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  • ACP Position Paper: Imaging for Uncomplicated Low Back Pain a 'Low-value' Service

    Public and private payers are widely using performance measures to assess the use of low-value interventions, such as imaging for patients with uncomplicated low back pain, and using the results for public reporting and pay-for-performance, say authors of a position paper written on behalf of the American College of Physicians Performance Measurement Committee and published October 30 in Annuals of Internal Medicine.

    The paper gives an overview of performance measures that target low-value services in order to help physicians understand the strengths and limitations of these measures, provides specific examples of measures that assess the use of low-value services, and discusses how these measures can be used in clinical practice and policy.

    The discussion includes 2 categories of low-value  interventions: (1) those for which the harms probably exceed the benefits (eg, performing colorectal cancer screening for patients older than age 85 years) and (2) those that may provide benefits but for which a quantitative assessment of their benefits and costs by a multistakeholder group (patients, clinicians, and policymakers) suggests that the tradeoff between health benefits and expenditures is undesirable (eg, screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease).

    "Ideally, performance measures should be based on rigorous study designs (for example, randomized controlled trials) that assessed the benefits, risks, and costs of interventions," say the authors. However, to develop performance measures for low-value services, they suggest that researchers "will probably need to use data from different types of research design and methods, including subgroup analyses from clinical trials, cohort studies, cost–benefit analyses, and cost-effectiveness analyses."

    "Just as with other performance measures, those for low-value services can be used in a variety of ways to improve quality and health care value," they add. 

    Read more about the American College of Physicians' (ACP) high-value care initiative that aims to help physicians and patients understand the benefits, harms, and costs of interventions, and determine whether services provide good value. Go to the February 2011 issue of Annuals of Internal Medicine for free full text of ACP's clinical guideline for diagnostic imaging for patients with low back pain. The guideline calls for diagnostic imaging only if patients have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. 

    Obesity Presentation Available From Osteoarthritis Action Alliance

    The Osteoarthritis Action Alliance (OAAA) recently posted a recording of its October 17 "lunch and learn" event titled Energy Balance and the Obesity Epidemic. This 30-minute presentation by weight control and obesity expert Steven Blair, PED, FACSM, offers some possible explanations about the causes of the US obesity epidemic. Blair discusses some of his research on this issue, including his energy balance study, which revealed critical information about the relationship between diet, weight, and energy expenditure. 

    APTA is a member of OAAA.

    Patients With COPD at Increased Risk of Carotid Artery Plaque Formation

    New research from the Netherlands shows that older patients with chronic obstructive pulmonary disease (COPD) are at increased risk for carotid artery plaque formation and for the presence of vulnerable plaques with a lipid core, according to the American Thoracic Society

    The cross-sectional study, part of the Rotterdam Study, an ongoing population-based cohort study examining the occurrence of and risk factors for chronic diseases in subjects aged 55 years and older, involved 253 patients with COPD and 920 patients without the condition. COPD was confirmed by spirometry. Participations with carotid wall thickening (intima-media thickness ≥ 2.5 mm) on ultrasonography underwent high-resolution MRI to characterize carotid plaques.

    Participants with COPD had a twofold increased risk of carotid wall thickening on ultrasonography compared with controls. This risk increased significantly with the severity of airflow limitation. On MRI, vulnerable lipid core plaques were significantly more frequent in participants with COPD compared with those without COPD.

    "Clinicians should be aware that COPD patients are at increased risk for asymptomatic carotid atherosclerosis and that COPD might lead to vulnerable plaques by inducing or aggravating the presence of plaques with a lipid core," said researcher Bruno H.C. Stricker, MD, PhD.

     "Understanding the underlying risk factors for stroke in COPD patients can help identify those at high risk and lead to the development of more personalized preventive treatment strategies targeting this devastating complication," he added.

    The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

    Foundation of Haitian Rehabilitation Seeks Volunteers

    The Foundation of Haitian Rehabilitation (FONHARE) is a grassroots Haitian organization providing rehabilitation services to the citizens of Ouanaminthe. It is the only organization providing rehab services in the northeast of Haiti to 13 cities with almost 500,000 citizens. Ivens Louius, the founder and director, is a physical therapist and an occupational therapist. FONHARE currently is providing services in a medical clinic owned and run by Louius's  brother, who is a physician. A foundation has been laid for a large onsite rehabilitation clinic adjacent to the medical clinic. There is a genuine need for volunteers to be part of establishing rehabilitation and physical therapy as a specialized service in a country that had virtually none before the 2010 earthquake. For more information about volunteer opportunities, as well as opportunities to provide financial support, visit FONHARE at www.fonhare.org.   

    New in the Literature: Exercise and Manual Therapy for Hip OA (Arch Phys Med Rehabil. 2012 Oct 16. [Epub ahead of print])

    Self-reported function, hip range of motion (HROM), and patient-perceived improvement occurred after an 8-week program of exercise therapy (ET) for patients with hip osteoarthritis (OA), say authors of an article published in Archives of Physical Medicine and Rehabilitation. Manual therapy (MT) as an adjunct provided no further benefit, except for achieving higher patient satisfaction, they add.

    For this investigation, 131 patients with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants in Dublin, Ireland, were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and wait-list control (n=43).

    Participants in both ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either the ET or ET+MT group after the 9 week follow-up. Their data were pooled with original treatment group data—ET (n=66) and ET+MT (n=65).

    The primary outcome was the WOMAC physical function (PF) subscale. Secondary outcomes included physical performance, pain, HROM, anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction.

    There was no significant difference in WOMAC PF between ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference 0.09) or at 18 weeks (mean difference 0.42), or other outcomes, except "patient satisfaction with outcome," which was higher in the ET+MT group. Improvements in WOMAC, HROM, and patient-perceived change occurred in both treatment groups compared with the control group.

    APTA Launches Online Managed Care Contracting Toolkit

    Physical therapists (PTs) should consider a number of details before contracting with payers, whether private or public. View APTA's new Managed Care Contracting Toolkit today to learn valuable information about joining a managed care plan, and securing and tracking contracts. A chapter on "doing the math" can help you decide which fee schedules, patient populations, and payment methodologies are best suited to your practice. The toolkit also breaks down the pros and cons of common methodologies that third-party payers use to pay for physical therapy services and offers information on negotiating contracts.   

    APTA's Payment and Practice Management Department created the member-only toolkit to help PTs make informed decisions about joining a provider network.

    Clinical Practice Guidelines Not Meeting IOM Standards

    An analysis of clinical practice guidelines archived on the National Guideline Clearinghouse (NGC) website as of June 2011 demonstrated poor compliance with Institute of Medicine (IOM) standards, with little if any improvement over the past 2 decades, say authors of an article published this month in Archives of Medicine

    For the study, 2 reviewers independently screened 130 guidelines selected at random from NGC's website for compliance with 18 of 25 IOM standards.

    The overall median number of IOM standards satisfied (out of 18) was 8 (44.4%). Fewer than half of the guidelines surveyed met more than 50% of IOM standards. Barely a third of the guidelines produced by subspecialty societies satisfied more than 50% of the IOM standards surveyed.

