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  • Looking Back, Looking Good: Check Out APTA's Year in Review

    In one of those "that was the year that was" moods that hits about this time of the season? Be sure to take a few minutes to include the physical therapy profession and APTA while you're reminiscing.

    Now posted on the APTA website: the "2015 Year in Review" webpage, a collection of best-ofs, must-sees, most-populars, what's-ins and what's-outs, infographics, podcasts, and more, all introduced by way of a letter from APTA President Sharon L. Dunn, PT, PhD, OCS.

    The webpage is a great way to remind yourself of a truly transformative year in the association's evolution, marked by achievements that speak to what the physical therapy profession can accomplish when it shares a common vision.

    "I have many times heard and spoken the words 'we're better together,'" Dunn writes in her letter. "It's not a new concept but it's an important one. One that rings true. We could not have achieved any of this without the work, support, and camaraderie of our members and components."

    Take a look at what you helped to achieve, see what you might've missed, and get ready for another great year.

    Study: FES and Fast-Walk Training May Help Keep Individuals Walking After Rehab Ends

    Authors of a new study say that for individuals poststroke, community walking ability may have more to do with reducing the energy cost of walking, and less to do with changes to timed walking evaluations such as the 6-minute walk test (6MWT). And they believe that functional electrical stimulation (FES) coupled with rehabilitation training at faster speeds can play a big role in helping to decrease that energy cost.

    The study focused on 50 individuals who had experienced a stroke 6 or more months earlier and demonstrated "observable gait deficits," but were able to walk without support for at least 6 minutes. Participants were assigned to 1 of 3 12-week rehabilitation programs: gait training at self-selected speeds (SS), gait training at fast speeds (FS), or gait training at fast speeds with the addition of FES (FastFES). Sessions were held 3 times a week for 36 weeks and comprised 5 bouts of 6 minutes of treadmill walking, followed by 1 bout of 6 minutes of overground walking (with breaks in-between). The training speeds of the FS and FastFES groups were based on each participant's maximum overground walking speed (MWS).

    While the SS and FS groups received similar sessions (albeit at different speeds), the FastFES group also received FES for 15 of the 30 minutes of the treadmill walking sessions. The FES was targeted to the paretic ankle plantarflexors during late stance phase and dorsiflexors during swing phase, triggered by switches attached to the sole of the participant's shoe, in an alternating pattern of 1 minute on and 1 minute off. Results of the study were published in Neurorehabilitation and Neural Repair (abstract only available for free). Authors of the study include APTA members Darcy S. Reisman, PT, PhD, and Stuart Binder-Macleod, PT, PhD, FAPTA.

    To evaluate the energy cost (EC) of walking, participants' oxygen consumption was measured after the participants walked overground at their comfortable walking speed for 5 minutes at baseline, at the conclusion of the 12-week program, and again 3 months later. Researchers found that the FastFES group reduced the energy cost of walking by 24%—a change that researchers describe as "substantial" given that at the beginning of the study, all participants averaged 61% more oxygen consumption per meter ambulated than healthy older adults.

    Authors of the study also conducted oxygen consumption tests after ambulation at fast walking speeds for the FS and FastFES groups. They found that the FastFES group reduced energy cost at that speed by 19%, while the group that did not receive FES recorded no significant reduction—"additional evidence supporting [the use of FES] during gait training," they write.

    Yet despite the reduction in energy costs, the FastFES group did not significantly outperform the other groups in the 6MWT, authors noted. All 3 groups improved, with both the FS and FastFES groups recording improvements slightly above the minimal detectable change. Authors write that this apparent "disconnect" between improvements in energy expenditure and 6MWT results "suggests that the 6MWT may not be sensitive to changes in EC" and that "persons poststroke may improve 6MWT performance through metabolically expensive compensatory mechanisms."

    That "disconnect" also prompted researchers to question how well the 6MWT really correlates to community walking after a stroke.

    "Walking performance in ecological contexts may be markedly different than what is observed during the 6MWT because individuals may not engage in long-distance walking-related activities that would necessitate frequent rests," authors write. "EC, in contrast, has been posited to be a variable able to bridge the disconnect between clinical measures of walking function and real-world walking performance."

    Authors acknowledged that their study has several limitations, among them the fact that participants were not blinded to the interventions used and that factors other than participants' baseline walking speed may have affected results. Additional studies, with larger sample sizes, would help to clarify whether these limitations had an effect, they write.

    Still they argue, results from this study show that FES coupled with faster-speed training does increase the energy efficiency of walking for individuals poststroke and that this important improvement may be overlooked by "gross measurers of walking function" such as the 6MWT. "A better understanding of how reductions in the energy cost of walking contribute to improved community walking participation is needed," they write.

    The value of FES was the subject of the 2015 Maley Lecture presented by Gad Alon, PT, PhD, during APTA's NEXT Conference and Exposition. In that lecture, Alon advocated for personalized rehabilitation programs in which FES is "a standard-of-care intervention option in rehabilitation medicine."

    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.

    Movie as Game-Changer: Opinions Vary on How 'Concussion' May or May Not Affect the NFL

    Concussion has been released—and with it, a wave of opinions on whether the film about chronic traumatic encephalopathy (CTE) among National Football League (NFL) players will make a difference in how the league, and society at large, view sports that involve high-impact body contact.

    The movie, which opened on December 25, stars Will Smith as forensic pathologist Bennett Omalu and chronicles Omalu's battle with the NFL to bring attention to CTE and its relationship to repeated head injury.

    And while there were plenty of reviews of the movie itself, even more media attention was focused on what the film had to say about the NFL, the sport of football, America's passion for the game, and the chances that a big-budget movie would spark any meaningful change that would reduce injury. Here's a quick rundown of some of the reactions published recently.

