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  • Relevant Reading: 2018's Top PT in Motion Magazine Stories

    Want to get a feel for the reach and diversity of the physical therapy profession? Browse through a few issues of PT in Motion magazine, APTA's award-winning monthly member publication—whether it's an exploration of what physical therapists (PTs) and physical therapist assistants (PTAs) need to know about medical marijuana or an investigation into working with particular populations such as combat athletes, articles are packed with information, insight, and most important, relevance.

    If you missed out on a story, don't worry—APTA maintains an online archive of back issues you can access any time.

    And if you don't know where to start, we can help with that, too. Here are links to the 5 most popular articles from 2018.

    A Growing Interest in Medical Marijuana
    When it comes to the use of medical marijuana, PTs and PTAs need to understand not only the complicated legal landscape associated with use of the drug, but the ways in which use of medical marijuana may influence physical therapy care.

    Improving the Lives of People With Dementia
    Although it may seem counterintuitive to some, PTs and PTAs have an important role to play in the care for individuals with Alzheimer's disease and other dementias.

    Working With Combat Athletes
    Combat athletes—individuals who compete in sports such as boxing, wrestling, mixed martial arts, and Brazilian jiu jitsu—subject their bodies to intensely demanding situations that can lead to serious injury. But PTs and PTAs can be instrumental in helping them recover from (and even prevent) those injuries and come out swinging—or kicking. Or both.

    Pedaling Past Injury
    More than 100 million Americans ride a bike each year. No matter the kind of riding they do, all riders face some of the same challenges, such as risk for falling, overuse injuries, and improper alignment due to a poor bike fit. That's where PTs and PTAs come in.

    Not 'Small Adults'
    PTs and PTAs treating pediatric overuse injuries must approach their work with the understanding that the biomechanics of children can be different from those of adults. And that can get complicated.

    Getting an Eyeful: Top APTA Videos of 2018

    APTA produced a wide variety of videos during 2018, ranging from a full recording of its live "Beyond Opioids" Facebook Live event to short-form public awareness spots featuring people such as Dani Burt, PT, DPT, an adaptive Olympics champion.

    In the end, viewers' preferences were equally diverse. Here's a rundown of the 4 most-watched APTA videos of 2018.

    CSM interview: Blood flow restriction training
    This dispatch from the 2018 APTA Combined Sections Meeting brought together Johnny Owens, PT, MPT, a longtime proponent of blood flow restriction training, and ESPN's Stephania Bell, PT, for a conversation with Jason Bellamy, APTA's vice president of communications.

    You Are APTA
    APTA members are advocates, entrepreneurs, global servants, researchers, motivators, healers, innovators, and so much more. And the APTA community is helping all of them to make important connections, advance their careers, and expand their ability to help patients. This quick video provides a glimpse into the diversity and passion within the association.

    CSM 2018: Bigger Than Ever!
    Missed the largest-ever Combined Sections Meeting (CSM) and want to get a feel for what all the excitement's about? Or maybe you went to CSM and want to feel a bit of the energy all over again. This video's for you (and after watching, make plans to attend this year's CSM, January 23-26 in downtown Washington, DC).

    “You’re never alone!” (Joanna Lohman profile)
    When Washington Spirit midfielder Joanna Lohman tore the anterior cruciate ligament in her left knee, it didn’t just end her 2017 season. It also “shattered” her identity. But through hard work with her physical therapists, Lohman returned to the sport she loves.

    Moving Forward With Move Forward Radio's Most Popular Podcasts of 2018

    APTA's popular Move Forward Radio helps you connect with your patients and clients. It's an interview series that features patients, PT and PTA experts, and even the occasional celebrity discussing physical therapy's role in a wide range of issues. In 2018, the podcast kept that tradition alive and well.

    But don't take our word for it: check out the 5 most popular Move Forward Radio podcasts of 2018.

    The Benefits of Exercise on Brain Health
    There’s a growing body of evidence that being physically active benefits brain health and can help slow the decline in brain function that come with age. In this episode, Joyce Gomes-Osman, PT, PhD, discusses her latest research about overall physical activity on brain health. She and her research associates have concluded that when it comes to brain health, the overall and cumulative effect of physical activity is what’s most important.

    Avoiding Muscle Atrophy When Injured
    Individuals who work out regularly can become anxious after they've experienced an injury that keeps them from exercising—worrying about what will happen to their bodies, when they can return to exercise, and how much their age might affect recovery. Ryan Balmes, PT, a board-certified clinical specialist in both sports physical therapy and orthopaedic physical therapy, addresses those concerns and more.

    Beyond Opioids: Transforming Pain Management to Improve Health
    On February 5, 2018, APTA convened a panel of 7 experts to discuss how pain management in America can be transformed to move beyond opioids and improve the health of society. “Beyond Opioids: Transforming Pain Management to Improve Health” was broadcast live on Facebook and included the debut of APTA’s latest public service announcement for the #ChoosePT campaign. This special episode of Move Forward Radio provides full audio from that event.

    Bowel Health: What You Should Know
    Though it may be uncomfortable to discuss, bowel health is important. Improper habits can develop in childhood and follow us into adulthood, or issues can arise through sickness, sensitivities, microbiome changes, pain, or various diseases such as irritable bowel syndrome, Crohn’s disease, and diverticulitis. Jenn Davia, PT, DPT, a board-certified clinical specialist in women's health, discusses matters that most of us might like to keep behind closed doors, including breaking bad habits, why proper positioning is important, and tips to achieve good bowel health.