    Information on conflicts of interest was given in fewer than half of the guidelines surveyed. Non-English literature, unpublished data, and/or abstracts were rarely considered in developing guidelines. Differences of opinion among committee members generally were not aired in guidelines. Benefits of recommendations were enumerated more often than potential harms. Guidelines published from 2006 through 2011 varied little with regard to average number of IOM standards satisfied.

    "Everybody everywhere is developing guidelines and there is no real quality control," lead author Philip A. Mackowiak, MD, told Reuters News. "There is no good oversight of who actually develops the guidelines or what criteria need to be met in order for them to be published."

    IOM's standards were not published until 2011. Mackowiak acknowledges that the experts who developed the guidelines reviewed by his team would not have been able to use IOM's standards.  However, he added that similar standards have been published before and that they were basic enough that they should have been followed, says Reuters.

    How Are You Celebrating National Physical Therapy Month?

    E-mail photos and brief descriptions of your events to public-relations@apta.org and we will consider them for our NPTM Celebrations webpage.

    Nominate a Deserving Member for APTA's 'Fit After 50' Member Challenge

    Nominate a deserving APTA member who is 50 years or older, committed to being active and fit, and encourages others to be the same. Go to www.apta.org/FitAfter50/ to learn more about the campaign and to nominate yourself or another deserving 50+ year old.

    APTA Statement on Proposed Legal Settlement of Medicare 'Improvement Standard' Case

    "APTA applauds the proposed legal settlement of the nationwide class action lawsuit directed toward ensuring Medicare coverage of reasonable and necessary therapy and nursing services for people with chronic and degenerative health conditions," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement issued today regarding the lawsuit Glenda Jimmo, et. al vs. Kathleen Sebelius. Plaintiffs in the lawsuit alleged that the US Department of Health and Human Services, Medicare contractors, and administrative review boards were arbitrarily limiting coverage for patients who did not show long-term improvement in their conditions, even though official Centers for Medicare and Medicaid Services rules state these services should be covered.

    Under this proposed agreement, Medicare would pay for skilled therapy and nursing services if they are needed to maintain the patient's current condition or prevent or slow further deterioration.

    The New York Times highlighted how the policy change will result in significant cost savings in the long term by allowing patients to receive physical therapy and other services in community-based settings and avoiding expensive care in hospitals and nursing homes.

    APTA will continue its efforts to ensure access to appropriate physical therapy services. The association also will work with the Centers for Medicare and Medicaid Services and its contractors to ensure accurate and fair incorporation of revisions to the current Medicare manuals and regulations that reflect this significant change. In addition, the association will continue to analyze the proposed settlement for potential impact on Medicare policies regarding the reporting of functional limitations on the claim for outpatient therapy and the requirement to complete a functional reassessment at defined intervals under the Home Health Part A benefit.

    APTA plans to actively educate members to ensure proper understanding and application of the newly revised Medicare regulations.

    APTA Hosts Online Roundtable Discussion on Social Media

    Although 66% of online American adults use social networking sites, according to a 2012 Pew Internet Project study, many users remain skeptical about using social media for professional purposes. To demonstrate some of the potential benefits of social media, APTA hosted an online roundtable discussion Monday with 5 physical therapists and 1 student of physical therapy, all of whom actively use Twitter and other social media tools to network about physical therapy issues.

    The 53-minute discussion, conducted using Google+ Hangouts and archived via YouTube, covers the weekly #SolvePT tweetchat, ways that social media are effective in advocacy efforts, benefits of social media for physical therapy educators and students, and the challenges of discussing critical issues in a social media environment, among other topics.

    Participating in the panel were Allan Besselink, PT, Dip MDT, Christopher Bise, PT, DPT, MS, OCS, physical therapist student Matt DeBole, Selena Horner, PT, MS, GCS, Eric Robertson, PT, DPT, OCS, and Ann Wendel, PT, ATC, CMTPT.

    The roundtable is available on the Social Media Tips & Best Practices webpage of APTA.org, which includes links to APTA's policy on social media, a new video tutorial for Twitter, and other resources.

    Help Celebrate Extraordinary PTs and PTAs: Nominate for Honors and Awards

    Before National Physical Therapy Month ends, take the time to acknowledge your colleagues or students with an APTA 2013 Honor or Award nomination. By nominating the person or people you feel are most deserving of an honor or award, you can help APTA celebrate their many contributions to the physical therapy profession. 

    Your participation in the nominating process is extremely important. It's quick, easy—and in keeping with APTA's green initiative, all APTA national Honors and Awards applications are available for electronic submission.   

    Go to APTAs Honors and Awards page and submit your nominations online. All submissions must be received by December 1.

    E-mail questions to honorsandawards@apta.org or call 800/999-2782, ext 3233, for more information.

    NC 1 Forms Due November 1

    Time is running out to nominate yourself or an APTA-member colleague to national office. The online Nomination Form (NC 1) is available on APTA's website under "Leadership and Governance" and then "Elections and Nominations." The APTA Nominating Committee is seeking recommendations for the 2013 Slate of Candidates for the following positions: secretary, vice speaker, 3 directors, and 2 Nominating Committee members.

    New Podcast: Measuring Body Mass

    The value of gathering information on body mass on patients or clients is the focus of a new podcast in the recently launched series titled Extracting Hidden Gems from Simple Clinical Measures: The Why, How, and Then What?

    Excess body mass or obesity has been identified as a critical health issue in the United States and around the world. Learn what data physical therapists should gather and what to do with it, and find additional resources on body mass index, in this prerecorded podcast that discusses the anthropometric characteristic of body mass.     

    The Extracting Hidden Gems from Simple Clinical Measures series can be found on APTA's recently enhanced vital signs and other patient screenings webpage. This quality-focused web resource provides information on why and when vital signs and other patient information should be gathered. 

    Nonmedical Factors Associated With Readmissions

    New research shows that age, race, employment status, living situation, and education and income levels are just some of the factors that may play a role in hospital readmissions. However, the Centers for Medicare and Medicaid Services (CMS) is not taking these causes into account in its readmissions reduction program, which started penalizing hospitals October 1 for excessive readmissions, says an article by Reuters News.   

    In the study, published in Journal of General Internal Medicine, researchers analyzed data from 20 studies on pneumonia and 52 on heart failure.

    For pneumonia patients, among the factors linked to the risk of being readmitted to the hospital were being older and not white. Having a low level of education, low income, and being unemployed also were tied to a higher risk of going back into the hospital.

    For heart failure patients, the risk of being readmitted to a hospital was associated with being elderly, African American, or Hispanic.

    The researchers cannot say for certain that the risk factors identified are what cause a patient to be readmitted to the hospital. But they note in their report that this kind of information could be used by physicians, case managers, and discharge planners "to flag patients at high risk of readmission because of certain nonmedical vulnerabilities," says Reuters

    Visit APTA's hospital readmissions webpage for information about how physical therapists can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions.