    • "CTE, and the prevalence of the disease among the young, however, has given [the NFL] a PR nightmare. And Concussion is likely to worsen the public's perception of the game." Newsweek: "Concussion: Can a Will Smith Movie Change the Way America Views Football?"
    • "Many of our retired gridiron heroes have come forward to say they have some form of brain damage from their glory days. Joe Namath, Brett Favre, Tony Dorsett, Terry Bradshaw, Harry Carson, the list goes on and it will continue to grow. I have no pity for them." Chicago Tribune: "NFL Players, Owners, and Fans All to Blame for Concussion Danger" (opinion from columnist Jerry Davich)
    • "[CBS Philadelphia sports commentator Jeff] Roe saw the film with me and questioned why, after seeing it, I was rushing home to see the Eagles. My response was I thought the players were now informed fully of the risks and didn't feel that I was morally shaky by enjoying such a violent game." CBS Philadelphia review: "Concussion Movie Will Not Cripple the NFL"
    • "But Concussion may actually make a difference because it doesn't require government action or even civilian action. All civilians have to do to voice their opposition is to not watch football and not play football." Forbes magazine: "Why Will Smith's 'Concussion' May Actually Impact the NFL"
    • "In a film with so little interest in gray areas, the bad guy becomes everyone who isn't the good guys, which leads us to Concussion's most troubling villain: us. For a movie that's ostensibly about how awful football is, Concussion sure has a lot of nice things to say about football." Slate: "Hands to the Face: The Woeful 'Concussion' Fails to Hold the NFL—or Anyone—Accountable for the CTE Crisis"
    • "Parents and players now know the warning signs [of CTE]. It does not mean that football will ever go away. As noted in the film, the NFL owns a day of the week. And it now stretches its tentacles to Thursday nights, Monday nights, and the occasional Saturday playoff game." Orlando Sentinel: "Brain Science Slowly Beaten Into NFL Owners' Heads in 'Concussion'" (opinion from columnist George Diaz)
    • “Any activity which results in repeated blows to the head has the risk of causing brain damage. Once you know the risk involved in something, what's the first thing you do? Protect the children from it.” Quote from Bennett Omalu in the Guardian: "Doctor Who Fought NFL Says 'No Equipment Can Prevent' Such Injuries"
    • "We have a grandson who plays. He's 7. After seeing this movie, I should probably go call his parents and say he shouldn't play anymore. But I can't do that. Isn't that awful? I'd rather roll the dice.” Quote from Taz Anderson, former NFL player, in Sports Illustrated: ‘Paid to Give Concussions' (Screening of 'Concussion' with 70 former NFL players)

    Physical therapists have a critical role in concussion prevention and management. APTA offers multiple resources on concussion, which include a Traumatic Brain Injury webpage, and a clinical summary on concussion available for free to members on PTNow. The association also offers a patient-focused Physical Therapist's Guide to Concussion on APTA's MoveForwardPT.com consumer website. Continuing education offerings from APTA include the prerecorded webinar "Managing Concussions With an Interprofessional Team" and the online course "Concussion and the Postconcussive Syndrome,” both available through the APTA Learning Center.

    Study: Health Information Data Breaches Hit Nearly Every Industry Between 2004 and 2014

    Data breaches of protected health information (PHI) aren't just a challenge for health care providers: according to a new report, it's a problem that has been experienced in 90% of all industries, from agriculture to entertainment. And those compromises could be changing patient behavior.

    In its recently released PHI Data Breach Report (.pdf), researchers for Verizon analyzed reported PHI data breach incidents in 25 countries from 1994 to 2014. Unlike other analyses that searched for records of breaches filed under "health care" in the North American Industry Classification System, the Verizon report expanded its review to include not only the health care industry, but any breach in any industry in which the data type lost was listed as "medical records," or the data subject (victim) of the breach was listed as "patient."

    The widened search yielded 1,972 breaches that affected 392 million records, most occurring between 2004 and 2014. The health care industry was the leader in terms of number of breaches, but nearly every other industry experienced breaches that involved PHIs.

    According to the study's authors, the widespread nature of the problem isn't all that surprising.

    "How many companies have employees?" authors write. "How many of these employees are involved in workers' compensation claims? These are likely to include health information, so that is one source where we'd expect to see this type of data collected." Other sources for PHI include wellness programs, the management of health insurance programs, and for some businesses such as insurance companies, the collection of PHI from customers.

    "The fact that an organization is not in the health care industry or isn't a HIPAA-covered entity doesn't mean that it's not at risk of a PHI data breach," authors write.

    The study found that most of the breaches were caused by "external actors" accessing PHIs (903 of the 1,972 breaches), but that internal actions weren't far behind (791). The difference: many of the internal breaches were likely accidents, with no malicious intent.

    Researchers believe that for the PHI breaches that were tied to actual theft, the perpetrators weren't as interested in the medical information as they were in accessing data that often accompanies this information—payment information, personal identity information, and credentials that can allow further access to other data.

    Authors of the study fear that regardless of the motivation for the breaches, the prevalence of the problem is having an effect on the relationship between the health care provider and the health care consumer. As public awareness of the breach issue increases, so does a patient's fear of providing information to a health care provider in the first place.

    "As reports of medical record losses continue to pile up, the trust between medical providers and their patients is being eroded," authors write. "The implications of this may be wider than practitioners anticipate."

    Want to learn more about protecting PHI? Check out the "Compliance Matters" column in the August issue of PT in Motion magazine for more on safeguarding patient information, as well as a link to a federal government resource on HIPAA rules around privacy, security, and breach notification.

    Is Physical Therapy Cost-Effective? It's Complicated

    A new systematic review takes on the question "is physical therapy cost-effective?" and responds with a definitive "it depends." But the equivocation isn't about whether physical therapy treatment actually makes a difference in patients as it is about the definition of "cost-effective"—and particularly, whether that definition includes societal costs.

    According to authors of the review, e-published ahead of print in the December issue of Physical Therapy (PTJ), APTA's research journal, there is little doubt that physical therapy improved health in nearly all 18 studies reviewed. But the question of whether the therapy was cost-effective is a little harder to pin down, with authors of this study applying a fairly rigorous definition of "cost-effectiveness" and finding that about half the studies cleared the bar.

    Researchers analyzed studies between 1998 and 2014 that compared physical therapy with usual care only, as well as studies that compared physical therapy added to usual care with usual care only. Of the 18 studies, 13 were classified as focusing on musculoskeletal issues, 2 were linked to "internal conditions" (urinary incontinence and intermittent claudication), 2 were related to neurological conditions, and 2 to what authors called "internal medicine" (falls prevention and the intermittent claudication study, which was also included in the internal conditions category). Studies reviewed were limited to only those that included data that would allow for an analysis of cost-effectiveness.

    Authors of the study found that in the 8 physical therapy vs usual care settings, the physical therapy approach was cost-effective in 5 studies—4 of those related to musculoskeletal conditions. Among the 11 studies that compared physical therapy plus usual care with usual care only, the addition of physical therapy was cost-effective in 4 of 11 studies.

    Authors of the study arrived at a cost-effectiveness determination by analyzing the cost difference between the intervention and the usual care divided by the difference in health outcome provided by the 2 treatments. Authors explain that this could at times be a difficult thing to nail down, as several studies didn't analyze data this way, and the manner in which outcomes are measured can vary.

    In the end, authors employed what they describe as a "very strict" definition of cost-effectiveness.

    "To be cost-effective, an intervention has to be cheaper than the standard treatment," authors write. "Usually, a more expensive intervention is accepted if additional costs are not too high. However, there is no clear defined cutoff above which costs should be considered as too high, hence our choice."

    That strict definition helped with the analysis, but doesn't necessarily capture the idea that physical therapy can be even more cost-effective when societal costs and long-term outcomes are factored in, according to the analysis.

