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  • US Receives Failing Grades on Walking and Walkability

    Ask any kid: you know you're in trouble when the high point on your report card is a C among 2 Ds, 5 Fs, and an "incomplete." That's precisely the spot the US is in when it comes to walking and walkable communities, according to a recently released report card from the National Physical Activity Plan Alliance (NPAPA). APTA is an alliance partner.

    Released this fall, the Walking and Walkable Communities Report Card reflects the NPAPA's assessment of “the extent to which the US population and US communities meet selected standards for participating in walking and providing physical and social supports for behavior." The NPAPA used a similar approach in 2014 when it released a report card on physical activity across the country that reflected an overall 1.5 GPA. Like the earlier report card, the results this time around aren’t honor roll material.

    The best the country could muster, according to the alliance, was a “C” for “adult walking behavior”—the number of adults who report walking on a regular basis for work, recreation, or planned exercise. Assessors were looking for the percent of adults who reported walking for 10 minutes or more at least once in the preceding week: the 63.9% of respondents who reported meeting that mark earned the US its highest grade. The narrative that accompanies the report card points out that walking prevalence has not increased much between 2010 and 2015, though women did experience a 2.6% rise during that time.

    It was all downhill from there.

    In the areas of “pedestrian policies” and “walkable neighborhoods,” the alliance gave the US a D grade for each. Pedestrian policies fall short, says the alliance, because communities aren’t doing enough to support a “complete streets” model that ensures streets are built to support all forms of transportation, not just automobiles. The low grade for walkable neighborhoods reflects the fact that only 16 states report that 30% or more of residents live in a highly walkable neighborhood.

    But the most prevalent grades, by far, were Fs, with 5 failing grades issued by the alliance. According to the report card, the US earned Fs on children and youth walking behavior, pedestrian infrastructure, safety, institutional policies, and public transportation. A grade of “incomplete” was assigned to walking programs because there is no system in place that monitors the prevalence of those programs across the US, according to the alliance.

    Dianne Jewell, PT, DPT, PhD, who served on the advisory panel for the report card, says the report card should be understood more as a way to encourage serious dialogue and advocacy for walking and community walkability, and less a hard-nosed assessment.

    “These grades should be viewed thoughtfully,” Jewell said. “I see them as flares indicating serious potential hazards ahead if we don’t address the issues in each domain, rather than as absolute indicators of performance.”

    "We now have a consolidated baseline picture of our successes and challenges in supporting walking and walkability, and we now can measure change over time,” Jewell added. “There are important lessons underneath those grades, including data on differences in walking behavior by age, gender, and ethnicity, as well as some examples of state-level successes in some of the walkability domains.”

    Jewell has since stepped down from the NPAPA. These days, Chris Hinze, PT, DPT, serves as APTA’s representative to the group.

    Like Jewell, Hinze believes that the report card points to the need for societal change. And he thinks physical therapists (PTs) and physical therapist assistants (PTAs) can play an important role in making that change happen.

    “With their expertise in human movement, PTs, PTAs, and students can and should be key voices in this discussion,” Hinze said. “First, PTs and PTAs should educate themselves on social determinants of health—specifically, how the built environment influences health and health-related behaviors. Then they should consider becoming advocates for policies and infrastructure that encourage active transportation in their communities.” Hinze points to a comprehensive set of strategies and tactics developed by NPAPA that can help inform and guide PTs and PTAs in this work.

    For both Hinze and Jewell, the bottom line is clear: things need to change, and soon.

    “For decades, communities have largely been designed around the automobile, with human movement an afterthought—this needs to change,” Hinze said. “Cities and communities need to be intentional with their policies, planning, and design to make active transportation a safe and convenient choice for moving about."

    “If we can’t even meet the minimum threshold of safety, then efforts in other areas will ultimately be limited,” Jewell said. “Common sense says injury or fatality while walking or cycling should be socially unacceptable without the need for debate, yet we still favor policies and infrastructures designed for motorized vehicles moving at speed with a minimum of interference. Until that perspective changes, I think we will only see small, incremental improvements in many of these grades.”

    Want to learn more about the NPAP and the work of the NPAPA? Check out this video, and read the entire National Physical Activity Plan , a revised roadmap for community-level change.

    APTA Expands Efforts to Address the Opioid Crisis

    The country’s response to the national opioid crisis is evolving: President Trump announced that he will soon declare opioid abuse a national emergency; cities are lining up to sue pharmaceutical companies; and state attorneys general are pressing insurance companies to better support nondrug approaches to pain treatment.

    Meanwhile, APTA has been bringing the physical therapy profession’s voice and perspective to the national dialogue on how best to reshape the health care system’s approach to pain treatment and management.