    Jewell Appointed to NQF Ad-hoc Planned Readmissions Committee

    APTA Board of Director member Dianne Jewell, PT, DPT, PhD, CCS, recently was appointed to the National Quality Forum's (NQF) Ad-hoc Planned Readmissions Committee. NQF readmissions panels have primarily been staffed with physicians, which makes Jewell's appointment particularly significant for the physical therapy profession.

    An ad hoc review may be conducted on an endorsed measure at any time if 1 or more of the following criteria are met:

    • the evidence supporting the measure has changed
    • implementation of the measure results in unintended consequences, and/or
    •  material changes have been made to the measure.

      Ad hoc reviews can be requested at any time by any party, as long as there is adequate evidence to justify the review.

    NQF will conduct an ad hoc review requested by the Centers for Medicare and Medicaid Services for the endorsed measures: 1551, hospital-level 30-day all-cause risk-standardized readmission rate following elective primary total hip arthroplasty and total knee arthroplasty; 0330, hospital 30-day all-cause risk-standardized readmission rate following heart failure hospitalization for patients 18 and older; and 0505, hospital 30-day all-cause risk-standardized readmission rate following acute myocardial infarction hospitalization.

    This review is being completed due to material changes to a currently endorsed measure (eg, expansion of a measure to a different population or setting). This is intended as a focused review of the planned readmission algorithms that have been incorporated into each of the condition/procedure specific readmission measures.

    CDC Updates Clinician Resources on Fungal Meningitis Outbreak

    The Centers for Disease Control and Prevention (CDC) has updated its clinician guidance webpage to reflect the most current information based on the investigating into the multistate fungal meningitis outbreak among patients who received contaminated steroid injections.

    The page contains updates to FAQs, case definitions, and information on diagnostic testing. Three interim treatment guidance documents also have been updated.

    CDC urges clinicians to contact patients who have received medicines associated with 3 lots of preservative-free methylprednisolone acetate from the New England Compounding Center that were recalled on September 26. The potentially contaminated injections were given starting May 21.

    New Podcasts: Health Behavior Change Models and Theories

    Changing behavior is important for patient or client success in all practice settings. Physical therapists and physical therapist assistants have long been asking patients and clients to change some of their behaviors, either for the short term or for the long term and for reasons that will improve their functional status or quality of life or prevent decline. A new podcast introduces a series on health behavior change, providing an overview of key theories and models and their value to PTs and PTAs.

    A second podcast focuses exclusively on the Transtheoretical Model of Behavior Change, an important and complex model that involves emotions, cognitions, and behavior. This model, relying on self-report, has been applied to a wide variety of problem behaviors including smoking cessation, condom use for HIV protection, the use of sunscreens to prevent skin cancer, and stress management. The podcast provides an example of how the model can be applied to a patient with a shoulder strain due to an injury.

    New in the Literature: Early Use of Thrust Manipulation (Man Ther. 2012 October 2. [Epub ahead of print])

    Results of a study that investigated the comparative effectiveness of early use of thrust manipulation (TM) and nonthrust manipulation (NTM) in patients with mechanical low back pain (LBP) suggest that there is no difference between early use of TM or NTM, and, secondarily, that personal equipoise affects study outcome. Intra-group changes were significant for both groups, say authors and APTA members Chad Cook, PT, PhD, MBA, FAAOMPT, Kenneth Learman, PT, PhD, OCS, COMT, Christopher Showalter, PT, OCS, FAAOMPT, Vincent Kabbaz, PT, and Bryan O'Halloran, PT, OCS, SCS.

    For this trial, patients aged 18 and older with mechanically reproducible LBP were randomized into 2 treatment groups. The main outcome measures were the Oswestry Disability Index (ODI) and a Numeric Pain Rating Scale, with secondary measures of rate of recovery, total visits and days in care, and the work subscale of the Fears Avoidance Beliefs Questionnaire work subscale.

    A total of 149 subjects completed the trial and received care over an average of 35 days. There were no significant differences between TM and NTM at the second visit follow-up or at discharge with any of the outcomes categories. Personal equipoise was significantly associated with ODI and pain.

    Innovation Summit 2013: Last Call for Nominations

    The deadline to submit nominations to participate in APTA's Innovation Summit 2013: Collaborative Care Models is October 22.

    The Summit will bring together innovators and thought leaders from physical therapy, health policy, payment, and other health professions to explore the role of physical therapists in new models of health care delivery and payment. Participation in the Summit will be available to all members through live web streaming. Attendance onsite will be limited to speakers, panelists, and invited attendees, including the member innovators selected through this nomination process. 

    APTA sections, chapters, and the Student Assembly are each invited to nominate a member who is involved in an innovative model of care to attend the March 7-8, 2013, onsite meeting in Alexandria, Virginia. A panel of member experts will select 20 member innovators to share their innovative practice models as a part of the Summit. Those selected will receive free registration and a stipend for travel and lodging expenses. Chapters and sections whose nominees are selected will receive special recognition during the Summit. 

    Members involved in innovative models of care or payment may want to contact their chapter or section directly to ask to be nominated to attend the Summit. 

    Information and nomination materials are available at this link. Components may direct questions about the nomination process to innovationsummit2013@apta.org.   

    Last Call for Topics for Final House Proposal Town Hall

    It's your last chance to weigh in on the topics to be covered in the final House proposal town hall scheduled for Tuesday, October 23, 9:00 pm-10:30 pm, ET. What would you like to discuss? What topic have we missed? Let us know. Suggest ideas via the Additional Thoughts comment blog posted to www.apta.org/governancereview. Contact Amber Neil if you are interested in attending. Can't join a town hall? Have your voice heard via the comment blogs on the following topics: House constituency, House activity, and Resolutions Committee.

    New Guide Helps Providers Make Effective Connection With Senior Patients

    "Communicating With Older Adults: An Evidence-Based Review of What Really Works," the latest report from The Gerontological Society of America, provides 40 pages of recommended guidelines for health care providers interacting with the fastest-growing age segment of America's population.

    The report provides 29 specific recommendations in 4 categories: general tips for improving interactions with older adults, general tips for improving face-to-face communication with older adults, tips for optimizing interactions between health care professionals and older patients, and tips for communicating with older adults with dementia.

    Among the specific steps outlined in the report, providers are encouraged to avoid speech that might be seen as patronizing to an older person, verify listener comprehension during a conversation, and pay close attention to sentence structure when conveying critical information.

    The recommendations were contributed by experts in the fields of gerontology and communications. Each is accompanied by a brief explanation of the rationale, tips for implementing the recommendation in busy health care settings, and selected references for further reading. The objective is to encourage behaviors that consider the unique abilities and challenges of older adult patients and produce positive, effective interactions among everyone involved. 

    Recursos de Actividad Física en Español

    Encourage your Spanish-speaking patients to visit Ejercicioy estado físico, a comprehensive web resource from MedlinePlus that offers tips on becoming and staying active based on the Department of Health and Human Services' 2008 Physical Activity Guidelines for Americans, the latest news on the benefits of physical activity, and information on exercise-specific topics—such as strength training, aerobics, and interval training. Users can find links to a heart rate calculator, food tracker, and calories-burned calculator. Tutorials and videos, information tailored to women, and patient handouts also are available.    

