fight, as did other APTA components and individual members.

    APTA Director of State Affairs Angela Shuman says the decisive victory is a testament to both the validity of dry needling as a legitimate component of PT practice and the commitment of PTs, the North Carolina Chapter of APTA, and the association as a whole.

    "This is a major win for patients and physical therapists in North Carolina," Shuman said. "But it could not have been achieved without some amazingly hard word by the North Carolina Chapter and its members, and APTA is proud of what they have accomplished."

    New APTA Partnership Aimed at Improving Health Care Throughout the Americas

    APTA will be doing even more to support access to rehabilitative services beyond US borders, thanks to its newest partnership, with the Pan American Health Organization (PAHO), the world's oldest international public health agency.

    PAHO is now a participant in the APTA Partnerships Program, an initiative aimed at enhancing relationships between the association and other organizations that share common goals. APTA's collaboration with PAHO initially will focus on collecting data on what countries in the Americas are doing ensure and improve access to health and rehabilitation services. According to the World Health Organization (WHO), an estimated 150 million people in the western hemisphere live with a disability. Rehabilitation services are extremely limited in many countries across this region.

    Founded in 1902, PAHO works with other entities to promote equity in health and improve the lives of the peoples of the Americas. It serves as the Regional Office of WHO for the Americas and is the specialized health agency of the Inter-American System.

    "APTA has been working to build and strengthen relationships that can be leveraged strategically to benefit health care. We've also been exploring ways to expand our activities related to global health and international development, and to promote to our members the importance of these issues," said APTA CEO Justin Moore, PT, DPT, in an APTA news release. "Our vision to transform society by optimizing movement to improve the human experience is well aligned with PAHO's plan. They are an ideal partner for us."

    PAHO Director Carissa F. Etienne agrees that her organization and APTA are a good collaborative fit and thinks the partnership comes at an opportune time.

    "Rehabilitation is an increasingly important health service for the region, particularly for older populations and those who have experienced an injury or noncommunicable disease or for many with long- or short-term impairments," Etienne said. "This is an important partnership for PAHO as we look to strengthen rehabilitation services in the Americas."

    Other partners in the APTA Partnership Program include the American Academy of Manual Physical Therapy, the American College of Sports Medicine, the Federation of State Boards of Physical Therapy, Move Together, Special Olympics, and the US Department of Veterans Affairs.

    Researchers: Aquatic Exercise Offers Similar Results With Less Pain for Patients With Chronic LBP

    Aquatic exercise, a common physical therapist intervention for patients with chronic low back pain (CLBP), shouldn't be viewed as "less strenuous or less effective" than land-based exercise, according to authors of a recent study in PTJ (Physical Therapy). In fact, they write, water-based exercise can be beneficial for people whose movement is limited by pain.

    Researchers recruited 40 men aged 18 to 45 with a healthy body mass index. Half of participants had experienced CLBP for greater than 12 weeks; the control group experienced no back pain. Both groups performed 15 aquatic exercises and 15 land-based exercises with movement patterns similar to the aquatic exercises. Fourteen of the exercises included upper extremity dynamic movements, and 16 focused on the lower extremities.

    The authors measured heart rate, rate of perceived exertion, and pain. They also used video motion analysis and wireless, waterproof EMG sensors to measure bilateral activation of the erector spinae, multifidus, gluteus maximus, gluteus medius, rectus abdominis, external oblique, and internal oblique muscles.

    Among their findings:

    There were few significant differences between the CLBP and control groups. Heart rate (HR), rate of perceived exertion (RPE), pain, and muscle activation for both land and water-based exercises were similar for both groups. Patients with CLBP had greater mean left erector spinae activations in one exercise and higher RPE in another.

    Differences were seen when comparing results for exercises performed in water versus land. Muscle activation was greater on land in 29% of cases and in water in 5% of cases. Heart rate was higher on land with all exercises, but RPE was not consistently higher or lower in either environment.

    Pain was reported more than twice as frequently when subjects exercised on land. However, pain levels were generally low in both environments.

    While the study was small, and the researchers say it was the first to examine this data set for aquatic exercises, the fact that results were similar for both groups suggested to them that "exercising in the water can be beneficial for rehabilitation and strengthening by allowing people with CLBP to perform the exercises and activate muscles without their condition adversely affecting them."

    [Editor's note: interested in aquatic physical therapy? Check out the APTA Academy of Aquatic Physical Therapy.]

    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.