    "Physical therapy sessions added to usual care increases health care costs," authors write. "However, when the analysis includes societal costs, such as costs related to absence from work, then the total costs are not higher for the group who received physical therapy added to usual care …. Therefore, cost-effectiveness analyses should not be limited to health care costs; total costs which consider both aspects are more relevant." Authors also noted that the strongest links to the cost-effectiveness of physical therapy—musculoskeletal conditions—are in an area of health care that affects large populations and generates considerable costs over time.

    Lymphedema Coverage Legislation Now in House and Senate

    Expanding Medicare coverage for lymphedema treatment, a change long-supported by APTA, may be closer to reality now that companion bills to that effect have been introduced in the US Senate and House of Representatives.

    In early December, Sen Maria Cantwell (WA), along with Sens Chuck Grassley (IA), Charles Schumer (NY) and Mark Kirk (IL), introduced the Senate version of the Lymphedema Treatment Act (S. 2373), a proposal that would expand the range of compression supplies covered by Medicare "that are the cornerstone of lymphedema treatment," according to a consumer group created to support the legislation. The version introduced in the Senate is companion legislation to a House bill (H.R. 1608) introduced in March by Rep. David Reichert (WA-8). The House bill now has 175 cosponsors.

    APTA's support for the legislation dates to 2014, when association representatives participated in a congressional hearing to educate lawmakers and staff on the bill after its introduction.

    More recently, APTA President Sharon Dunn, PT, PhD, OCS, reemphasized the association's backing for the bill in a letter to Reichert.

    "Currently, many of these items and services either are not covered or only are covered on a limited basis," Dunn wrote. "Passage of this legislation would ensure access to these supplies for individuals with lymphatic impairments and conditions." In her letter, Dunn also emphasized the role of physical therapists in manual lymph drainage, fitting patients for compression garments, and helping them engage in exercises to improve their cardiovascular health and potentially decrease swelling.

    APTA staff will monitor the legislation’s progress and update members with news and advocacy opportunities.

    Can a PT's Personality Traits Affect Outcomes for Patients With Chronic Disease? This Study Says Yes

    Want to improve physical therapy outcomes for patients with chronic diseases? Have a "calmer, more relaxed, secure, and resilient" personality, according to Dutch researchers.

    In an article published in the December 16 issue of BioMed Central's Health Services Research, researchers from the Netherlands compared treatment outcomes from patients with chronic disease such as arthritis, cardiovascular disease, cancer, chronic respiratory disease, and diabetes with the ways their treating physiotherapists (PTs) scored on "The Big 5" Index (BFI), a widely used personality test (you can take the test here).

    Authors of the study hoped to get a full picture of how the 5 personality dimensions measured in the test—neuroticism, agreeableness, conscientiousness, extraversion, and openness to experiences—played into patient outcomes. In the end, they found that only neuroticism seemed to have an impact.

    The neuroticism scale is essentially a measure of emotional stability, impulse control, and the tendency to express unpleasant emotions. A lower neuroticism score indicates "being more calm, relaxed, secure, and hardy," according to the study's authors.

    What researchers found was that worse patient outcomes seemed to be linked to PTs with a higher neuroticism score. The lack of any measurable link between the other personality dimension scores and outcomes "contradicts previous research in psychotherapy suggesting that traits including being empathetic, cautious, non-intrusive, respectful, being able to adjust, and exuding warmth … improve treatment outcomes," authors write.

    Treatment outcomes were measured using the Numeric Rating Scale (NRS), a "widely used Dutch outpatient practice tool for evaluating treatment effect by looking at the course of complaints during treatment." Scores were recorded at the beginning and end of physical therapy.

    In addition to scores on the personality test, researchers also looked at whether the PT experienced a "major life event" (a yes/no question with no accompanying explanation from the PT) during the past 3 years, as well as demographic features of the PTs. They found that having experienced a major life event correlated to better patient outcomes, as did being a male PT, but cited few reasons for the connections.

    Authors admit that the voluntary nature of the study led to a significant amount of missing data and relatively small PT sample size (39). They also acknowledge that there may be better personality tests but that the BFI was chosen "for practical reasons, since it does not take too long for a therapist to fill out."

    Despite these limitations, authors assert that their study supports the idea that "if a therapist does not feel mentally stable, it is reasonable to assume that this might have consequences for his or her attitude when interacting with the patient."

    Authors suggest that more research into personality dimensions could underscore the importance of self-reflection among providers—and the development of educational components that strengthen this ability.

    "Tools like communication skills training might be used as supplement to reflection, but [we] believe that self-awareness and reflection training during the early stages of study are needed before these tools can be used effectively," they write.

    APTA emphasizes the importance of prevention, wellness, and disease management, and offers resources for physical therapists (PTs) and their patients at MoveForwardPT.com in addition to online continuing education on disease management models. This year, the APTA House of Delegates emphasized the PT's important role in chronic disease management and treatment by adopting an official position titled "Health Priorities for Populations and Individuals" (RC 11-15).

    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.

    Physical Therapy 'Leader Among Leaders' Marylou Barnes Dies

    Physical therapy leader Marylou R. Barnes, PT, EdD, FAPTA, Catherine Worthingham fellow, educator, and author, died November 26. She was 85.

    Described during her Worthingham Fellow induction as a "leader among leaders" who possessed "visionary abilities tempered by her practical sense of reality," Barnes was professor Emerita of Georgia State University, where she earlier served as chair of the physical therapy program. Before coming to Georgia State, Barnes was founding director of the West Virginia University physical therapy program.

    Barnes was a highly respected member of APTA who earned multiple recognitions throughout her career, including the Leadership in Education Award (1995), the Mary McMillan Award, the Lucy Blair Service Award (1988), and the Service Award for the APTA Section on Neurology (1995), which also established the "Marylou Barnes Adopt-a-Doc" scholarship in her name. Barnes received an honorary doctorate from the University of Indianapolis, and a James Madison University (Virginia) Distinguished Alumni Award.

    In addition to her clinical and teaching achievements, Barnes was also the author of several textbooks, including The Patient at Home: A Manual of Exercise Programs, Self-Help Devices, and Home Care Procedures; and The Neurophysiological Basis of Patient Treatment, a text that was later expanded into 3 volumes with co-author and friend Carolyn Crutchfield, PT, FAPTA.

    Donations in Barnes' name may be made to the Foundation for Physical Therapy. Donations will be directed to the Neurology Section Fund, which annually supports a Promotion of Doctoral Studies (PODS) II scholarship awarded in honor of Barnes.