    Family Caregivers Taking On Medical and Nursing Tasks

    The role of family caregivers has dramatically expanded to include performing medical/nursing tasks once only provided in hospitals, says a new report by the AARP Public Policy Institute and the United Hospital Fund. The report is based on a nationally representative population-based online survey of 1,677 family caregivers to determine what medical/nursing tasks they perform.

    Almost half (46%) of caregivers performed medical/nursing tasks for family members with multiple chronic physical and cognitive conditions. Three out of 4 (78%) family caregivers who provided medical/nursing tasks were managing medications, including administering intravenous fluids and injections. Caregivers reported finding wound care very challenging; more than a third (38%) wanted more training.

    The report reveals the complexity and difficulty of specific tasks, the lack of support and training family caregivers receive, and the effect on their quality of life. It makes 10 recommendations, including:

    • revisiting measures used to define what caregivers do
    • strengthening oversight of how effectively institutions meet family caregiver needs and requiring corrective steps to address deficiencies
    • conducting further studies to understand medical/nursing tasks performed by different types of family caregivers and their needs for training and support

    "No single profession or health care provider is solely responsible for ensuring that family caregivers who take on these daunting responsibilities are trained and supported," the authors write. "This effort requires the coordinated efforts of all sectors—hospitals, home care agencies, community agencies, nursing homes, hospices, and physician and other clinician practices—and a level of teamwork that challenges attitudes and behaviors so firmly entrenched in the current system."

    Open Door Forum on Manual Medical Review Scheduled for October 22

    The Centers for Medicare and Medicaid Services (CMS) will hold a special open door forum (ODF) on October 22, 2:00 pm-3:30 pm ET, to allow providers to ask questions about the manual medical review of therapy services that exceed $3,700. 

    During this special ODF (conference call only), CMS will discuss therapy documentation requirements and answer any questions providers may have. CMS requests that providers who order or provide therapy services nationally participate in the call. The therapy cap applies to all Part B outpatient therapy settings and providers in:

    • private practices
    •  Part B skilled nursing facilities
    •  home health agencies hospital
    • outpatient departments rehabilitation agencies (outpatient rehabilitation facilities)
    • comprehensive outpatient rehabilitation facilities

    Participants may submit questions prior to the special ODF to therapycapreview@cms.hhs.gov. To participate, call 866/ 501-5502 and enter conference ID 44803009.

    New Adult Fitness Exam Tool Promotes Continuum of PT Care for Adults

    APTA's newest publication, Adult Fitness Examination: A Physical Therapy Approach, brings together a series of tests and measures that enables physical therapists to build lifelong health and wellness plans with their asymptomatic adult clients.

    Written by APTA member Dan Millrood, PT, MEd, and Charlotte Chua, PT, DPT, this groundbreaking assessment tool contains the ready-to-use instructions and resources PTs need to identify, quantify, and qualify key components of physical health and wellness.

    For educators, it's a textbook that addresses educational objectives related toprevention, health promotion, fitness, and wellness.

    Adult Fitness Examination includes:

    • preparticipation health screening overview
    • 16 ready-to-use examinations, complete with step-by-step instructions and full color photos; normative data, charts, flowcharts, illustrations; and notes and warnings (when to terminate testing)
    • equipment supply checklist
    • clinician workbook to promote easy, accurate record-keeping
    • client take-home form to help clients follow treatment plans, track results, and stay motivated to achieve health and fitness goals

    Order Adult Fitness Examination (AFE-001, $34.99 for APTA members) from APTA's online bookstore.

    Diabetic Foot Ulcers Linked With Higher All-cause Mortality

    Diabetic foot ulceration (DFU) is associated with a nearly 2-fold increased risk for all-cause mortality above that of diabetes alone, says a Medscape Medical News article based on a meta-analysis published in Diabetologia.   

    The authors included 8 studies in their analysis. The studies were published between 1996 and 2011 and reported on a total 17,830 patients with 81,116 patient-years of follow-up. Patients with both type 1 and type 2 diabetes were included in all but 1 study, in which all patients had type 2 diabetes.

    The 3,095 patients with DFU had a significantly longer duration of diabetes (12.72 years) compared with the 14,735 patients without DFU (7.19 years). The prevalence of coronary artery disease was significantly higher among patients with DFU (31.4% vs 14.7%), as was that of both hypertension (57.6% vs 35.7%) and hypercholesterolemia (47.6% vs 11.1%).

    During follow-up, there were a total 3,619 deaths from any cause. The population with DFU had a 1.89 pooled relative risk for all-cause mortality compared with the patients with diabetes without DFU. Unadjusted rates of all-cause mortality were 99.9 per 1,000 person-years for the population with DFU vs 41.6/1,000 in the group with diabetes only.

    Further analysis of 3,138 patients in 4 studies for whom information on cardiovascular mortality was available showed that rates of fatal myocardial infarction and fatal stroke also were higher among patients with DFU. However, the overall proportion of deaths resulting from cardiovascular causes was almost the same in the DFU and non-DFU groups—43.6% of the 117 DFU patients and 44.2% of the 952 diabetes-only patients.

    The higher mortality rate in patients with DFU may also "relate to their more advanced stage of diabetes, with greater overall disease burden and noncardiovascular complications of foot ulceration such as sepsis," Medscape says.

    Blue Cross Blue Shield of North Carolina to Cover EMG by PTs

    In acknowledgement of  legislation effective October 1, the Right to Choose a Physical Therapist, Blue Cross Blue Shield (BCBS) of North Carolina has revised its corporate medical policy to include electrodiagnostic studies that are provided by a licensed physical therapist who currently is listed on APTA's website as a board-certified clinical electrophysiologic specialist per the American Board of Physical Therapy Specialties. 

    The North Carolina Chapter worked diligently for 3 years with state legislators and BCBS of North Carolina, citing physical therapists' education and clinical preparation to provide these services. After being assured that qualified PTs provide evidence-based, outcome-based, and cost-effective health care that encourages collaboration of the health care team, BCBS adopted the policy reflecting the ability of PTs certified in clinical electrophysiology to independently perform the testing.

    Studies Show 'Mixed Results' on Pay-for-Performance Initiatives

    Studies on the effects of pay-for-performance have found mixed results and raise a number of questions that require more research and experimentation, says a new Health Affairs issue brief.  

    The brief summarizes the results of 9 studies that looked at public and private pay-for-performance initiatives. Two studies focus on the Centers for Medicare and Medicaid Services' Premier Hospital Quality Incentive Demonstration project. The first study found that hospitals in the demonstration initially showed promising improvements in quality compared with a control group. However, the effects were short lived. After the fifth year of the demonstration, there were no significant differences in performance scores between participating hospitals and a comparison group of hospitals not in the project. In the second study, which analyzed 30-day mortality rates for patients with acute myocardial infarction, congestive heart failure, pneumonia, or coronary artery bypass graft surgery between 2004 and 2009, the results showed no difference in mortality rates between hospitals in the Premier demonstration and a control group of nonparticipating hospitals.