    Fourth Trimester: What Is It and Why Is It Important?
    Fourth trimester is the term used to describe the weeks and early months after delivery, when the baby has been born but health care involvement remains vitally important to ensure optimal recovery from pregnancy for the mother, and optimal postpartum care of the child. Carrie Pagliano, PT, DPT, a board-certified clinical specialist in both women's health physical therapy and orthopaedic physical therapy, as well as president of APTA’s Section on Women’s Health, discusses why women should be sure to check in with a physical therapist who specializes in women’s health before, during, and after pregnancy.

    Diverse Voices, 1 Community: The Top APTA Blog Posts of 2018

    The past year saw more blog activity than ever at APTA. Readers of the #PTTransforms blog and the student-focused Pulse blog experienced different voices, new perspectives, and even calls-to-action that challenged assumptions.

    It's not too late to get in on the energy. Here are links to some of the year's most popular blog posts, with a quick description of each.

    "Top 5 Questions Physical Therapists Can’t Answer"
    Does the profession know itself? What needs to happen to achieve a better understanding of issues such as variation in care and use of clinical practice guidelines?

    Changes to the Blood Pressure Guidelines: Is It a Change for Physical Therapists?
    A new blood pressure guideline has sparked discussion in the health care community regarding blood pressure targets and best practices. How does the new guideline affect physical therapist practice and the patients we treat?

    2018 Presidential Address
    This video (and accompanying transcription) of APTA President Sharon Dunn's address to the 2018 APTA House of Delegates captures an important moment in APTA's evolution, as the association begins to make bold moves toward inclusivity, collaboration, and strong advocacy for population health.

    My Whole Body Is a Nervous System: The Anxiety Diaries of an SPT
    "Welcome to year 2, day 1, of my doctor of physical therapy program. I leave my musculoskeletal dysfunction class early so I can make my first appointment with a therapist at my school's Counseling and Psychological Services office." A candid and informative discussion of the emotional health challenges experienced by Heather Beaudoin, SPT, a second-year PT student at Northwestern University.

    Stereotype Threat: How Fear Led Me to Passion
    Everyone has felt the pressure of stereotypes of one kind or another. Do you embrace the stereotype that's been applied to you? Do you reject it? Can you tell when a stereotype has become an obstacle to achieving your dreams? Author Ron Peacock, Jr, SPT, provides a heartfelt perspective.

    Primary Care and the Physical Therapist: Lessons From the Military
    The US military has been involving PTs in primary care for several years. It's time for the civilian health care system to take note, writes Jason Silvermail, PT, DPT, DSc.

    How Do I Avoid Burnout? A Perspective From an Engaged PT
    Burnout can happen to anyone, but the nature of the physical therapy profession presents some special dangers. This post provides tips on how to spot burnout in yourself, and what to do to regain that spark.

    Blunt Conversations: Setting Realistic Patient Expectations for Pain
    At APTA's "Beyond Opioids" panel, Sarah Wenger, PT, DPT, observed that clinicians need to give patients realistic expectations for pain and pain relief. But how do we have these difficult—yet important—conversations? In this Q&A, Wenger delves deeper into the topic.

    The More Things Change, the More They…Change: CMS Announcements Dominate Top PT in Motion News Stories for 2018

    Looking back over 2018, it's hard to overstate the magnitude of Medicare-related changes experienced by physical therapists (PTs), physical therapist assistants (PTAs), and their patients. It was a year that included the end of the hard cap on therapy services under Medicare and the announcement of the inclusion of qualifying PTs in its Quality Payment Program starting in 2019—a dramatic shift toward value-based payment. And did we mention the launch of new requirements for skilled nursing facilities (SNFs) beginning later in 2019?

    While payment news is almost always of interest to PT in Motion News readers, keeping up with the US Centers for Medicare and Medicaid Services (CMS) was apparently top-of-mind in 2018, as Medicare-related stories dominated this year's list of most-read News items.

    Here's what grabbed the attention of readers in 2018:

    A permanent fix to the Medicare therapy cap was finally approved...
    In early February, Congress enacted change that ended the hard cap on therapy services under Medicare part B, putting to rest "a 20-year cycle of patient uncertainty and short-term fixes."

    …but not before the cap was applied for a few weeks.
    When 2017 ended without the usual 11th hour temporary fix in place, the therapy cap was triggered for the first weeks of 2019, throwing PTs and patients into (fortunately, short-lived) uncertainty.

    The post-therapy cap world has its own requirements.
    Instead of a hard cap, CMS began relying on the KX modifier threshold for physical therapy and speech-language pathology—and yes, the monetary limits were still combined. PT in Motion News published a list of "5 basics you need to know" about the new approach.

    SNFs need to prepare for a new payment landscape in 2019.
    CMS unveiled a proposed rule for SNFs in 2019 that replaces the Resource Utilization Groups Version IV (RUG-IV) with something new—the Patient-Driven Payment Model. This story from April breaks down the basics of the proposal.

    Even more dramatic changes to come: QPP and MIPS are on the way.
    When the proposed 2019 physician fee schedule from CMS contained what many expected was coming: the inclusion of qualifying PTs in the agency's Quality Payment Program (QPP) and its Merit-based Incentive Payment System (MIPS). This PT in Motion News story presented the basics of a major shift in payment and reporting for PTs.

    Move Forward Radio Catches a 'Big Wave' Surfing Legend

    If you're going to face down a 30-foot wall of water armed with nothing but a surfboard, you'd best be someone who's not afraid of a little danger—either that, or someone who's ready to learn from potentially injurious failure. Turns out big wave surfing champion Laird Hamilton is a little of both.

    Now on APTA's Move Forward Radio: an interview with Hamilton, who's made an international name for himself as, yes, a fearless surfer but also as an athlete who, in his own words, has survived his body being "torn, punctured, ripped, scraped, broken…you name it." It's those injuries, he says, that have enabled him to learn more about his own body and the importance of staying active, even when things aren't at 100%.