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

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

    Joy Crist, PT, MPT, GCS, helps a teenager regain mobility after a broken neck. (Magic Valley, Idaho, Times-News)

    Brad Cooper, PT, MSPT, MBA, MTC, ATC, CWC (and author of PT in Motion's "Well to Do" column),"The world's fittest CEO" – Profile of Cooper and his completion of the "endurance trifecta." (Colorado Runner)

    "One step at a time, the machine is helping this toddler regain his strength." – Story on 3-year-old Desmond Davis, the youngest-ever person to use the Lokomat Therapy Machine. (WDIV-TV, Detroit)

    Students from the University of Central Florida's physical therapy program hold a GoBabyGo! workshop that produces 16 cars for children. (UCF College & Campus News)

    "I love these people. They're like family." – Patient at a Detroit physical therapy clinic that helps people achieve mobility through robotics. (Michigan Live)

    Mick Bates, PT, and member of the West Virginia House of Representatives, has been appointed to the state's Workers' Compensation Council. (West Virginia State Journal)

    With their game cancelled, the US women's national soccer team decided to pay a visit to a Hawaii physical therapy clinic that treats wounded warriors. (Fox Sports)

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

    New York Times: Nursing Homes Challenged by Increased Obesity Rates

    As rates of obesity rise, so do the challenges associated with providing care. And nursing homes are feeling the strain.

    A recent article by Kaiser Health News (KHN) and The New York Times (NYT) looks at how care facilities are struggling to accommodate an ever-increasing number of residents who require special care and equipment related to their weight.

    "Obesity is redrawing the common imagery of old age: the slight nursing home resident is giving way to the obese senior, hampered by diabetes, disability, and other weight-related ailments," reporter Sarah Varney writes. "Facilities that have long cared for older adults are increasingly overwhelmed—and unprepared—to care for this new group of morbidly heavy patients."

    The KHN/NYT article explains that many nursing homes have been unable to keep up with the rapid rise in obesity rates among patients, and describes how these patients' needs for specialized beds and chairs, increased staff, and costlier medical equipment are not covered by Medicaid. The result: some nursing homes are declining hospital referrals for patients that the facilities cannot afford to care for.

    According to the article, "the reluctance to accept hospital referrals, especially when physical therapy or wound care is needed, comes down to practical matters: how many staff members will it take to turn the patient? Where is the wound? How long will physical therapy take?"

    APTA has been a strong advocate in the battle against obesity, and offers multiple resources on the role physical therapists and physical therapist assistants play in addressing prevention and wellness, including a 2-part podcast on the inactivity epidemic (part 1, part 2). In addition to continuing education on the PT and PTA role in countering obesity, the consumer-focused MoveForwardPT.com offers a guide to obesity, and PTNow includes several practice guidelines related to obesity. And look for more activity in the future: in 2015, APTA House of Delegates approved a measure to create and strengthen partnerships between the association and other organizations committed to addressing obesity.

    PT, PTA Education Leadership Institute Accepting Applications for a Program That Empowers, Inspires, and Connects

    Being a director for a physical therapist (PT) or physical therapist assistant (PTA) education program can sometimes seem as lonely as it is overwhelming—but it doesn't have to be that way. Again in 2016, APTA is inviting a select group of emerging program directors to learn from mentors and each other in ways that will enhance their own work and strengthen the profession overall.

    Called the Education Leadership Institute (ELI) Fellowship, the yearlong program uses a blended learning approach (online and onsite components) to help PT and PTA education directors in academic, residency, and fellowship settings to hone their skills in facilitating change, thinking strategically, and engaging in public discourse to advance the physical therapy profession. APTA is accepting applications to the program through January 15, 2016, 5:00 pm ET.

    For Merrill Landers, PT, DPT, PhD, OCS, chair of the Department of Physical Therapy at the University of Nevada, Las Vegas, ELI was the right program at the right time. "The ELI program was just what I needed as a new department chair," Landers said. "It provided me a big-picture understanding of the role that a department chair plays in higher education, and it gave me the tools to be a vision-driven leader."

    Holly Clynch, PT, DPT, MA, GCS, said that ELI helped her gain the confidence to step up to her current role as director of the physical therapist assistant program at St Catherine University, in Minneapolis. "The self-assessment and development activities were really beneficial in helping me decide if I was mentally ready to take on the challenge of becoming a program director," Clynch said. "The knowledge I gained helped me prepare for those challenges."

    In addition to the personal benefits ELI provides, both Clynch and Landers view the program as a help to the profession.

    "When you participate in ELI, you learn how to facilitate strong teaching and learning environments, which ultimately enhances the skills, knowledge, and confidence of students entering the physical therapy profession," Clynch said. "And those skills learned in ELI are transferrable—as leaders in the profession, we can use them not just in academia, but in service to our patients and APTA."

    Landers agreed. "Better academic leadership helps facilitate better student outcomes, and better student outcomes in turn help to better patient outcomes," Landers said. "The improved academic leadership that ELI promotes lifts the whole profession and better positions physical therapists as leaders of the health care team."

    And as for that "it's lonely at the top" feeling, Clynch says that ELI helps lessen that sense of isolation.

    "Because it's a yearlong program that encourages interaction not just with mentors but among participants, ELI builds real connections," she said. "I now have a new network of colleagues that I can continue to turn to when I need advice or support." ELI is a collaborative effort with the American Council of Academic Physical Therapy, Education Section, Physical Therapist Assistant Educators Special Interest Group, and APTA. It is accredited by the American Board of Physical Therapy Residency and Fellowship Education.

    Considering the fellowship experience? Check out the video testimonials of ELI graduates.

    Board Approves 2016 Budget, Discusses Strategic Plan Objectives, and More at November Meeting

     Editor's note: this story has been altered from an earlier version that incorrectly stated the date of the next in-person meeting of the APTA Board of Directors. The correct meeting date is February 16, not February 17. 

     Solidifying the association’s anticipated activities in 2016 with approval of next year’s budget, the APTA Board of Directors (Board) met at APTA headquarters November 18-21 to discuss current issues that impact the association and its members. The Board took action on the following items:

    • Approved the $45 million operating budget for 2016, with a net zero balance
    • Adopted recommendations from the Excellence in Education Task Force that are intended to best prepare physical therapist students for current and future practice
    • Reviewed the motions from the 2015 House of Delegates and approved a document outlining their disposition so far
    • Agreed to send to send a motion to the 2016 House of Delegates to adopt a new definition of “scope of practice” in physical therapy

    Board members heard strategic reports from the Foundation for Physical Therapy; the new editor of Physical Therapy, APTA’s scientific journal; and the Recruitment and Retention of Early-Career Members Task Force. Additional discussions covered a national quality strategy, ongoing improvements to support the House of Delegates, and mid- and long-term communications strategies that included a crisis communications plan.

    A key discussion during the meeting involved further development and refinement of APTA’s Strategic Plan. With top-level goals already in place in the areas of transforming society, transforming the profession, and transforming the association, the Board conferred on potential sub-level objectives that will be potential measures of how the association is achieving the goals. Critical activities in this regard involved payment reform, partnerships, and recognition and application of the movement system in physical therapist practice.

    As part of its fiduciary responsibility, the Board also conducted its annual business as the governing body of the PT Fund and APT Properties.

    Find the minutes for this and past APTA Board of Directors meetings on the association’s website. The Board meets monthly by conference call and is scheduled for its next in-person meeting on February 16, 2015, in Anaheim, California, during Combined Sections Meeting.