    Showing greater success is the Medicare Physician Group Practice Demonstration, a pilot project that ran from 2005 to 2010, awarding bonuses to physicians in 10 large physician group practices if they achieved lower cost growth than local controls and met quality targets. Researchers at Dartmouth College and the National Bureau for Economic Research found an improvement in quality but modest reduction in the growth of spending for most Medicare beneficiaries. Cost reductions were greatest for the 15% percent of patients with dual eligibibility, typically low-income people who qualify for both Medicaid and Medicare and who often have complex, chronic conditions.

    The brief also examines studies on Medicare's Hospital Value-based Purchasing Program, Medicaid-focused health plans in California, and safety net providers.

    In a Health Affairs blog post, 3 policy experts discuss how monetary rewards can undermine provider motivation and worsen performance, suggesting that pay-for-performance initiatives might backfire.

    Joint Commission Launches Palliative Care Resource for Patients

    A new campaign recently launched by the Joint Commission provides information to patients about how and when to get palliative care, and offers examples of questions that palliative care providers may ask them and questions that they can ask providers. The educational campaign is part of the Joint Commission's Speak Up program that urges people to take an active role in their health care. Speak Up brochures are available in English and Spanish.

    Learn more about the role of physical therapists in palliative care at APTA's Hospice and Palliative Care webpage.

    NIH 'Biggest Loser' Study: Exercise Is Key in Reducing Body Fat While Preserving Muscle

    Exercise and healthy eating reduce body fat and preserve muscle in adults better than diet alone, according to a study funded and conducted by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH).  

    NIDDK senior investigator Kevin Hall, PhD, analyzed the individual effects of daily strenuous exercise and a restricted diet by examining data from 11 participants from the reality television program "The Biggest Loser." Researchers measured body fat, total energy expenditure, and resting metabolic rate 3 times: at the start of the program, at week 6, and at week 30, which was at least 17 weeks after participants returned home. Participation in the program led to an average weight loss of 128 pounds, with about 82% of that coming from body fat, and the rest from lean tissue.

    Hall used a mathematical computer model of human metabolism to calculate the diet and exercise changes underlying the observed body weight loss. Because the TV program was not designed to directly address how the exercise and diet interventions each contributed to the weight loss, the computer model simulated the results of diet alone and exercise alone to estimate their relative contributions.

    At the competition's end, diet alone was calculated to be responsible for more weight loss than exercise, with 65% of the weight loss consisting of body fat and 35% consisting of lean mass such as muscle. In contrast, the model calculated that exercise alone resulted in participants losing only fat, and no muscle. The simulation of exercise alone also estimated a small increase in lean mass despite overall weight loss.

    The simulations also suggest that the participants could sustain their weight loss and avoid weight regain by adopting more moderate lifestyle changes, such as 20 minutes of daily vigorous exercise and a 20% calorie restriction, than those demonstrated on the television program.

    Physical Therapy After ACL Surgery Should Begin 'Early' and 'Rigorously'

    "The most important thing for ACL surgery patients is to start physical therapy early and rigorously," says Rick W. Wright, MD, in a Medical News Today article about his systematic review published in Journal of Bone and Joint Surgery. "It can be difficult at first, but it's worth it in terms of returning to sports and other activities."

    Wright and his colleagues in the Department of Orthopedic Surgery at Washington University School of Medicine identified 85 articles on treatment following reconstructive ACL surgery from 2006 to 2010 through multiple search engines. Twenty-nine Level-I or II studies met inclusion criteria and were evaluated with use of the CONSORT (Consolidated Standards of Reporting Trials) criteria. The authors included studies on postoperative bracing, accelerated strengthening, home-based rehabilitation, proprioception and neuromuscular training, and 6 miscellaneous topics investigated in single trials.

    The authors also found that bracing following ACL reconstruction is not beneficial, but home-based rehabilitation can be successful. Neuromuscular interventions, while not harmful to patients, are not likely to yield large improvements in outcomes and should not be performed to the exclusion of strengthening and range-of-motion exercises. Vibration training may lead to faster and more complete proprioceptive recovery, but further evidence is needed.

    New in the Literature: Eccentric Strengthening for Achilles Tendinopathy (Am J Phys Med Rehabil. 2012. Oct 5. [Epub ahead of print])

    Eccentric strengthening was more effective than concentric strengthening in reducing pain and improving function in patients with Achilles tendinopathy, say authors of an article published online in American Journal of Physical Medicine & Rehabilitation.

    Thirty-two men with Achilles tendinopathy were assigned to either the experimental group (n = 16) that performed eccentric strengthening or the control group (n = 16) that performed concentric strengthening for 8 weeks (50 minutes per day, 3 times per week). A visual analog scale, isokinetic muscle testing equipment, the side-step test, and the Sargent jump test were used to assess pain, muscle strength, endurance, and functional fitness factors before and after the intervention.

    In comparison with the control group, the experimental group showed significant improvement in pain, ankle dorsiflexion endurance, total balance index, and agility after the intervention. However, there was no significant difference in dexterity between the 2 groups.

    New Podcast: Using Evidence in a Private Outpatient Setting

    In a new podcast titled "Using Evidence in a Private Outpatient Setting," Jason Grandeo, PT, DPT, OCS, shares the 3 main strategies that he and his colleagues at Body Dynamics Inc in Falls Church, Virginia, use to incorporate evidence in practice: monthly journal clubs, grand rounds focused on the hands-on examination and treatment aspect of physical therapy, and Physicians' Information and Education Resource (PIER) summaries. PIER summaries are completed when a physician or other health care provider comes to the facility to discuss an area in which he or she specializes.   

    Grandeo also offers tips for physical therapists who have not yet incorporated evidence in their practice. "Make a pitch for using 1 of the strategies we use, such as a journal club, or doing it as a group. If there is no interest, you may need to ask yourself if you are working at the best place to support your career growth."

    This recording is part of the Research to Practice podcast series, which provides practical information on implementing the use of research as part of evidence-based practice in the physical therapy clinic.

    PT Innovators: Contact Your Chapter or Section for Nomination to Summit

    Are you involved in an innovative model of care delivery such as an accountable care organization or pay for performance? If so, contact your chapter or section and ask your leadership to nominate you to attend APTA's Innovation Summit: 2013: Collaborative Care Models. 

    The Summit will bring together innovators and thought leaders from physical therapy, health policy, payment, and other health professions to explore the role of physical therapists in new models of health care delivery and payment. Participation in the summit will be available to all members through live web streaming. Attendance onsite will be limited to speakers, panelists, and invited attendees, including the member innovators selected through this nomination process.

    APTA sections, chapters, and the Student Assembly are each invited to nominate a member who is involved in an innovative model of care to attend and participate in the Summit, to be held March 7-8, 2013, in the Washington, DC area. A panel of member experts will select 20 member innovators to share their innovative practice models as a part of the Summit. Those selected will receive free registration and a stipend for travel and lodging expenses. Chapters and sections whose nominees are selected will receive special recognition during the Summit.

