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  • Advocacy Forum, Upgraded App: Get This Year's Efforts Off to a Strong Start

    Ready for some physical therapy advocacy? Because advocacy's ready for you.

    APTA's 2016 advocacy efforts are up and running, with plenty of opportunities for members to participate in person or by way of their handheld device of choice.

    This year's Federal Advocacy Forum is scheduled for April 3-5 at the Grand Hyatt in Washington, DC. It's your opportunity to make the physical therapy profession's voice heard loud and clear on Capitol Hill, and to network with other professionals who share your commitment.

    With the sustainable growth rate gone from the Medicare physician fee schedule, APTA government affairs staff see opportunities to focus on other important issues that deserve attention and action.

    Registration and information on housing is available at the APTA Federal Advocacy Forum webpage. Special room rates are available until March 11, and CEUs are available for the event.

    Whether or not you can make it to DC this April, you can still participate in professional advocacy through the APTA Action App, the grassroots tool that makes it easy to stay on top of issues and influence state and federal decision-makers.

    The upgraded app is even more powerful than before, and now includes state government affairs information for a growing list of states—29 and counting. Available for free, the app includes an action center to contact lawmakers in Congress and in the state legislatures, Congressional and state directories, talking points, and more.

    If you don't have it, get it. If you downloaded the app earlier, be sure to get the update. The APTA Action App is available in the Apple and Google Play app stores.

    2016 - 01 - 27 - Advocacy App

    Physical Therapy 'Ineffective' for PD? Headlines Overstate Study's Conclusions

    A recent study from England involving physical therapy, occupational therapy, and individuals with Parkinson Disease (PD) has generated plenty of dramatic headlines about physical therapy's supposed "ineffectiveness." But as is often the case with dramatic headlines, there's more to the story.

    The study in question, published in JAMA Neurology (abstract only available for free), aimed to evaluate the clinical effectiveness of individualized physical and occupational therapy for individuals with PD by comparing outcomes at baseline and 3 months among 381 participants who received treatment with an equally sized control group that didn't.

    Researchers found little to no difference in outcomes primarily based on the Nottingham Extended Activities of Daily Living (NEADL) scale, and secondarily based on the Parkinson Disease Questionnaire-39 and the EruoQol-5D, writing that "physiotherapy and occupational therapy were not associated with immediate or medium-term clinical improvements in [activities of daily living] or quality of life in mild to moderate PD."

    Headlines ensued. "Parkinson's patients may not benefit from physical therapy," wrote United Press International. "Physical, Occupational Therapy Ineffective in Parkinson," was how Medscape framed the study. "Millions of pounds wasted providing physiotherapy for Parkinson's say researchers," was the headline at the UK newspaper The Telegraph. Several other news outlets took a similar approach.

    While dramatic, the headlines may be off the mark. According to researcher and physical therapy professor Theresa Ellis, PT, PhD, NCS, the study may have more to say about a particular intervention model used in England than it does about the effectiveness of physical therapy on individuals with PD.

    Ellis identifies several issues that may not make the study suitable for generalization. Among them: a low dosage of physical therapy (median number of physical therapy sessions received was 4, meaning that half of all treatment participants received fewer than 4 sessions); widely variable expertise among the physical therapists (PTs) delivering services; the use of 38 different sites for interventions; a wide range of severity among participants; the use of an outcome measure (NEADL) that has not been validated for use in PD; and little attention paid to participants' follow-through, particularly in relation to any homework assigned. "Essentially, most participants had 1 to 2 therapy sessions followed by nothing over 15 months," Ellis said.

    "The very low dose of therapy—below what is typically provided in the US—and the absence of an ongoing home exercise program contribute substantially to the lack of improvement observed," Ellis said. "Other studies in Parkinson, in which larger doses of physical therapy were provided, reveal improvements in walking, functional mobility, and balance."

    Authors of the study admit that the number of sessions was relatively low, but argue that the dosage reflects common practice in England, and that other studies that incorporated more sessions yielded results similar to theirs. Still, they were careful to limit their conclusions only to the effectiveness of low-dose physical and occupational therapy that uses "an individual goal-setting approach" on patients with mild-to-moderate PD, and then only to short and medium-term benefits in activities of daily living or quality of life.

    According to Ellis, even those more narrow conclusions may be questioned. For Ellis, 1 potential problem is the fact that about a third of the patients in the study were in the more severe stages of PD. Another issue: among the mild-to-moderate group, "a substantial number scored at the upper limits of their measure [at baseline], making it impossible to show any progress in these participants," Ellis said.

    While authors of the study hold to their conclusions about the effectiveness of low-dose physical and occupational therapy for individuals with mild-to-moderate PD, they acknowledge that more research is needed—particularly around "the development and testing of more structured … therapy programs in patients with all stages of PD"—the kind of nuance that apparently isn't the stuff of headlines.

    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.