    New Study Says Schools Missing Out on Physical Activity Opportunities

    While adolescents technically get the majority of their moderate-to-vigorous physical activity (MVPA) at school, when you consider the fact that school is where adolescents spend most of their time in the first place, the actual proportion of that activity isn't all that impressive. But then again, neither are the MVPA numbers for just about any other place they spend their waking hours, according to researchers.

    Those are just 2 of the findings in a new study that used GPS devices and accelerometers to track exactly where and when MVPA took place among 12- to 16-year-olds. The study, e-published ahead of print in Pediatrics (abstract only available for free), tracked the activities of 549 adolescents to get a glimpse of how close the group came to meeting public health guidelines for at least 60 minutes of MVPA per day, and where they experienced the activity. Samples were drawn from the Baltimore-Washington and Seattle-King County metropolitan areas, and included 446 census block regions. Half of the participants were female; 31.3% were nonwhite or Hispanic.

    Overall, what researchers found was not news: the adolescents came up short on meeting MVPA goals, on average attaining only 39.4 minutes per day of this type of activity. Of particular interest to the study's authors, however, were the GPS-generated data that helped them track where the MVPA occurred: at home, at school, near-home (defined as within 1 km of the home), near school (within 1 km of the school), or all other locations. Here's what they found:

    School is where most MVPA happens—but that's not saying much. During the week, participants recorded 42.4% of their overall MVPA at school. The problem, according to researchers, is that school takes up the biggest chunk of an adolescent's waking hours, which means that proportionally speaking, physical activity only makes up about 4.8% of a school day—the lowest proportion in all locations studied.

    Home isn't much better. Participants spent 27.7% of their waking hours at home. During that time, only 5.3% of the time was spent engaged in MVPA.

    Near-home and near-school are higher-proportion MVPA locations. Time spent in near-home locations accounted for 12.6% of waking time, with 9.5% of that time spent in MVPA. Near school locations comprised 3.5% of waking time, and 9.7% of that time consisted of MVPA.

    Other locations were not standouts, either. On average, 14.1% of participant time was spent in other locations, with MVPA occurring at a 7.1% rate during that time.

    Differences surfaced among participants. Although researchers found no significant age, racial, or ethnic disparities, they did record fewer MVPA hours among girls than among boys, with the exception of the near-school location.

    Authors of the study pointed to school as the location with the biggest gap in waking hours vs MVPA, and warned that it was possible that the rate of MVPA might be even lower than the 4.8% recorded, given that the rate may have included sports or afterschool programs—not technically part of the school day.

    But that differential presents an opportunity, they write, noting that "because adolescents spend so much time at school, even a small increase in the proportion of at-school time spent physically active could lead to meaningful increases in overall physical activity and metabolic health." In fact, they add, if the proportion of MVPA were upped to 7.5% of the day—about 4.5 minutes per hour—students could achieve the 30 minutes of MVPA recommended per school day.

    Another promising area, according to the study's authors, are the near-home and near-school locations, where community and neighborhood-based efforts to make physical activity easier and safer—particularly travel to and from school—could pay off.

    "Supporting neighborhood-based activity through organized programs and informal supervision could improve parents' perceptions of safety and may lead them to allow their adolescents to spend more time outdoors being active in the neighborhood," they write. "Increasing active travel remains an intervention priority, because active travel is a significant contributor to overall physical activity, but current rates are low."

    And authors believe health care providers can make a difference.

    "Health care providers can advocate for youth physical activity by engaging in local planning and decision-making processes to increase use of neighborhood locations that support physical activity and to improve facilities and physical activity programs in all settings," they write. "Health care providers can parents to encourage their children to spend less time at home and more time in home and school neighborhoods where youth are more likely to engage in physical activity."

    APTA has long supported the promotion of physical activity and the value of physical fitness, and has representatives on the practice committee of Exercise is Medicine. The association offers several resources on obesity, including continuing education on childhood obesity, and a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity.

    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.

    Study: Surgical Site Injections, Not Femoral Nerve Blocks, Work Best for Recovery After TKA

    For patients undergoing total knee arthroplasty (TKA), femoral nerve blocks may result in more inpatient physical therapy sessions and longer hospital stays than the injection of anesthetics around the surgical site only (periarticular injections), according to a new study. Authors believe the improved results from the periarticular injections may underscore the importance of maintaining as much motor function as possible postoperatively.

    The study, published in the Journal of the American Osteopathic Association, compared average numbers of inpatient physical therapy sessions and hospital days among a group of 16 patients (mostly women) who received 2 TKAs—1 TKA with femoral nerve block, and then a later TKA with periarticular injection. All procedures were performed by the same surgeon, with an average of 2.3 years between procedures.

    Researchers looked at treatment records for both procedures to find out just what it took for patients to reach their discharge goal: the ability to walk 150 or more steps independently, and the achievement of self-rated levels of pain less than 5 on a 10-point scale.

    When they compared the techniques, they found that periarticular injection reduced the number of required physical therapy sessions to an average of 2.3, compared with 3.5 for femoral nerve block. Similarly, hospital stays were less with the periarticular approach, at an average of 1.5 days compared with 1.9 days for the nerve block. Researchers estimated that the reductions amount to a per-patient savings of approximately $480 for physical therapy and $759 in hospital stay charges.

    Authors of the study note that femoral nerve blocks weaken quadriceps muscles and force patients to wait from 12 to 24 hours for motor function to return, and write that their findings "suggest that patients who receive periarticular injection … are able to ambulate independently faster because it does not affect postoperative motor function."

    The researchers acknowledge that their study has limitations, including the possibility that patients who undergo a second TKA may recover more quickly "because they had already experienced the procedure and knew what was expected of them during the postoperative period." While a possibility, researchers believe there's not enough research evidence to substantiate that theory. "In our experience, the type of postoperative analgesia has been the single largest factor influencing patients' ability to complete inpatient physical therapy," they write.

    APTA's PTNow includes a clinical summary on rehabilitation after TKA.

    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.  

    Big Gaps in Evidence Still Exist for Electromechanical and Robot-Assisted Arm Training Poststroke

    Robot-assisted arm training for individuals poststroke may be increasingly prevalent, but the quality of evidence supporting its effectiveness remains low. And though studies do seem to characterize the intervention as a way to improve arm function after a stroke, the lack of sufficiently strong clinical trials leaves authors of a recently updated Cochrane review wondering if the gains might simply be a matter of the amount of repetitions available through a robotic system, or even due to increased patient motivation fueled by the "novelty" of the devices.

    The update published earlier this year—and now available through APTA's PTNow website—reviewed 34 trials involving 1,160 participants up to March of 2015. Authors included trials examined in the 2008 and 2012 versions of the review as well as 15 more recent studies, all of which compared electromechanical and robot-assisted arm training with "any other intervention" for improving arm function during activities of daily living and improving impairments.