    The deadline for nominations is Monday, October 22. More information about the Summit is available at www.apta.org/innovationsummit. Components can direct questions about the nomination process to innovationsummit2013@apta.org.

    Stroke Incident Rates for Young Adults Increasing

    In a study of the Greater Cincinnati/Northern Kentucky region, researchers found that the rate of strokes among adults younger than 55 years of age increased from 12.9% in 1993/1994 to 18.6% in 2005.

    Stroke incidence rates in people aged 20 to 54 were significantly increased in both black and white patients in 2005 compared with earlier periods. The investigators also found that the mean age at stroke significantly decreased from 71.2 years in 1993/1994 to 69.2 years in 2005.

    Possible explanations for the increase could be that physicians are detecting strokes in young people more often, both as a result of better imaging technology and more vigilant screenings, says a Reuters Health article.

    "But I really don't think that's the major reason," lead researcher Brett Kissela told Reuters. "We're definitely seeing a higher incidence of risk factors for stroke now."

    With people developing obesity, diabetes, and high blood pressure at a younger age, they also are increasing their risk of stroke at a younger age.

    "This is of great public health significance because strokes in younger patients carry the potential for greater lifetime burden of disability and because some potential contributors identified for this trend are modifiable," the authors write.

    The study is published in Neurology.   

    APTA Seeks Members' Suggestions for Topics for Additional House Proposal Town Halls

    Don't forget to weigh in on the topics to be covered in the next House proposal town halls scheduled for Thursday, October 18, and Tuesday, October 23; 1 session will be offered on each of those evenings at 9:00 pm-10:30 pm, ET. What would you like to discuss? What topic have we missed? Let us know. Suggest ideas via the Additional Thoughts comment blog posted to www.apta.org/governancereview. Contact Amber Neil if you are interested in attending. Can't join a town hall? Have your voice heard via the comment blogs on the following topics: House constituency, House activity, and Resolutions Committee.

    Health Information Breaches Affect 13K Medicare Beneficiaries in 2-year Period

    More than 13,000 Medicare beneficiaries were affected by 14 breaches of protected health information between September 23, 2009, and December 31, 2011, requiring notification under the American Recovery and Reinvestment Act, according to a new report by the Department of Health and Human Services' Office of Inspector General (OIG).

    For the most part the breaches involved beneficiaries' names, Medicare identification numbers, dates of birth, diagnoses, and services received. One breach affected 13,412 beneficiaries. This breach involved a Medicare Summary Notice printing error by a Centers for Medicare and Medicaid Services' (CMS) contractor, which caused the notices to be sent to incorrect addresses. Ten breaches resulted from other mismailings or from loss of documents during transit. In another 2 breaches, beneficiary information was posted online. In the remaining breach, a CMS contractor employee was arrested for stealing beneficiary information.

    Although CMS notified all beneficiaries affected by the 14 breaches, it failed to meet the Recovery Act’s standard for timeliness for 7 of them. Notification letters for 6 of the breaches did not explain how the contractors were investigating the breach, mitigating losses, or protecting against further breaches. Moreover, notification letters for half the breaches, including the largest breach, were missing either the date the breach occurred or the date it was discovered. Notification letters for 3 breaches did not include the types of unsecured protected health information involved, contact procedures for individuals who want to learn more, or steps individuals can take to protect themselves from harm.

    "CMS has made progress in responding to medical identity theft by developing a compromised number database for contractors," says the report. "However, the database's usefulness could be improved."  

    Based on its findings, OIG recommends that CMS ensure that breach notifications meet Recovery Act requirements, improve the compromised number database, provide guidance to contractors about using database information and implementing edits, develop a method for ensuring that beneficiaries who are victims of medical identity theft retain access to needed services, and develop a method for reissuing identification numbers to beneficiaries affected by medical identity theft.

    Commission Calls for Greater Protections of Patient Data in Genome Sequencing

    To realize the promise of whole genome sequencing, scientists and clinicians must have access to data from large numbers of people who are willing to share their private information, say authors of a report issued yesterday by the Presidential Commission for the Study of Bioethical Issues. "This in turn requires public trust that any whole genome sequence data shared by individuals with clinicians and researchers will be adequately protected," they write.

    The commission's investigation found that current governance and oversight of genetic and genomic data varies in its protection of individuals from the risks associated with sharing their whole genome sequence data and information. In particular, a great degree of variation exists in what protections states afford to their citizens regarding the collection and use of genetic data.

    To improve current practices and help ensure privacy and security as the field of genomics advances, the commission offers 12 recommendations, including proposals that clinicians and researchers use robust and understandable informed consent procedures and engage in productive exchanges of those collections of genomic information that are based on such consent procedures. The commission recommends that the federal government facilitate broad public access to the important clinical advances that result from whole genome sequencing. The commission also urges federal and state governments to ensure a consistent floor of individual privacy protections covering whole genome sequence data across state lines, regardless of how the data were obtained.

    Education Leadership Institute Fellowship Now Accepting Applications for 2013

    APTA's Education Leadership Institute (ELI) Fellowship, a shared collaborative with the Academic Council, Education Section, Physical Therapist Assistant Educators Special Interest Group, and APTA, now is accepting applications for 2013 with a submission deadline of January 4, 2013. This yearlong invitational blended learning (online and onsite components) fellowship program includes mentorship and is designed to provide emerging and novice (0-7 years) physical therapist and physical therapist assistant education program directors with leadership skills to facilitate change, think strategically, and engage in public discourse to advance the physical therapy profession. Successful graduates from this program are recognized as Fellows of the Education Leadership Institute. To learn more about the ELI Fellowship, click here. To access the application, click here.

    Improving Safety for Patients With Limited English Proficiency

    Hospitals of all types can engage in a systematic approach to better identify and prevent medical errors and adverse events that occur commonly among patients with limited English proficiency (LEP). Research available from the Agency for Healthcare Research and Quality makes these 5 key recommendations to improve detection of medical errors across diverse LEP populations and prevent high-risk scenarios from becoming safety events:

    • Foster a supportive culture for safety of diverse patient populations.
    • Adapt current systems to better identify medical errors among patients with LEP.
    • Improve reporting of medical errors for patients with LEP.
    • Routinely monitor patient safety for patients with LEP.
    • Address root causes to prevent medical errors among patients with LEP.

    For hospitals with resource or other limitations that preclude a full rollout of these strategies at once, the authors suggest beginning incrementally by choosing any strategies that can be readily implemented and, at a minimum, focus on addressing the root causes that lead to high-risk scenarios for medical errors among patients with LEP. 

    A case study, Bringing It to Life, highlights a breakdown in communication involving hospital staff and a 45-year-old Spanish-speaking man with type 2 diabetes who goes to the emergency department accompanied by his wife.  