    Your Help Needed to Guide Movement System Integration

    APTA is leading the way in advancing the integration of the movement system as the core of physical therapist (PT) practice, education, and research. Now the association needs input from you to take an important next step: making the crucial leap from the conceptual to the practical through the development of a movement system diagnosis framework and movement screen.

    Draft diagnosis and screening templates have been created by the Movement System task force and work groups, and APTA would like you to take them for a test drive and provide your comments by the June 1, 2019, deadline.

    "We're at an exciting point in the evolution of the movement system concept and now need the widest possible stakeholder input," said Sue Whitney, PT, PhD, APTA Board of Directors member and chair of the Movement System Task Force. "Many PTs have been incorporating movement system concepts into their practice and teaching for some time now, but the development of these diagnosis and screening resources has the potential to accelerate the adoption of these concepts across the profession. That's why participation in the review and comment process is so critical—with the development of a repository of movement system diagnoses and the development of the screening templates, we hope to move the bar and create excitement about using the movement system in daily practice."

    Evaluation of each template involves a 2-step process. For the diagnosis template, reviewers are asked to submit an example of a movement system diagnosis using a specially developed online form, and then provide feedback about the template itself. The movement screen—a tool that helps PTs identify patient movement impairments observed during functional tasks and activities so that they can pinpoint which additional tests and measures should be brought into play—doesn't need to be filled out, just reviewed and evaluated through an accompanying survey. Click here to view the templates and provide your feedback.

    Work toward the development of the movement system concept in the physical therapy profession began in 2013, when APTA adopted a new vision statement with guiding principles that characterized the system as "the foundation of optimizing movement to improve the health of society." The association produced a white paper on the movement system in 2015 and held a Movement System Summit in 2016 that brought together 100 thought leaders to discuss how best to integrate the system throughout all facets of the profession. Since then, members of APTA’s Movement System Task Force have been developing resources to make widespread integration a reality.

    Want to learn more about the movement system? Visit APTA's Movement System webpage for a history of the association's work.

    Education Leadership Partnership Looks Back On a Productive Year

    When the purpose of a group is nothing less than "partnering to drive excellence in physical therapy education," you have every reason to expect that group to be doing, well…a lot of stuff. The 2018 annual report of the entities collectively known as the Education Leadership Partnership (ELP)—APTA, the American Council of Academic Physical Therapy (ACAPT), and the Academy of Physical Therapy Education (APTE)—shows how the group has been living up to that expectation while maintaining focus on important core values.

    The annual report recaps an important year for the collaborative group, documenting a year in which the partners took action on key initiatives around education research, including the approval of an educational research agenda, cosponsorship (with the Association of American Medical Colleges) of 2 medical education research certificate workshops (aka "MERCs"), the creation of an education research network, and the first-ever Grantsmanship and Mentorship in Education Research (aka "GAMER") workshop to help education researchers refine their abilities to secure grant funding.

    Education research wasn't the partnership's only area of focus, however. In 2018, the partners also held stakeholder meetings to develop action plans on clinical education, developed a framework to capture data related to physical therapist education, and provided a webinar and article, published in PTJ (Physical Therapy) on entrustable professional activities. Partnership members also formed a task force to address physical therapy program student debt.

    "It's been a busy year for the ELP," said Steven Chesbro, PT, DPT, EdD, APTA vice president of education, who helps to provide staff support to the partnership. "Progress in multiple areas is happening at a quick pace. The annual report provides a good snapshot of 2018, but we intend to keep stakeholders informed on an ongoing basis through the various partners' newsletters and other means—not only to maintain transparency, but to encourage as much participation as possible when ELP partners reach out for feedback."

    ELP comprises representatives from the 3 founding member organizations as well as ex-officio nonvoting members representing the American Board of Physical Therapy Residency and Fellowship Education, the American Board of Physical Therapy Specialties, the Commission on Accreditation in Physical Therapy Education, and the Federation of State Boards of Physical Therapy. Representatives from various areas of the clinical community—private practice, veterans, acute care, and health systems—also participate in the partnership.

    Want more information on the ELP, its history, and resources as they develop? Check out APTA's ELP webpage .

    CMS Promotes More Access to Nondrug Pain Management in Medicaid

    Could states be doing more to increase access to nonopioid and nonpharmacological approaches to management of chronic pain under Medicaid? The US Centers for Medicare and Medicaid Services (CMS) thinks so, and has issued guidance that outlines options and shares examples of some states' promising initiatives. The approaches are largely consistent with APTA's #ChoosePT opioid awareness campaign, which emphasizes the importance of patient access and choice in the treatment of pain.