    Beyond that basic comparison, however, there were lots of variations among the studies. Some compared robot-assisted training plus conventional arm therapy with conventional arm therapy alone, while others compared the robotic intervention with a placebo. Study duration ranged from 2 weeks to 12 weeks, with treatment intensity varying from 20 minutes to 105 minutes each working day (and in some studies, intensity was not clear). Participants’ ages ranged from 20 to 80 years old, depending on the study, and sample sizes varied from 8 to 127 participants. The studies used a total of 19 different devices, although the Bi-Manu-Track was the most commonly used technology.

    Authors write that while the evidence was rated as "low to very low" quality, "there seems to be a potential benefit" of electromechanical and robot arm training: namely, in improvements of activities of daily living among participants treated in the acute and subacute phase poststroke. Patients in the chronic phase did not register more improvement.

    But when it comes to why, exactly, any increased improvement might be possible, evidence was lacking, and authors of the review were left guessing. As an example of the research gaps, authors cited the fact that most studies matched time in therapy for the treatment and control groups—but they didn't actually identify treatment dosage received beyond that.

    "One could … argue that robot-assisted arm therapy after stroke is more effective … than other interventions if the same time of practice is offered," authors write. "Then again … it could just be that more repetitions in the same time were applied by robotic-assisted arm training (higher dose). This appears to be an important issue that should be taken into account when discussing the effectiveness of electromechanical and robot-assisted therapy."

    If it's a matter of increased repetitions available through robot-assisted therapy, authors argue, "electromechanical devices could … be used as an adjunct to conventional therapies." But it's not clear if the differences are clinically meaningful.

    And without better evidence, it's not even clear that higher-dose therapy is at the heart of any improvements.

    "Perhaps 1 main difference between electromechanical or robot-assisted arm training and other interventions could be an improvement in motivation due to the feedback of the device, or the novelty of the robotic device, or both," authors write. "However, we can only speculate about this."

    Dazzle at Your Next Party: Fill Up on Stats With This 'PT in Motion' News Quiz

    The holiday season is upon us, which means holiday gatherings are upon us, which means you're going to be forced into making small talk at some point. At a loss for subject matter? Don't worry—PT in Motion News has you covered.

    Take the quick 5-question quiz below, with questions (and answers) chock full of statistics courtesy of the Agency for Healthcare Research and Quality's (AHRQ's) National Quality Measures Clearinghouse. Commit a few to memory; then, when the weather and "what streets did you take to get here" talk tapers off, drop a musculoskeletal statistic or 2. Boom, you're a hero.

    Because let's face it: nothing livens up a party like casually spouting off median workdays missed due to carpal tunnel syndrome in 2012. (Oh, yeah, we've got that stat.) Test yourself on these:

    1. What percentage of Americans report back pain each year?
      A. 5%-10%
      B. 10%-15%
      C. 15%-20%
      D. 20%-25%
        
    2. According to private sector employers in the US, what portion of workday losses in 2012 were attributable to musculoskeletal disorders?
      A. 1 out of 10
      B. 1 out of 8
      C. 1 out of 4
      D. 1 out of 3
        
    3. About those musculoskeletal disorder-related workday losses mentioned in question 2: how many involved injury to the back?
      A. 42%
      B. 54%
      C. 60%
      D. 66%
        
    4. Across the US, approximately how many cases of carpal tunnel syndrome that resulted in days away from work were reported by private sector employers in 2012?
      A. 10,500
      B. 15,400
      C. 7,600
      D. 5,000
        
    5. About how many private sector workers experienced a nonfatal work-related amputation in 2012?
      A. 2,330
      B. 3,150
      C. 4,200
      D. 5,120

    ANSWERS

    1. Answer: C. According to AHRQ, 15%-20% of Americans report back pain each year, resulting in an estimated 100 million workdays lost.
    2. Answer: D. Private employers report that a third of lost workday cases were related to musculoskeletal disorders. That's equivalent to 35.1 musculoskeletal disorder cases per 100,000 full-time workers.
    3. Answer: A. Just over 42% of all musculoskeletal disorder-related cases were due to back injury. Injuries to the upper extremities were the second most-prevalent, at 28.5%.
    4. Answer: C. In 2012, there were 7,590 reported cases of carpal tunnel syndrome that resulted in days away from work. Median number of days away from work: 30.
    5. Answer: D. Of the 5,120 nonfatal work-related amputations, about 95% involved the hand. Just over 8 out of 10 workers who experienced nonfatal work-related amputations (of all kinds) were male.

    UnitedHealthCare to Cover Standing Systems as Medically Necessary

    Thanks in part to expert input from APTA, beneficiaries of UnitedHealthCare (UHC) who are nonambulatory and can benefit from stationary, mobile, or active standing systems may have the cost of the system covered by their insurance. UHC has reversed its medical policy on covering the costs of standing systems (.pdf) after asking for and receiving recommendations from APTA. The new policy became effective December 1, 2015.

    Commercial payers such as UHC periodically ask professional societies to provide evidence-based guidance during reviews of their coverage policies, to ensure that policies are comprehensive, accurate, and up-to-date. APTA pulled together subject matter experts who presented evidence to UHC's Assessment Committee earlier this year; that presentation contributed to UHC changing its stance on the medical necessity of standing systems for patients who meet certain criteria. The evidence showed that enabling these patients to maintain an upright posture can increase their range of motion, reduce swelling, decrease spasticity, prevent pressure sores, improve bowel and bladder function, and maintain bone density, muscle strength, and cardiovascular endurance. Not only can these and other benefits improve the patient's quality of life, they can reduce or avoid costly medical procedures.

    Among the criteria for considering a standing system to be medically necessary for a particular individual are that the person must have been unable to accomplish his or her medical goals with current devices, equipment, or alternative treatment; and an independent review must show that the person complies with usage requirements and tolerates the system, and must show demonstrated potential clinical benefit.

    The updated policy still considers some key accessories as convenience items; however, the decision to cover these systems in general is major progress toward transforming the lives of our patients by providing them with the necessary tools to optimize their function.

    Mobile Device-Based Research Ethics Will Be Target of New Program

    Health care research that uses data collected from sensors, social media, and mobile devices such as iPhones already has a catchy name—"mHealth" research. What it doesn't have are specific guidelines for research ethics. A new initiative aims to change that.

    According to a press release from the University of California, San Diego, the university will begin creating a web-based resource to guide ethically sound mHealth research, called the Connected and Open Research Ethics (CORE) project.

    Research that uses mobile devices and similar technologies has increased dramatically in 2015, thanks in part to technologies such as Apple's ResearchKit health research app, which turns iPhones into interactive monitoring devices and feeds data back to researchers. Less than 24 hours after the debut of the app, researchers studying Parkinson disease reported receiving participation consent from more than 5,500 subjects, with cardiac researchers receiving double that number.