    Transition to Better Care Video Contest

    The Robert Wood Johnson Foundation (RWJF) is hosting a video contest for health care providers to showcase their innovative, patient-centered approaches that improve the way care teams communicate with their patients, especially when a patient is transitioning from the hospital to home care. If you've pioneered a collaborative way to improve patients' care and their health outcomes, read the judging criteria and submission guidelines and submit your video by November 17.

    Winners will receive special recognition from RWJF, a professionally produced video segment on their innovation, and the opportunity to discuss their methods with patients and health care providers in local and national media.

    Aquatic Therapy Linked With Higher Physical Endurance

    Aquatic workouts may trump land-based exercise for people with chronic obstructive pulmonary disease (COPD), says an article by Reuters Health based on a study published in European Respiratory Journal.

    For their investigation, Australian researchers randomly assigned 53 participants to workouts in a hydrotherapy pool, gym-based training, or standard medical care without exercise. The exercise programs include 3 weekly 1-hour sessions over 2 months. Forty-five patients completed the study.

    Whether they worked out on land or in water, patients were able walk faster after the training than when they just got usual care. But patients who exercised in the pool reported less fatigue and developed more physical endurance than those who trained in the gym.

    On the endurance shuttle walk test, patients who'd exercised in water outpaced the gym trainers by 228 meters (748 feet).

    "Participants in the water-based exercise training group reported an improvement in many functional aspects of their daily life such as improved stamina and ability to complete tasks such as walking long distances when shopping," said lead author Renae McNamara, PT.

    There had been some concerns that people with COPD might not tolerate the pressure from the water on the chest. The researchers saw no drop-outs due to worsening COPD in patients training in the pool, although they did see some in the gym group. The authors reported that most of the participants in the study did not have severe disease, says Reuters.

    Bill Aimed at Weakening NY Self-referral Law Vetoed

    On Wednesday, New York Gov Andrew Cuomo vetoed legislation that would have weakened existing state restrictions on physicians' ability to refer patients to facilities in which they have a financial interest. Assembly Bill 3551-A would have added some of the same exemptions found in the federal Stark law, such as the in-office ancillary exceptions for certain designated health services.

    The New York Chapter has been actively opposing the bill, which was approved by the state legislature earlier this year and sent to the governor in September. The Alliance for Integrity in Medicare—a coalition of provider organizations, including APTA, committed to ending the practice of inappropriate physician self-referral—sent a letter to Cuomo in July asking him to veto the bill.

    APTA Seeks Members' Plans for Celebrating National Physical Therapy Month

    APTA wants to know how you are planning to celebrate National Physical Therapy Month. E-mail your plans to public-relations@apta.org.

    New in the Literature: Physical Therapy on Balance in People With Multiple Sclerosis (J Rehabil Med. 2012. Sept 19. [Epub ahead of print])

    Authors of a meta-analysis published in the Journal of Rehabilitation Medicine report that their findings indicate small, but significant, effects of physical therapy on balance in people with multiple sclerosis who have a mild to moderate level of disability.

    A systematic literature search was conducted in Medline, Cinahl, Embase, and PEDro, both electronically and manually up to March 2011. The authors selected randomized controlled trials of physical therapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classification of Functioning, Disability and Health category "changing and maintaining body position." The quality of studies was determined by the van Tulder criteria. Meta-analyses were performed in subgroups according to the intervention.

    Of the 233 full-text papers screened, 11 studies were included in a qualitative analysis and 7 in a meta-analysis. The methodological quality of the studies ranged from poor to moderate. Low evidence was found for the efficacy of specific balance exercises, physical therapy based on an individualized problem-solving approach, and resistance and aerobic exercises on improving balance among ambulatory people with multiple sclerosis.

    APTA's 'Fit After 50' Campaign Officially Under Way

    APTA's  Fit After 50 campaign is officially under way. Launched in conjunction with National Physical Therapy Month, Fit After 50 is designed to reach Baby Boomers with the message that physical therapists play a vital role in helping people aged 50 and older remain active, fit, and mobile as they age.

    Check out 50 Days, 50 Ways, a daily series of 50 tips for Baby Boomers from APTA members about how to prevent injury and maintain mobility by staying active and fit. Find the tips on www.moveforwardpt.com/FitAfter50, Twitter @MoveForwardPT, and Facebook.com/MoveForwardPT. Encourage your friends, family, colleagues, and community members who are 50 and older to visit the site and share the tips with their social networks.

    Also check out the APTA Fit After 50 Member Challenge, an opportunity to nominate a deserving APTA member, including yourself, who is 50 years old or older and committed to being active and fit, and encourages others to be the same. Go to www.apta.org/FitAfter50/ to learn more about the campaign and submit your nomination.

    If you are currently helping people aged 50 and older to remain active and fit as they age, let us know by contacting public-relations@apta.org.

    Additional House Proposal Town Halls Scheduled

    Thanks to the many members who have joined the virtual town halls to discuss the House governance proposals! The discussions have been rich and the input very informative. Based on attendee feedback, 2 additional town halls have been scheduled for Thursday, October 18, and Tuesday, October 23; 1 session will be offered on each of those evenings at 9:00 pm-10:30 pm, ET. The topics will be chosen by you. What would you like to discuss? What topic have we missed? Let us know. Suggest ideas via the Additional Thoughts comment blog posted to www.apta.org/governancereview. Contact Amber Neil if you are interested in attending. Can't join a town hall? Have your voice heard via the comment blogs on the following topics: House constituency, House activity, and Resolutions Committee.

    Providers With Work-Family Conflict More Likely to Experience Musculoskeletal Pain

    A study by The George Washington University School of Public Health and Health Services suggests that the higher the work-family conflict the greater the risk that health care workers will suffer from neck and other types of musculoskeletal pain. 

    To examine if an association exists between work-family conflict and musculoskeletal pain among hospital patient care workers, researchers conducted a survey among 2,000 hospital workers who provided direct patient care in 2 large Boston hospitals. Nearly 80% of the workers took the survey. The research team included 1,199 patient care workers in the current analysis. The team assessed work-family conflict with 5 questions. Researchers asked workers if they agreed with statements such as "The amount of time my job takes up makes it difficult to fulfill family or personal responsibilities" and "My job produces strain that makes it difficult to fulfill my family or personal responsibilities."

    In addition, the team used a questionnaire to assess how much the participants in the study experienced musculoskeletal pain during the previous 3 months. It also recorded factors that might affect the outcome of the study, such as the amount of on-the-job lifting or pulling.

    The researchers discovered that nurses and other employees who reported high conflict between their job duties and obligations at home had about a 2 times greater chance of suffering from neck or shoulder pain in the last 3 months. Workers with the highest work-life imbalance had nearly a 3 times greater risk of reporting arm pain during that period.

    The researchers found that workers who reported a lot of conflict had more than a 2 times greater chance of experiencing any kind of musculoskeletal pain. At the same time, the research found no lasting link between this kind of ongoing conflict and lower back pain, which might be caused when hospital workers lift heavy patients on a regular basis.