    The CMS information bulletin released in late February is anchored in the US Centers for Disease Control and Prevention's (CDC) guidelines for prescribing opioids for chronic pain, published in 2016. Those guidelines, which recommend nonopioid approaches including physical therapy as the preferred first-line treatment for noncancer chronic pain, have been increasingly acknowledged and adopted by state health care entities, and early reports are positive, according to CMS. The new CMS document is designed to help states understand possible avenues for incorporating programs that help support the CDC guidelines.

    In outlining possibilities that could allow for the use of nonpharmacological approaches to chronic pain, CMS offers states a wide palette of mandatory and optional benefits, from more effective use of inpatient, outpatient, and health center services to expanded coverage for rehabilitative, physical therapy, and preventive services. The bulletin also offers home health benefits, special "demonstration" projects, and potential waivers as ways states could take creative steps to strengthen their nondrug offerings.

    CMS also offers examples of states that have changed or extended their Medicaid coverage options, including Oregon, which expanded its list of Medicaid-covered services for uncomplicated back and neck pain to include physical therapy, cognitive behavioral therapy, and other services; and California, where a 14-county Medicaid program implemented an intensive prescriber education program on nonopioid options for pain management.

    APTA has been engaged in the fight against opioid misuse in multiple ways. In addition to its flagship #ChoosePT opioid awareness campaign, the association has produced a white paper on reducing opioid use and contributed to the National Quality Partners Playbook on Opioid Stewardship. On the advocacy front, APTA continues to meet with legislators and agency representatives to address the opioid crisis, and comments on a range of topics, including a federal Pain Management Best Practices Inter-Agency Task Force draft report. Additionally, a recent formal partnership between APTA and the Department of Veterans Affairs includes collaboration to promote veterans' access to nopharmacologic approaches to pain management.

    "Providers and beneficiaries need access to effective therapy for chronic pain," CMS writes. "A multidisciplinary approach…that incorporates nonopioid pharmacologic and nonpharmacologic therapies, well-communicated treatment goals and expectations, and a careful consideration of the benefits and risks of available treatment options is the most appropriate approach for most patients and has the potential to lead to more appropriate prescribing of opioids."

    From PT in Motion Magazine: Health 'Consumerism' Is Changing How PTs Think About Care

    Call it the Amazonification of society, or a signifier of the shift toward "value-based" models, or simply a logical response to the pressure of ever-growing insurance deductibles and copays, but one thing's for certain: patients are increasingly extending their consumer savvy to choosing health care providers—and that includes physical therapists (PTs).

    In its March issue, PT in Motion magazine offers a primer on what's known as the "consumerism movement" in health care. The article explores how some PTs are responding to an environment in which patients take a more active role in selecting a provider and making informed choices about pathways of care.

    The movement is associated with the rise of online provider rating systems, but it's broader than that—according to author Chris Hayhurst, it's a mindset in which "would-be patients are the drivers of change, leveraging the power of their limited health care budgets to push providers to better meet their needs." And if they're not happy with the result? You (and anyone else with Internet access and a smart phone) will hear about it.

    In addition to providing the fundamental concepts behind health care consumerism, "PTs and the Consumerism Movement" also shows how some PTs are recognizing the new realities and making changes to their practices to stay competitive.

    Kathryn Stenslie, PT, DPT, one of the PTs interviewed for the article, puts it bluntly. "The fact is, people are shopping around for care," she says. "And as much as we PTs don't like to think about it, not every practice is equal."

    Stenslie and other PTs featured in the piece offer up multiple examples of changes they've made to improve patient satisfaction—everything from routinely walking patients to their cars to offering Saturday hours and more extensive home-exercise regimens to keep clinic visits (and copay totals) as low as possible. The PTs interviewed agree that while the changes can require that more effort be applied to developing team approaches and dedicating more time to discussing patient expectations and treatment options, the payoffs can be significant.

    And those payoff aren't just limited to business results. Janet Bezner, PT, DPT, PhD, FAPTA, a professor in the Department of Physical Therapy at Texas State University, says the changes can help promote what she sees as a much-needed evolution in the way society approaches health care in general.

    "The idea that I don't have to blindly take what my health care provider tells me and just do it is part of the notion that 'I'm in charge of my own health,'" Bezner says in the article. "It's the idea that I, the patient, know what's best for me. I may appreciate you, the health care provider, telling me what my choices are, and explaining them to me. But in the end, I'm the one who gets to decide."