    Hamilton remembered the lessons he had learned through his surfing injuries and applied them to his preparation for—and recovery from—hip replacement surgery. In the podcast, he describes how he avoided pain medicine of any kind during the process, and how he surprised his health care team with one of the fastest recoveries they had ever seen. He also tells Move Forward Radio that he drew no small amount of inspiration from his wife, volleyball star Gabby Reece, who was featured on 2016 podcast to talk about her drug-free recovery from a total knee replacement (performed the same day as Hamilton's hip operation, by the way).

    Move Forward Radio is archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes.

    CoHSTAR Announces Fellowship Opportunities; Applications Due by February 15

    The Center on Health Services Training and Research (CoHSTAR) has opened its latest call for fellowship applicants for 4 research opportunities. All fellowships have a February 15, 2019, application deadline. The positions are:

    • Full-time postdoctoral fellowships: Trainees may focus their activities on a unique research focus area or craft an individual experience that involves activities at 2 or 3 collaborating sites.
    • Part-time faculty fellowship: Faculty fellows will retain their faculty appointments at their home institutions while using CoHSTAR support to maximize their protected time for research activities.
    • Part-time faculty fellowship at naviHealth: The selected faculty fellow will retain her or his faculty appointment at a home institution while using CoHSTAR support to maximize protected time to engage in research activities as a naviHealth faculty fellow. NaviHealth is a care transitions and postacute care management company serving both payer and provider marketplaces.
    • Postdoctoral fellowship at Vanderbilt University Medical Center: This 2-year postdoctoral fellowship will support an analysis of registry and trial data, particularly data related to spine surgery and associated outcomes. The fellowship is funded jointly with Vanderbilt University Medical Center's Department of Orthopaedics and Rehabilitation.

    CoHSTAR was established with a grant of $2.5 million from the Foundation for Physical Therapy. Funding for this initiative was made possible with a $1 million gift from APTA, gifts from 50 APTA components, and donations from physical therapists, foundations, and corporations with a shared passion for the field of physical therapy.

    DoD Moves to Include PTAs in TRICARE

    Nearly a year after being signed into law, the wheels are finally turning: a proposed rule to include physical therapist assistants (PTAs) as authorized providers under TRICARE, the health care system used throughout the military, has been issued by the US Department of Defense (DoD). APTA strenuously advocated for the change and says it's time for supporters to help push the rule over the finish line.

    The proposed rule is a fairly straightforward plan that seeks to have the TRICARE system adopt Medicare's requirements for PTAs and occupational therapy assistants (OTAs). "This rule will align TRICARE with Medicare's policy, which permits PTAs and OTAs to provide physical or occupational therapy when supervised by and billed under a licensed physical therapist or occupational therapist," DoD writes in its summary of the proposal.

    According to Kara Gainer, APTA's director of regulatory affairs, the proposal, while strongly supported by APTA, has a few issues that need to be addressed.

    "The rule references 'physical therapy assistants' when it should be 'physical therapist assistant'—that area, and a few other places in which DoD uses inconsistent language around physical therapist qualifications, are easy fixes and something that we'll be recommending," Gainer said. "Overall, however, the release of this proposed rule is a very positive step because it starts the clock ticking toward final implementation."

    The timeline for when PTAs could actually begin participating in TRICARE was an uncertainty that lingered throughout 2018—although DoD intended to have the change in place no later than 2021, nobody seemed to know just when the rulemaking process would begin. The publication of the proposed rule kicks off a series of timelines that put progress on a more trackable schedule, beginning with a 60-day deadline for public comment. According to an APTA chart on possible implementation of the rule (scroll down to view), PTAs could be participating in TRICARE as early as fall of 2019, or as late as early 2020 if all goes according to plan.

    What's next? APTA urges supporters of the change to make that support known to DoD by providing comments on the proposed rule by the February 19, 2019, deadline. In early January, APTA will offer a template letter that will make the comment process easy—be on the lookout for an announcement when that becomes available, or look for the letter on APTA's "Take Action" webpage sometime after January 1, 2019.

    The Good Stuff: Members and the Profession in the Media, December 2018

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

    The entrepreneurial PT: Jill Marlan, PT, MPT, received national recognition as a 2018 Ernst and Young "Entrepreneurial Winning Woman." (Ernst and Young announcement)

    Reducing pain for guide dog users: University of North Georgia professor Sue Ann Kalish, PT, DPT, is exploring ways to help avoid joint pain among individuals with visual impairment who use guide dogs. Her work is assisted by UNG physical therapy students Mitchell Aarons, SPT; Rachel Philips, SPT; Lauren Johnston, SPT; Erin McCarthy, SPT; and Tommy Otley, SPT. (University of North Georgia News)

    Preventive physical therapy in the military: Maj Nicholas Koreerat, PT, DPT, is helping to keep soldiers healthy and fit in a deployed environment. (US Army website)

    A shorts story about a PT inventor: Ruth Maher, PT, DPT, PhD, helped to develop wearable technology, recently approved by the US Food and Drug Administration, to assist women experiencing stress urinary incontinence. (Live Well Nebraska)

    Working for diversity in the profession: Jessica Nguyen SPT; Jessica Goytizolo, SPT; David Tang, SPT; and Chris Floyd, SPT, are among the University of Southern California physical therapy students leading a student physical therapy multicultural leadership alliance. Terry Richardson II, PT, is the faculty advisor. (USC News)

    Can you outrun the pain? Richard Tavel, PT, DPT, provides insight on how to know when it's safe to run through knee pain. (Self)

    Diastasis recti: Marianne Ryan, PT, explains what diastasis recti is and how to approach treatment. (Today Show online)

    Bringing physical therapy to the world: Efosa Guobadia, PT, DPT, cofounder of Move Together, shares his journey toward helping to create an organization committed to bringing rehabilitation medicine to parts of the world in need. (UMASS, University of Massachusetts alumni newsletter)