    "There are an estimated 6,000 IRBs [institutional review boards] out there, and they all will need to think about how the existing regulations apply to 21st century research tools and methods," said CORE Principal Investigator Camille Nebeker, EdD, MS, in the press release. "At the same time, IRBs frequently lack the expertise or resources necessary for making informed decisions about studies involving [mobile device and other personal technology] methods, so researchers are engaging independently with them—which means they’re often duplicating efforts."

    Nebeker commented that "what is challenging now is that technology is outpacing the development of ethical standards to guide the evaluation of study risks and benefits."

    The CORE project will focus on technologies it dubs MISST: mobile imaging, pervasive sensing, social media, and location tracking. The team developing the ethical framework will include researchers, IRBs, and research participants. CORE is funded through a 2-year grant from the Robert Wood Johnson Foundation.

    4 Reasons You Should Read the PTJ Series on Health Services Research and Policy Right Now

    Not news: physical therapists (PTs) and physical therapist assistants (PTAs) face a policy environment that increasingly demands the profession to demonstrate its value, not just in terms of individual patient outcomes but across the entire spectrum of health care.

    News: PTs are laying the research foundation that will help to do exactly that and help to keep the profession at the table when it comes to the big discussions about big health care policy ideas.

    And you are affected whether your professional focus is clinical, academic, or research.

    Beginning with the December 2015 issue, Physical Therapy (PTJ) launches a 3-part special series on health services research (HSR). The offerings featured in the series aren't your usual clinically focused articles (although the issue includes those as well); instead, they examine health services from a physical therapy perspective. PTJ is available for free to APTA members.

    In a guest editorial, Linda Resnik, PT, PhD, director of the Center on Health Services Training and Research (CoHSTAR), and Janet Freburger PT, PhD, senior research fellow at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, make the case that when it comes to HSR, "physical therapy has arrived," and the profession now has a "critical mass" of experts doing important work in this area. From that editorial, here are 4 reasons you should pay attention:

    1. HSR will shape the way you care for patients and clients, and how policymakers look at that care.
      "HSR provides data, evidence, and tools to make health care affordable, safe, effective, equitable, accessible, and patient-centered," according to the editorial. "At one end of the spectrum, HSR can enable providers and patients to make better decisions about their individual health care; at the other end, HSR can inform decisions about payment policy and health care coverage for populations."
    2. HSR is building the profession's research chops in critical ways.
      "The interdisciplinary nature of HSR draws on methods and data sources that are common to a variety of other disciplines … but that are not typically taught in rehabilitation science graduate degree programs," write Resnik and Freburger, co-editors of the series. The fact that there were more than enough high-quality HSR projects to span a 3-issue series (PTJ had originally contemplated a single-issue version) shows that "the physical therapy community coalesced to address this gap."
    3. This is an ideal time to get familiar with HSR, because you'll be hearing a lot more about it in the future.
      The publication of the PTJ series arrives during the same year as a watershed moment for the physical therapy profession: the establishment of CoHSTAR, a multi-institutional training center for physical therapy HSR. The $2.5 million center will focus on equipping PTs and PTAs to expand high-quality HSR, and it will raise the profile of physical therapy in HSR across disciplines. Bottom line: there's much more to come.
    4. One look at the topics covered in this issue, and it's easy to see why this research matters.
      If the first 3 reasons weren’t relevant enough for you, the articles speak for themselves. Topics include:

      - Alternative therapy cap systems
      - The validity of G-code severity modifiers
      - Therapy intensity and 30-day hospital readmission rates
      - Direct access to PTs and lower costs associated with episodes of low back pain
      - The burden of out-of-pocket costs for physical therapy
      - How research "clusters" measures (for example using patients seen by the same provider), and how to account for that effect in HSR

    Founded in 1921, PTJ is the official publication of the American Physical Therapy Association and is an international scholarly peer-reviewed journal. PTJ is available for free to APTA members.

    2016 CSM Registration Discounts End Dec 16

    The 2016 APTA Combined Sections Meeting (CSM) is shaping up to be one of the biggest ever, and you still have time to get in on early registration discounts—but do it soon, because they end December 16.

    Slated for February 17-20 in Anaheim, California, CSM 2016 is on track to include more than 10,000 physical therapy professionals and students for an event that will include over 300 sessions, preconference courses, unmatched networking opportunities, and a 1-of-a-kind exhibit hall. Plus, it's in Anaheim: close to Disneyland and not far from the beach.

    Tip: Hotels near the primary CSM site at the Anaheim Convention Center are almost sold out, so be sure to book housing soon.

    Free Webinar on 2016 Payment Changes Coming Dec 17

    January's just around the corner—are you ready? Ready to set new goals? Take fresh stock? Make a few resolutions? But most of all, are you up-to-date with changes in payment policy? APTA can help.

    Coming December 17: "The Year Ahead for Outpatient Physical Therapy—Payment Policies in 2016." This 90-minute webinar, led by APTA regulatory affairs staff experts Roshunda Drummond-Dye, JD, and Heather Smith, PT, MPH, will provide the latest information on the 2016 Medicare fee schedule, the therapy cap, quality initiatives, program integrity, and more. And the best part—it's free to APTA members.

    The live webinar runs 2:00 pm-3:30 pm, ET, and online registration is easy (just click on the "purchase" button on the course description page). Registration closes December 16 at noon ET.

    Not able to make the webinar? Register anyway—all registered participants will have access to a recording of the session within a few days of the air date.

    2016 Slate of Candidates Posted

    The 2016 Slate of Candidates for APTA national office is now available on the APTA website. The candidate webpage, including candidate pictures, statements, and biographical information will be posted on March 14, 2016.

    Elections for national office will be held at the 2016 House of Delegates on June 6, 2016. Please contact Amber Neil in APTA's Governance and Leadership Department for additional information.

    2014 Health Care Spending Up, Fueled by Increased Coverage Under ACA

    Last year, spending on health care in the US rose at its fastest rate since the 2008 recession, climbing 5.3% to $3.03 trillion, and representing 17.5% of the country's gross domestic product. It's a rise more or less in line with predictions, and one that has a lot to do with expanded health care coverage under the Affordable Care Act (ACA).

    In a report published on December 2 in Health Affairs, the Centers for Medicare and Medicaid Services' Office of Actuaries wrote that "the expansion of insurance coverage, particularly through Medicaid and private health insurance, and rapid growth in retail prescription drug spending" fueled the growth, which outpaced the overall economy.

    That overall growth translated into a 4.5% per-capita spending increase, which the report further breaks down into 3 factors: changes in the age and sex mix of the population, medical price inflation, and "residual use and intensity"—basically, the amount of health care usage that remains once the effects of age, population, sex, and inflation are removed. Of those 3 factors, residual use was responsible for nearly half of the 4.5% increase, with medical price inflation not far behind at about 40% of the increase. Demographic changes accounted for about 13% of the growth. Bottom line: more people are using more health care, largely due to expanded coverage made available through the ACA, with some analysts theorizing that the lack of insurance created a "pent-up demand" for certain procedures.