    Lead author Seung-Sup Kim says that the work-home conflict might exacerbate shortages of key health professionals caused when burned-out nurses or other health professionals retire early or leave the field because of the stress. In addition, Kim says, workers distracted by issues at home or by ongoing muscular pain might be more likely to call in sick or if they do show up for work might provide less than attentive care.

    CMS to Provide Data on Dollars Accrued Toward Cap on October 8

    On Monday, the therapy cap with an exceptions process went into effect for outpatient hospitals. In addition, the manual medical review exceptions process for claims exceeding $3,700 became effective for phase I providers. Originally, the Centers for Medicare and Medicaid Services (CMS) had announced that providers would know the dollar amount that their patients accrued toward the therapy cap on October 1. Due to some systems challenges, this information was not available. CMS announced this week that the information will be available October 8 through eligibility inquiries. Physical therapists (PTs) should check with their Medicare Administrative Contractors to determine the best way to obtain the dollar amounts accrued. When the data is available on October 8, PTs can then determine whether there is a need to seek an exception to the therapy cap.

    To help PTs with the implementation of the cap and the manual medical review exceptions process, APTA has created a Medicare Therapy Cap Resources webpage. This webpage compiles relevant information available from APTA and CMS in 1 place.

    Heard on the Hill: 2012 Election Update

    In this month's Heard on the Hill podcast, Mike Matlack, APTA director of grassroots and political affairs, breaks down the races for the United States Senate and House of Representatives and discusses the toss-up states in the Senate and competitive seats in the House. He also explains how the Electoral College looks as the candidates head into the debates.

    Election Results - 10/3/12

    Source: National Journal 

    Message From Diabetes Meeting: Physical Activity Should be 'Part and Parcel' of Care

    Researchers at the European Association for the Study of Diabetes 2012 Meeting reported this week that higher levels of leisure-time physical activity cut the risk of cardiovascular and all-cause mortality in people with type 2 diabetes, says an article by Heartwire. People with diabetes who did little or no exercise at baseline and then substantially increased their leisure-time physical-activity levels over approximately 5 years cut their risk of death by almost two-thirds.

    The researchers used data on leisure-time physical activity, recorded yearly, from more than 15,000 men and women with type 2 diabetes included in the Swedish National Diabetes Register. Participants were grouped as either "low physical activity" (no regular exercise or exercise once per week) or "regular exercise" (between 3 times per week and daily exercise). If patients died during the course of the study, their last recorded physical-activity level was used for the analysis.

    Over a 5-year period, regular exercisers were significantly less likely to have a cardiovascular event or to die either from cardiovascular disease or any other cause.

    The investigators also looked at patients who reported doing little or no physical activity at baseline but who increased their regular exercise to at least 3 times per week by the end of the study period (a mean of 4.8 years). Cardiovascular deaths among these patients dropped by 67% compared with patients who did not improve their exercise habits. Rates of all-cause mortality were reduced by almost the same degree.

    Session moderator Nick Wareham, MD, stressed that the data "… should encourage us to focus on encouraging physical activity as part and parcel of medical care."

    UK Researchers Identify Back Pain Gene

    Researchers at King's College London have identified a gene linked to age-related degeneration of the intervertebral discs, a common cause of lower back pain.

    Back pain costs the United Kingdom an estimated £7billion ($11 billion in US dollars) a year due to sick leave and treatment costs. Lumbar disc degeneration (LDD) is inherited in 65%-80% of people with the condition, suggesting that genes play a key role. Until now, the genetic cause of lower back pain associated with LDD was unknown, says King's.

    For this study, scientists compared MRI images of the spine in 4,600 individuals with genome-wide association data, which mapped the genes of all the volunteers. They identified that the gene PARK2 was implicated in people with degenerate discs and could affect the speed at which they deteriorate.

    The researchers say the results show that the gene may be switched off in people with LDD. Although it is still unclear how this might happen, it is thought that environmental factors, such as lifestyle and diet, could trigger this switch by making changes known as epigenetic modifications to the gene.

    The study was published online September 19 in Annals of Rheumatic Diseases.  

    Foundation Gears Up for 2013 Pittsburgh-Marquette Challenge

    The Marquette Challenge is an annual student-led grassroots fundraising effort that supports physical therapy research. Over the past 24 years, students participating in the Marquette Challenge have raised more than $2.3 million in support of the Foundation and its mission.

    To learn how your school can help advance physical therapy research and gain national recognition check out the interactive Challenge kit. 

    Reduction in Diabetes Prevalence Could Mean Decreases in HF Hospitalizations

    At the population level, diabetes is a stronger risk factor for new heart failure (HF) than 4 other modifiable risk factors, namely smoking, dyslipidemia, obesity, and hypertension, suggests the latest analysis from the Atherosclerosis Risk in Communities (ARIC) study cohort.

    ARIC is a longitudinal study of more than 15,000 African American and Caucasian men and women in 4 communities across the United States, who were recruited during the 1980s when they were aged 45 to 64. The current analysis included 14,709 of the participants followed an average of 17.6 years.

    According to the authors, the lifetime risk of incident heart failure was about 1 in 3 for its African American participants and reached 1 in 4 in Caucasians. In both groups, that risk was higher than the lifetime risk of new coronary heart disease or stroke in the same population. 

    In addition, they found that a percentage drop in diabetes prevalence would avert more cases of new HF than the same percentage decrease of any of the 4 other studied modifiable risk factors. Specifically, a 5% proportional reduction in the prevalence of diabetes in ARIC African American participants would result in approximately 53 fewer HF cases per 100,000 person-years and 33 fewer HF hospitalizations per 100,000 person-years for Caucasians.

    Free full-text of the article is available in Journal of the American College of Cardiology.

    Registration Open for 2012 APTA State Policy and Payment Forum

    Registration for the 2012 APTA State Policy and Payment Forum now is open. This year's event will take place December 1-3 at the Hilton Alexandria Old Town in Alexandria, Virginia. The State Policy and Payment Forum is designed to increase your involvement in and knowledge of state legislative and payment issues that have an impact on the practice of physical therapy and improve your advocacy efforts at the state level. You will hear from influential public policymakers and other physical therapy advocates, collaborate with colleagues in developing your chapter or section's advocacy efforts, and network with other professionals from across the country.  

    Programming this year will include presentations on physical therapy copay legislation, term protection for physical therapy, emerging scope of practice issues, silent preferred provider organizations (PPOs), health information technology (HIT), Medicaid, state health exchanges, and much more. Some programming highlights for this year's forum include:

    • a case study on the West Virginia Chapter's efforts to pass fair physical therapist (PT) copay legislation
    • practice and payment strategies for direct access
    • term protection for physical therapy
    • emerging areas of scope of practice in physical therapy
    • APTA's Alternative Payment System project
    • implementation of health care reform in the states

    This event is open to APTA members only. Registration is $140 for PTs and physical therapist assistants (PTAs) and $90 for students. Virginia Chapter members get a special discounted rate of $100 for PTs and PTAs, and $50 for students. Registration closes November 9. Registration will not be available onsite, so be sure to register by the deadline. Additional information is available at www.apta.org/stateforum.