    Looking through the cracks: David Reavy, PT, MBA, discusses what joint-cracking could mean. (Runner's World)

    Focus on women's health: Carrie Pagliano, PT, DPT, shares insights on the importance of educating women about pelvic health. (Awesome Women Entrepreneurs podcast)

    It's go time: University of Michigan – Flint physical therapy student Kei-Cze Prentis, SPT, was among the UM-F students who helped facilitate a GoBabyGo project along with department director Susan Talley, PT, DPT. (WNEM5 News, Saginaw Michigan)

    Must the shoe go on? Sean Brown, PT, DPT, discusses the pros and cons of barefoot running. (Rockford, Illinois Star)

    Service in Honduras: Western Carolina University Physical Therapy Program professor Todd Watson, PT, DPT, and program students Elizabeth Webber, SPT; Whitney Ward, SPT; Shannon Icenhour, SPT; Hannah Pollard, SPT; Emily Wilson, SPT; and Kelsey Sivley, SPT, helped provide pro bono services for individuals with little or no access to health care in Honduras. (Western Carolina University News)

    Quotable: "Physical Therapy is probably the best road to travel after you have completed surgery. A physical therapist will assist you in recovery and strengthening, bringing you back into the functioning world. Then they will set you free into the world of life-long exercise to maintain and protect your body from further injury." - columnist Deborah Jones on her upcoming knee replacement surgery. (Estes Park, Colorado Trail Gazette)

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

    APTA, NATA Joint Statement Calls for Collaborative Relationship

    In a statement that emphasizes a shared dedication to patient care and the advancement of population health, APTA and the National Athletic Trainers' Association (NATA) have announced a commitment to more collaboration among the 2 organizations. And they're encouraging individual members and stakeholders to do the same.

    The joint statement, issued December 19, calls for collaboration around legislative efforts, public relations initiatives, and interprofessional practice, among other areas. According to the 2 organizations, that collaboration could include better public and interprofessional education on the clinical training of both professions, promoting regulation that reflects the education and training of the professions, increased access to services, development of youth sports safety initiatives, and identification of best-practice models of care that highlight interprofessional practice and "the value of athletic training and physical therapy across health care."

    "APTA and NATA share the belief that quality health care is becoming increasingly collaborative, and it’s in the best interest of our patients and clients, and our members, to work together when possible," said APTA President Sharon Dunn, PT, PhD. "The fact that APTA and NATA already share members is a sign that we have common interests. This statement affirms our mutual interest in exploring activities that jointly advance our common goals."

    Founded in 1950, NATA has a worldwide membership of approximately 45,000.

    "Our organizations have an opportunity to work collaboratively to advance patient-centered care as well as overall population health," said NATA President Tory Lindley, MA, ATC. "This statement reflects an important first step toward exploring opportunities to work together for the benefit of our members and, most importantly, the patients we serve.”

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    Government Affairs and Public Service Awards Nominations Due January 18, 2019

    Do you know of an APTA member who in 2018 has gone above and beyond to advocate on behalf of the physical therapy profession at the federal level? Is there a member of Congress, staffer, or public figure who has championed physical therapy causes this year? Nominate them for APTA’s Federal Government Affairs Leadership Award or the Public Service Award.

    The Federal Government Affairs Leadership Award is presented annually to an active APTA member who has made significant contributions to the association’s federal government affairs efforts and shown exemplary leadership in furthering the association's objectives in the federal arena.

    The Public Service Award is presented annually to an individual who has demonstrated distinctive support for the physical therapy profession at a national level. Individuals from the following categories are eligible for nomination: members of Congress, congressional staff, federal agency officials, health and legislative association staff, and celebrities or other public figures.

    The award recipients will be invited, with expenses paid by APTA, to attend the 2019 Federal Advocacy Forum on March 31–April 2, in Washington, DC, for presentation of the awards. Additionally, recipients will be recognized on APTA's website, PT in Motion magazine, and PT in Motion News.

    Submit completed nomination forms and supporting documents to michaelmatlack@apta.org by Friday, January 18, 2019.

    Foundation Research Grant Awards, Kendall Scholarships Announced

    An APTA-funded $50,000 Health Services Research Pipeline grant will support an investigation into high-value early intervention (EI) for children with functional limitations. The award was among several Foundation for Physical Therapy (Foundation) grants and scholarship awards totaling more than $500,000.

    Grant recipient Beth McManus, PT, ScD, MPH, will be investigating regional variability in state and local early intervention and the ways that variability affects use and outcomes, all in an effort to improve service delivery. McManus is an associate professor in the Colorado School of Public Health's Department of Health Systems, Management, and Policy.

    APTA is the Foundation's Pinnacle Partner in Research and has been a leading donor in funding major research initiatives such as the Center on Health Services Training and Research (CoHSTAR), investing in research priorities to strengthen the physical therapy profession, and supporting the Foundation's scholarship program each year.

    Other grant and scholarship announcements from the Foundation:

    Eric Anson, PT, MPT, PhD, the recipient of the $40,000 Pittsburgh-Marquette Challenge Research Grant, will harness virtual reality to explore ways to improve self-motion perception and decrease fear of falling in older adults. This grant is funded in part by APTA's Supporting the Professions Fund.

    Annalisa Na, PT, PhD, was awarded the $40,000 Geriatric Research Grant. The goal for her project, titled "Functional Recovery in Patients with Type-2 Diabetes Mellitus following a Primary Total Knee Arthroplasty," is to improve outcomes by establishing effective guidelines. This grant is funded by the Academy of Geriatric Physical Therapy Fund.