    The association has been active in responding to opioid abuse since 2015, when APTA was invited to join a White House initiative under then-President Barack Obama. In 2016, APTA launched the #ChoosePT opioid awareness campaign, a high-visibility effort that was championed by individual members and state chapters, and received both state and national recognition.

    So what’s APTA been up to since then? A lot.

    We were at the table for the first-ever Integrative Pain Care Policy Congress.
    Sponsored by the Academy of Integrative Pain Management (AIPM), this recent event brought together representatives from organizations including APTA, the American Pharmacists Society, the American Osteopathic Association, BeaconHealth, Kaiser Permanente, the National Association of Social Workers, the American Cancer Society, and Aetna for discussions and presentations on how to best address conflicting pain care guidelines.

    APTA Director of Regulatory Affairs Kara Gainer, JD, represented the association, participating in a panel discussion on how to strengthen state-level policy on integrative pain management.

    We’re helping to draft a national playbook on opioid prescribing and effective pain management.
    The association is working with 40 other organizations as the Opioid Stewardship Action Team, a group assembled by the National Quality Forum (NQF), a health care research and advocacy group. APTA is a member of NQF.

    According to NQF, the goal of the team is to work on “strategies and tactics to support appropriate opioid prescribing practices and more effective pain management, particularly for individuals with chronic pain and those at risk of dependence and addiction.” That work will result in a “playbook” in March 2018 that NQF hopes will help to establish a more cohesive approach to pain management. In addition to APTA, task force participants include representatives from the US Centers for Disease Control and Prevention (CDC), the American Nurses Association, Kaiser Permanente, the US Centers for Medicare and Medicaid Services, Magellan Health, the American Society of Health System Pharmacists, and the Substance Abuse and Mental Health Services Administration. Alice Bell, PT, DPT, an APTA senior payment specialist, is representing the association on the task force.

    We’re keeping members in the loop, adding to evidence-based resources for pain management, and planning for next steps in advocacy.
    Policy-based approaches to the opioid crisis were front-and-center at the most recent APTA State Policy and Payment Forum in September, which featured a presentation by representatives from the National Journal. APTA also is thinking about the future and is working through its Public Policy and Advocacy Committee to develop a roadmap for where the association can have the biggest impact on policy.

    At the same time, APTA continues to add resources to put physical therapists in touch with the best evidence on pain assessment, treatment, and management through PTNow. The association is engaged in activities related to reviewing and developing CPGs, including reviewing CPGs related to opioid therapy for chronic pain from external groups and supporting the Education Section and Orthopaedic Section of APTA in the development of a CPG focusing on patient education and counseling for the management of chronic pain.

    APTA members have been awarded federal research grants to study pain treatment.
    The US Departments of Defense, Health and Human Services, and Veterans Affairs have created an interagency partnership that aims to focus on research related to nondrug approaches to pain treatment for military and veteran personnel. The partnership’s first order of business: providing grant awards to fund research projects. APTA members Julie Fritz, PT, PhD, FAPTA, and Steven George, PT, PhD, each were named as recipients in the first round of grants.

    According to a press release from the partnership, Fritz will research a “stepped care” approach to the treatment of low back pain. George will conduct a planning and demonstration project to improve access to nondrug therapies for low back pain through the Department of Veteran’s Affairs health care system.

    #ChoosePT continues to gain momentum.
    The video supporting the #ChoosePT campaign is still making the rounds nationally, while, more recently, #ChoosePT ads are appearing on national news websites during October. Additionally, the campaign toolkit was updated with several new graphics and resources—including the opportunity to purchase #ChoosePT t shirts at cost.

    The campaign also has advanced through the efforts of members. Most recently, APTA collaborated with student volunteers in New York to bring the #ChoosePT message to the Today Show in September and Good Morning America in October.

    We’re reaching out to other stakeholders.
    Over the past year, APTA staff and representatives have met with representatives from the Food and Drug Administration, the Department of Veterans Affairs, the Health Resources and Services Administration, CDC, and several other agencies and groups to discuss the importance of patient access to nondrug approaches to pain. Coming up: meetings with the Indian Health Service and the Administration for Community Living.

    APTA President Sharon Dunn, PT, PhD, believes there’s good reason for the association’s multifaceted approach to the issue.

    "We need to change the culture around pain management in this country—that’s going to require raising public awareness through efforts such as the #ChoosePT campaign, but it’s also important that individuals and organizations throughout the health care space are actively engaged in working to enhance understanding of safe and effective pain management through interdisciplinary care,” Dunn said. “It’s important that APTA and the physical therapy profession participate in these efforts because we bring a unique perspective to the conversation.”