    "PTs and the Consumerism Movement" is featured in the March issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Also don’t miss the issue’s other articles that cover the use of hippotherapy in PT interventions, perspectives from PTs who have disabilities, a look at CPT codes beyond the 97000 series, a PT who continues “rescuing” people after retiring from military service, and an ethics scenario around responding to a critical online review.

    Large-Scale Investigation: Falls-Prevention Exercise Interventions Work

    An extensive review of more than 100 randomized controlled trials (RCTs) strongly supports exercise interventions as a way to reduce both the risk of falls among adults 65 and older and the actual number of those who experience a fall. What's less clear are some of the nuances of that finding—such as the effectiveness of resistance training or walking programs, and the differences between interventions provided by "health professionals" versus "trained providers who were not health professionals."

    The recently published Cochrane systematic review (abstract only available for free) focused on 108 RCTs involving 23,407 community-dwelling adults in 25 countries. Participants were an average age of 76, and 77% were women. The majority of participants lived in the community, and RCTs that focused on participants with conditions that increased the risk of falls—Parkinson disease, stroke, multiple sclerosis, dementia, hip fracture, and severe visual impairment—were excluded.

    The Cochrane reviewers analyzed various categories of exercise interventions versus control, which consisted of either no change in usual activities or an intervention not anticipated to reduce falls, such as health education, social visits, "gentle" exercises, or sham exercises. The exercise interventions were categorized as balance and functional; resistance; flexibility training; "3D" exercise including Tai Chi and Qigong; "3D" dance-based exercise; walking programs; endurance; "other"; and exercise interventions that included more than 1 of the studied categories.

    Among the findings:

    • Overall, exercise reduces the rate of falls by 23% compared with control—but this difference doesn't seem to apply to individuals 75 or older.
    • In terms of risk, authors found that, overall, individuals who received an exercise intervention from a trained health care professional had a 31% lower risk of falls compared with controls, while participants who received the intervention from providers who weren’t trained health care professionals had an 18% lower risk compared with control. Interestingly the differences between the trained and not-trained provider rates weren't present when researchers looked at individual programs that combined 2 or more exercise interventions.
    • Overall, risk reduction was about the same for exercise interventions that were provided individually (21% risk reduction) versus in a group setting (24% risk reduction).
    • In terms of specific types of exercise, the interventions researchers defined as focusing primarily on gait, balance, coordination, or functional task training were found to reduce falls by 24%. Tai Chi/Qigong was estimated to reduce falls by 19%, and a combination of 2 or more interventions was estimated to reduce falls by 34%. Studies on resistance training, danced-based exercise, and walking programs alone versus control didn't yield strong enough evidence to support a definitive conclusion.
    • While a combination of interventions produced an overall reduction of 34%, authors found that when the most common combination—balance/functional exercises and resistance training—was looked at separately, the reduction rate remained nearly the same (31%).
    • Balance and functional exercise interventions reported the best results in terms of reducing the long-term risk of falls (18 months or more post-intervention), with a reported 18% reduction versus control.
    • Overall, exercise interventions were found to reduce the risk of later fall-related fractures by 27% and lower the risk of falls that require medical attention by 39%.

    While they acknowledge that there wasn't enough evidence for reviewers to look at the differences in exercise modality or doses, authors note that "there may also be longer-term benefits of introducing fall prevention exercise habits in people in the general community." They point out that most of the studies reviewed focused on programs that lasted 12 weeks or more, with nearly a third lasting a year or more. "These findings highlight the importance of primary prevention," they write.

    Even with the definitive conclusion on the overall effectiveness of exercise in falls prevention, authors of the review believe more work should be done to tease out the impact of various exercise programs, though they advise that the studies will need to be "very large." They also recommend further research into fall prevention programs in emerging economies "where the burden of falls is increasing more rapidly than in high-income countries," and the need to investigate how best to integrate falls prevention interventions into routine care of individuals 65 and older.

    Even with those gaps in evidence, "there is high-certainty evidence that falls can be prevented by exercise programs," authors write. "Exercise reduces both the rate of falls…and the number of people experiencing falls."

    APTA provides extensive resources on falls prevention at its Balance and Falls webpage. Offerings include consumer-focused information, online courses, and links to other sources of information, including the CDC and the National Council on Aging. In addition, APTA's PTNow evidence-based practice resource offers a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. The association's scientific journal, PTJ (Physical Therapy) has published a clinical guidance statement from the APTA Academy of Geriatric Physical Therapy on management of falls in community-dwelling older adults.

    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.

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