    Michael Tevald, PT, MPT, PhD, winner of the $40,000 Acute Care Research Grant, will investigate the early impact of lung transplantation on skeletal muscle, with an eye toward enabling the development of evidence-based rehabilitation strategies that will allow acute care physical therapists to effectively address effects of surgery, hospitalization, and illness. This grant is supported by a donation from the Academy of Acute Care Physical Therapy.

    Bahar Shahidi, PT, DPT, PhD, was awarded the $100,000 Magistro Family Foundation Research Grant in support of a project that will evaluate the benefits of more intensive exercise-based program for patients with low back pain and provide a platform for future clinical trials. This project is funded by the Foundation's Magistro Family Endowment Fund and Legacy Fund.

    Marcie Harris-Hayes, PT, DPT, received the $240,000 Paris Patla Musculoskeletal Grant for the development of effective treatment strategies for people with pre-arthritic hip disorders to improve function, decrease pain, and delay or prevent the onset of osteoarthritis. This grant was made possible by the Stanley Paris and Catherine Patla Fund.

    Barbara Sargent, PT, PhD, MS, who was awarded the $40,000 Pediatric Research Grant, will be investigating the identification of cerebral palsy (CP) in early infancy and effective interventions to improve walking outcomes of individuals with CP. This grant is supported by the Pediatric Physical Therapy Fund.

    Jason Beneciuk, PT, DPT, PhD, MPH, was named winner of the $40,000 Orthopaedic Research Grant for his project titled "Discriminant and Predictive Validity Assessment of the Keele STartT MSK Tool for Patients with Musculoskeletal Pain in Outpatient Physical Therapy Settings." The study aims to develop effective health care management for people with musculoskeletal pain and implement precision medicine through risk profiling to guide individualized treatment approaches. This grant is supported by the Academy of Orthopaedic Physical Therapy Fund.

    In addition to the research grants, the Foundation also awarded 4 Florence P. Kendall Doctoral Scholarships of $5,000 each. The scholarships are presented to outstanding PTs as they begin their first year of graduate studies toward a postprofessional doctoral degree. Scholarship winners are:

    • Allison Miller, PT, DPT, University of Delaware
    • Jonathan Tsay, PT, DPT, University of California at Berkeley
    • Julia Mazarella, PT, DPT, The Ohio State University
    • Julie Stutzbach, PT, DPT, University of Colorado-Anschutz Medical Campus

    These scholarships are funded by the Kendall Fund and the Rhomberger Fund.

    "The Foundation is pleased to support promising, productive physical therapist researchers as they develop innovative and cutting-edge treatments in physical therapy," said Foundation Board of Trustees President Edelle Field-Fote, PT, PhD, FAPTA, in a Foundation news release. "Each recipient has the potential to contribute to our understanding of movement-related health conditions, interventions, and approaches to health service delivery to improve the lives of our patients and clients."

    Large-Scale Study Finds Connection Between Early Physical Therapy and Lower Opioid Use

    The evidence of physical therapy's potential to make a difference in the nation's opioid crisis continues to mount—this time, by way of a study in JAMA Network Open, which concludes that for patients experiencing back, knee, neck, or shoulder pain, a visit to a physical therapist (PT) early on can reduce the chances that they'll take any opioids for the condition. And among those who do wind up taking opioids during the episode of care, researchers identified an association, albeit less strong, between early physical therapy and reduced number of pills taken for 3 of the 4 conditions.

    The study, one of the largest to date on the effects of early physical therapy, looked at data from 88,985 privately insured "opioid naïve" patients who had an index visit with a health care provider for back, knee, neck, or shoulder pain—the 4 most common musculoskeletal conditions. Researchers divided patients into 2 groups—those receiving treatment from a PT within 90 days of the index visit, and those who didn't—and tracked data for 1 year to note prescriptions and use, paying particular attention to use between 91 and 365 days after the index date.

    The patients, a national sample from multiple health networks, were 57.7% male with an average age of 46. Comorbidities and demographic factors were similar among both groups. Overall, 29.3% of the patients received early physical therapy.

    Here's what researchers found:

    • Early physical therapy was associated with a reduced risk of any opioid use for all 4 conditions: a 16% drop for knee pain patients, a 15% reduction for those with shoulder pain, 8% for neck pain, and 7% for low back pain (LBP).
    • Among patients who were prescribed (and used) opioids, early physical therapy seemed to have an association with fewer pills taken for 3 of the 4 conditions. Patients with knee pain recorded a 10.3% drop in oral morphine milligram equivalents taken compared with the control group; those with shoulder pain saw an average 9.7% reduction; and the LBP subgroup averaged a decline of 7%. The neck pain subgroup showed a slight 3.8% drop—not enough to be statistically significant, according to the study's authors.
    • Early physical therapy for knee pain and LBP was associated with a significant reduction in the likelihood of chronic opioid use—by 66% for knee pain and 33% for LBP—compared with patients who didn't receive early physical therapy. Chronic opioid use among patients with neck and shoulder pain didn't differ between the study groups.
    • As for when the early physical therapy group began sessions, that varied by condition, ranging from an average of 13 days after index visit for neck pain to 40 days for shoulder pain. The median number of physical therapy sessions ranged from 5 for knee pain and LBP to 8 for neck pain.

    Steven George, PT, PhD, FAPTA, one of the study's contributing researchers, told APTA that the study provides "encouragement and support" for guidelines such as those produced by the US Centers for Disease Control and Prevention (CDC) calling for nonopioid treatments, including physical therapy, to be considered a first-line approach to the management of chronic pain.

    "The guidelines emphasize nonpharmacological care being delivered early in the treatment episodes," George said. "In the study the nonpharmacological care was physical therapy, and there seemed to some benefit. The results provide early evidence that the new guidelines may help decrease long-term opioid use."