    In terms of spending by category, prescription drugs shot up by 12.2% in 2014—far and away the most dramatic increase. Hospital care rose by 4.1% last year, compared with 3.5% the year before, and "physician and clinical services" came close to doubling the 2013 rate of increase, from an historically low 2.5% rate in 2013 to a 2014 rate of 4.6%.

    The spending increase—and reasons for it—were widely covered in mass market media such as NBC News and the Wall Street Journal(WSJ), and industry-focused media includingModern Healthcare (subscription required). Most reports characterized the rise as not particularly surprising.

    According to those articles, while anticipated, the increase leaves some questions unanswered.

    In the WSJ report, those questions have to do with whether the ACA is actually fueling or tamping down the rates, and whether the higher-but-still-modest increase is due to greater reliance on out-of-pocket spending from patients, who in turn tend to use less health care.

    Modern Healthcare turns to questions about the shift away from fee-for-service payment systems and toward health care based on outcomes, and whether those efforts are making a difference in spending.

    "What remains murky from the actuaries' report is whether hospitals, doctors and others in the healthcare delivery system have been removing enough wasteful processes to help control costs," reports Modern Healthcare. "There's also skepticism that providers are shifting quickly away from the fee-for-service system, although some economists are optimistic value-based payments can lower the nation's healthcare expenses."

    Diabetes Rates Decline 2008-2014, But Experts Say Crisis Far From Over

    Across the US, diabetes rates have been falling—but not for everyone, and not dramatically enough to indicate that crisis is over.

    This week, The New York Times (NYT), National Public Radio (NPR), US News and World Report, and other media outlets reported on recent statistics from the US Centers for Disease Control and Prevention (CDC) that noted a drop in reported cases of type I and type 2 diabetes, from 1.7 million cases in 2008 to 1.4 million in 2014.

    According to the NYT, "the drop has been gradual and for a number of years was not big enough to be statistically significant," but the latest data "serve as a robust confirmation that the decline is real."

    Males, white people, young people, young and middle-aged adults, and people with more than a high school education all recorded declines; however, rates did not show consistent drops for the elderly and minorities, according to US News and World Report. The CDC report estimates the 2014 incidence of diabetes at 6.4 per 1,000 for whites, 8.4 per 1,000 among blacks, and 8.5 per 1,000 among Hispanics. The CDC report combines type 1 and 2 diabetes in its statistics.

    Experts contacted for the stories characterized the decline as positive news, but were clear that the relatively modest reductions were not a signal that the fight against diabetes is won. As for reasons for the drop, most of those interviewed point to overall societal trends toward healthier eating and increased physical activity as at least part of the cause for the decline.

    In an interview with NPR, David Nathan, MD, who works with the National Institute of Health's Diabetes Prevention Program, also credits more targeted prevention efforts as a possible contributor to the drop.

    "It's hard to argue that increasing activity levels and decreasing weight wouldn't be good for everyone, but for those programs to be efficient you've got to target high-risk people," Nathan tells NPR.

    APTA emphasizes the importance of prevention, wellness, and disease management, and offers resources on diabetes for physical therapists (PTs) and their patients through its Move Forward diabetes webpage and in a pocket guide to diabetes. The association also offers 21 clinical practice guidelines on care for patients with diabetes as well as 3 Cochrane reviews related to care for patients with diabetes-related foot ulcers through its PTNow evidence-based research tool. This year, the APTA House of Delegates emphasized the PT's important role in chronic disease management and treatment by adopting an official position titled "Health Priorities for Populations and Individuals" (RC 11-15).

    Still a Great IDEA: Disabilities Education Act Marks 40th Anniversary

    Move over Medicare, 2015 also happened to mark a significant anniversary for another major program: happy 40th to the Individuals with Disabilities Education Act (IDEA), a law that changed the lives of millions of children and families, and involved physical therapists (PTs) and physical therapist assistants (PTAs) from nearly the very start. PTs and PTAs, led by APTA's Section on Pediatrics (SOP), have been celebrating the landmark legislation, which was officially signed into law by then-President Gerald Ford on November 29, 1975.

    Originally called the "Education of All Handicapped Children Act," IDEA ensures that public education is made available to all children, regardless of disability. It's the law behind early intervention (Part C, birth through age 2) and special education and related services (Part B, ages 3-21) now provided to more than 6.5 million eligible children across the country.

    IDEA has dramatically altered the educational landscape for children with disabilities, but according to Tricia Catalino, PT, DSc, PCS, chair of SOP’s Early Intervention Special Interest Group, the law has also helped to shape the physical therapy profession.

    "In many ways, the early intervention provisions of IDEA have helped PTs transform our practice," Catalino said. "IDEA really led the way toward transdisciplinary teaming, family-centered care, participation-based outcomes and interventions, and delivering services in natural environments."

    As often happens, the law evolved over its 40-year history, incorporating provisions for transitions to adult living in 1984, introducing the Part C infant and toddler provisions in 1986, and officially becoming IDEA in 1990, among other changes. Along the way, lawsuits helped shape the way IDEA was interpreted, including a 2005 US Supreme Court ruling that held that parents, not a school system, are responsible for the burden of proving a claim that an individualized educational program (IEP) for a child with a disability does not satisfy the child's needs (Schaffer v Weast).

    IDEA's evolution—and at times, survival--was also aided by APTA, and especially SOP, which advocated for reauthorization and increased funding at various points, and helped legislators develop language changes that recognized the changing nature of the physical therapy profession, as well as the processes that needed to be put in place to ensure the cooperation and effectiveness of the IEP team.

    This year, SOP honored IDEA's 40th birthday during its annual conference in early November, with the school-based special interest group handing out stickers and information. Photos from the conference—including pictures of attendees holding " IDEA Opens Doors" signs (fashioned after APTA’s #PTTRANSFORMS version)—are available on the SOP's Facebook page.

    For Catalino, IDEA really is at the heart of what the physical therapy profession is all about—transforming society.

    "What is particularly gratifying about Part C Early Intervention, and, really, the entire IDEA, is that by supporting young children with disabilities and their families during naturally occurring activities and routines PT’s, and the entire team, are helping create inclusive environments for children’s development, learning, and participation as full members of their communities," she said. "Through the IDEA, we're helping to make real transformation possible."

    2015 - 12 - 2 - Woman Holding IDEA Transforms Sign

    APTA's Section on Pediatrics' annual conference included recognition of the 40th anniversary of the IDEA and its strong ties to physical therapy.

     

     

    Want to learn more about IDEA and its relationship to physical therapy? Check out APTA's webpage devoted to the IDEA and the Elementary and Secondary Education Act (ESEA).

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

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

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

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

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

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

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