    George said that the finding related to early physical therapy's lack of impact on opioid use among patients with neck pain took researchers somewhat by surprise. In the study, authors characterize that finding as dissimilar to other research on the effects of early physical therapy, and they theorize that the variation "could be explained by the differences in patient populations, the resistance of many neck conditions such as whiplash to physical therapy, the underlying rate of opioid use, the timing and rate of patients receiving early physical therapy, or our decision to limit the analysis to patients with indicators of higher severity."

    The study makes a strong case for early physical therapy as it relates to opioid use, but it shouldn't be interpreted as a statement on overall results, according to George.

    "The biggest takeaway is that early physical therapy may be a viable option for several musculoskeletal conditions, especially if preventing long-term opioid use is a treatment goal," George said. "This study does not suggest those receiving early physical therapy had better clinical outcomes. That's an important thing to remember when interpreting these findings."

    In addition to George, APTA members Chad Cook, PT, PhD, MBA; and Adam Goode, PT, DPT, PhD, were among the coauthors of the study.

    APTA has taken a leadership role in the physical therapy profession's response to the opioid crisis. In addition to its flagship #ChoosePT opioid awareness campaign, APTA also hosted a Facebook Live panel discussion and satellite media tour to highlight the effectiveness of nonopioid approaches to pain management. In addition, APTA produced a white paper on reducing opioid use and contributed to the National Quality Partners Playbook on Opioid Stewardship.

    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.

    Cochrane Researchers 'Confident' in Pelvic Floor Muscle Therapy as Effective UI Treatment

    Pelvic floor muscle therapy (PFMT) "could be included in first‐line conservative management programs" for women with urinary incontinence (UI), according to the authors of a recently updated Cochrane systematic review. While the conclusion itself isn't new, the revision includes more evidence that makes the case for PFMT even stronger.

    Authors analyzed data from 31 trials including a total of 1,817 women. The studies examined whether women were "cured" or "cured or improved" as a result of treatment for stress urinary incontinence (SUI), urgency urinary incontinence (UUI), or mixed urinary incontinence (MUI). Researchers also looked at the effects of PFMT on quality of life.

    The results were clear, according to authors: women with all types of UI experienced greater benefit from PFMT than from no treatment or control interventions, which included sham electrical stimulation, placebo drug, or other inactive treatments such as educational pamphlets.

    Other findings from the review:

    • In terms of cure, women with SUI in the PFMT groups were 8 times more likely than women who received no treatment or control interventions to a complete cessation of symptoms. Women with any type of UI in PFMT groups were 5 times more likely to report an end to symptoms.
    • Women with SUI in the PFMT groups were more likely to report improvement in symptoms and significant improvement in quality of life. Women with any type of UI reported that they experienced significant improvements in symptoms and quality of life if they received PFMT.
    • Women with any type of UI in the PFMT groups experienced fewer leakage episodes in a 24-hour period, as well as less urine leaked
    • Patient satisfaction was higher in the PFMT groups, and one study reported that women who received PFMT experienced better sexual outcomes.

    Authors’ conclusions have not changed since the 2014 version of the review, but the update contains 10 new studies, as well as an analysis of risk of bias in the included studies.

    Due the large variation the type and duration of the PFMT programs, authors were unable to assess their relative effectiveness. However, the quality of the evidence was of moderate quality, authors write, meaning that "we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI."

    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.

    New Draft CPG on Locomotor Function Seeking Comments: Deadline December 21

    If you have insight, or simply an interest, in best practice for improving locomotor function after chronic stroke, incomplete spinal cord injury, or brain injury, the clinical practice guideline (CPG) team overseeing a new CPG on that topic wants to hear from you.

    A draft of the CPG is available for review and public comment until December 21—all physical therapists, physical therapist assistants, and students are invited to comment.

    The CPG’s goal is to assess the relative efficacy of various interventions to improve walking speed and timed distance in individuals following stroke, incomplete spinal cord injury, or traumatic brain injury. For example, how does the evidence compare for training involving walking, virtual reality, strength, cycling, body-weight-supported treadmills, robotic-assistance, or sitting and standing balance; with or without virtual reality tools; alone or in combinations; and at what intensities?

    The CPG is being supported by APTA and the Academy of Neurologic Physical Therapy. Find a link to the draft and comment instructions on APTA’s CPG Development webpage under CPGs in the Review Phase, and be sure to respond by the December 21 deadline.

    Study: PTs, Family Physicians Similar in Knowledge of LBP Management

    The numbers were small and the participants limited to certain groups, but results of a recent survey seem to point to yet another reason to increase direct access to physical therapist (PT) services: namely, when it comes to management of low back pain (LBP), PTs know just as much—and sometimes more—than the family practice physicians (FPPs) who often are sought for primary care. Authors believe the results point to the need for further study of the potential for PTs in primary care settings, an issue that APTA is exploring.

    In a study published in the Journal of Manual & Manipulative Therapy (abstract only available for free), researchers provided results of a survey of 73 PTs and 30 FPPs regarding their knowledge of optimal management strategies for LBP as well as their attitudes toward and use of clinical practice guidelines for the condition. Authors of the study used 2 survey instruments that were developed for earlier studies: an 11-item review of LBP knowledge, attitudes, and guideline statements, and a modified 8-question survey on management interventions. APTA members Michael Ross, PT, DHS; Travis Enser, PT; Allyson Muehlemann, PT, DPT; and Ron Schenk, PT, PhD, were among authors of the study.

    Participants were asked to respond using a 5-point Likert scale that reflected their level of agreement with various statements on LBP (the 11-question review) or their belief in the importance of various approaches to LBP treatment (the 8-question survey). Answers were classified as correct or incorrect based on what authors describe as "the most recent reviews of the evidence." In the end, 73 PT members of the APTA Private Practice Section (PPS) and 30 members of the American Academy of Family Physicians (AAFP) provided useable responses.

    The bottom line: the PTs and FPPs achieved similar scores on nearly every item in the surveys. Both groups strongly rejected statements such as "patients should not return to work until they are almost pain free" and "X-rays of the lumbar spine are useful in the work-up of patients with acute LBP," and broadly supported the statements "encouragement of physical activity is important in the recovery of LBP" and "there is nothing physically wrong with many patients with chronic [LBP]." When it came to statements related to optimal management of LBP, PTs and FPPs reported equally strong levels of support for the importance of physical therapy, patient encouragement, and manual manipulation; and were equally emphatic in their disapproval of surgery.

    Not all scores were close, however. Researchers found that compared with the FPP group, PTs generally had more confidence in their ability to gauge the motivation of their patients, and tended to more consistently reject the idea that "interventions by doctors and other health care providers have very little positive impact on the natural history of acute LBP."

    Other areas of more modest disagreement included support for the statement "I would find clinical practice guidelines helpful in the management of LBP" (agreed with or strongly agreed with by 58.9% of PTs compared with 76% of FPPs) and disagreement with the idea that bed rest is important in recovery from LBP—83.3% of FPPs said bed rest was "not recommended" or "of minor importance," compared with 69.9% of PTs rating bed rest in a similar way. Authors characterized these differences as nonsignificant.

    As for the PTs' confidence in their ability to assess patient motivation, authors believe that the nature of the PT-patient relationship may be at work.

    "Assessing patient motivation levels is a time-consuming process," authors write. "The duration of a typical patient visit is longer with the [PT] than a[n] [FPP] and the [PT] typically sees patients on a serial basis for a period of time. This increased patient interaction may play a part in [PTs] having less difficulty in assessing patient motivation."

    Authors also cited the presence of what they describe as "guideline-discordant care" among notable percentages of both PTs and FPPs, including an inability to choose the drug treatment most preferable for patients with LBP (26% of PTs and 35% of FPPs answered incorrectly by choosing drugs other than acetominophin and nonsteroidal anti-inflammatories), a preference for imaging (18% of PTs and 10% of FPPs), and a belief that bed rest for patients with LBP was of "some importance" (30% of PTs and 17% of FPPs). The numbers indicate that "continued educational efforts in the management of LBP are indicated and represent an area of potential cost savings for the health care system while also improving the quality of care and patient outcomes," authors write.

    The study has its share of limitations, according to its authors: response rates were small, and the use of members of the APTA PPS and the AAFP may mean that results may not be generalizable. Additionally, authors write, respondents tended to describe themselves as having a "special interest in musculoskeletal medicine," which may affect the "representativeness of the results."

    Authors believe that, despite those issues, at the very least their study merits further research into the knowledge levels of PTs and what that could mean for patient care.

    "These results may have implications for health policy decisions regarding the utilization of [PTs] to provide care for patients with LBP without a referral," authors write, "including the potential placement of [PTs] in primary care clinics to initially manage patient with musculoskeletal conditions."

    [Editor's note: What's the latest on the role of PTs in primary care? Check out this feature article from the December-January issue of PT in Motion magazine for an in-depth look at where things stand, and what APTA is doing, and learn about the basis for the association's efforts in this paper on exploring the roles of PTs in primary care teams.]

    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.

    2019 Slate of Candidates Posted

    The 2019 Slate of Candidates for APTA national office is now posted on the APTA website. The candidate webpage, including candidate pictures, statements, and biographical information, will be posted on February 25, 2019.

    Elections for national office will be held at the 2019 House of Delegates on June 10, 2019. Please contact Justin A. Lini in APTA’s Governance and Leadership Department for additional information.

    PTJ: Physical Therapy Continuity of Care Linked to Lower Rate of Surgery, Lower Costs

    Patients with low back pain (LBP) who see a single physical therapist (PT) throughout their episode of care may be less likely to receive surgery and may have lower downstream health care costs, researchers suggest in a study published in the December issue of PTJ(Physical Therapy). "Limiting the number of physical therapy providers during an episode of care might permit cost savings," authors write. "Health care systems could find this opportunity appealing, as physical therapy provider continuity is a modifiable clinical practice pattern."

    Authors examined data from nearly 2,000 patients in Utah's statewide All Payer Claims Database (APCD) to look for associations between continuity of care for LBP patients and utilization of related services such as advanced imaging, emergency department visits, epidural steroid injections, and lumbar spine surgery in the year after the first primary care visit for LBP. APTA members John Magel, PT, PhD; Anne Thackeray, PT; and Julie Fritz, PT, PhD, FAPTA, were among the authors of the study.

    Patients were between the ages of 18 to 64 who saw a PT within 30 days of a primary care visit for LBP. Researchers excluded patients with certain nonmusculoskeletal conditions; neurological conditions, such as spinal cord injury, that could affect patient management; and "red flag" conditions such as bone deficit or cauda equina syndrome.

    Researchers found that greater provider continuity significantly decreased the likelihood of receiving subsequent lumbar spine surgery, noting that "disparate management strategies across a variety of providers might inhibit or prolong the recovery in a patient with a worsening condition and contribute to the patient eventually receiving lumbar surgical intervention." They also note that a strong therapeutic alliance is associated with improved outcomes.

    Contrary to authors' expectations, high provider continuity was not associated with decreased use of advanced imaging, steroid injections, or emergency department visits. "The timing of physical therapy for LBP might have a greater impact on these outcomes than does provider continuity," they suggest. Researchers did find a link between use of these services and the presence of comorbidities, previous lumbar surgery, and use of prescription opioids or oral steroids.

    The average cost of care in the year following the initial primary care visit was $1,826 per patient. Costs were slightly less, at $1,737, for the 90% of patients with high provider continuity but rose to $2,577 for patients with a lower level of provider continuity.

    While the study's findings do not identify any cause-and-effect relationships, "it seems reasonable that physical therapists should consider approaches to managing patients with LBP that limit provider discontinuity," authors write.

    Watch for an interview with Magel by PTJ Editor in Chief Alan Jette, PT, PhD, FAPTA, coming soon to the journal's podcast webpage. "It's intriguing that so little research has been done on continuity of care in physical therapy, considering that a lot of work has been done in this area in medicine," Jette said. "Continuity of physical therapy care is highly relevant not only for practitioners but for policymakers."

    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.

    Listen Up! APTA Podcasts Keep You Inspired, Motivated, and In-the-Know

    And just like that, the holiday season is upon us. It's a great time of year, but it can also sweep you up in a whirlwind that leaves you feeling exhausted and out of touch with your profession.

    APTA has just the answer.

    The past year has been a stellar one for APTA podcasts. We now offer more content and variety than ever before, from the emotional that reminds you of why you love what you do, to the nuts-and-bolts informational that could be crucial to your professional survival. The recordings are easy to download and listen to no matter what you're up to during the holiday season—decking the halls, say, or riding in a one-horse open sleigh, or just kicking back for a few peaceful minutes of chestnut roasting. So don the gay apparel (or your favorite workout gear), fire up that device, and get listening.

    It's easy. Check out APTA's podcasts webpage, where you can browse a complete list of podcasts. Where to start? Here are some suggestions.

    Get inspired.
    APTA's "Defining Moment" podcast series is the audio companion to PT in Motion magazine's regular feature of the same name, which highlights stories from members about those moments when they felt that special—often life-changing—connection to the physical therapy profession. The Defining Moment podcasts bring you the audio version of the magazine feature, read by the authors. Treat yourself.

    For inspiration you can share with your patients, the popular Move Forward Radio is your go-to option: an interview series that features patients, PT and PTA experts, and even the occasional celebrity (past episodes have featured NBA All-Star Grant Hill and country music's Clay Walker) discussing physical therapy's role in a wide range of issues. Like APTA's MoveForwardPT.com website, the Move Forward podcast series is designed for patients and their families as well as for clinicians. Definitely share-worthy.

    Get energized.
    The secret is out: some of the liveliest discussion in the profession is taking place at the student level, and a new APTA podcast series brings the energy to you. APTA's Student Pulse, the newsletter for students, has created a podcast series that features Pulse contributors, mostly students. With titles such as "How War Led Me to Become a Physical Therapist," "Stereotype Threat," and "The X-Ray Showed a Bird," how could you not be intrigued? A great way to re-charge your enthusiasm for the profession

    Get up to speed.
    From payment and regulation to the latest in evidence-based care, it can be hard to stay in the loop. APTA helps make it a little easier to keep pace through a variety of podcasts. Wonder what all this "value-based care" talk is about, and how it applies to you? Check out APTA's value-based care series. Feel like hearing from some of the profession's thought leaders? Download the audio from the highly regarded Maley and McMillan lectures delivered at the 2018 NEXT Conference and Exposition. Getting yourself in the mood for the upcoming 2019 Combined Sections Meeting (you are going, right?)? Browse the podcast page for audio from last year's event.

    And when it comes to research, you can listen your way right to the source: PTJ (Physical Therapy), the association's scientific journal, offers a podcast series that features PTJ authors discussing their research with Editor in Chief Alan Jette, PT, PhD, FAPTA. The conversations are lively, accessible, and packed with useful information. Don't miss out.

    Study: Early Physical Therapy for Neck Pain Associated With Lower Imaging Rates, Opioid Prescriptions, and Overall Cost

    In findings on neck pain that echo the results of similar studies on low back pain, researchers have identified an association between early consultation with a physical therapist (PT) and lower rates of opioid prescription, imaging, and injections. Those lower-use rates contributed to significant cost savings over a 1-year study period compared with patients who waited 90 days or more before seeing a PT, according to the study's authors.

    The study, published in BMC Health Services Research, looked at health care utilization over 1 year among 308 patients who presented with neck pain. The patients were divided into 3 groups: an "early" group that consulted a PT within 14 days, a "delayed" group that received a PT consultation between 15 and 90 days after initial health care provider consultation, and a "late" group that waited from between 91 and 364 days to consult with a PT. All patients were members of the University of Utah Health Plans, either through private insurance or via Medicaid, and none had a recorded health care encounter for neck pain in the 90 days preceding initial consultation. APTA members Maggie Horn, PT, DPT, PhD; and Julie Fritz, PT, PhD, FAPTA, coauthored the study.

    Horn and Fritz tracked rates of spinal injection, opioid prescription, imaging (MRIs, X-rays, and CT scans), and overall health care costs at the 1-year mark, analyzing data for each group. Demographic and comorbidity information also was collected and compared.

    Overall, of the 3,533 patients who reported a new neck pain encounter with a health care provider, only 15.1% had a consultation with a PT over the entire 1-year study period. Of the 536 patients who consulted with a PT, 308 were deemed eligible for the study. The average age of patients in the study was 48.7 years, and most (69.2%) participants were women.

    Among the findings:

    • Overall, 35% of patients in the study received spinal injections at some point; however, compared with the early group, the delayed group was 5.34 times more likely than the early group to receive an injection, while the late group was 4.36 times more likely to receive the treatment compared with the early group.
    • Opioids were prescribed to 62.7% of all patients. However, when broken down by early, delayed, and late groupings, the late group was estimated to be 2.79 times more likely to receive an opioid prescription than the early group. The delayed group had about the same odds of receiving a prescription as the early group.
    • When it came to imaging, the delayed and late groups were more than 4 times as likely to receive an MRI and nearly 3 times as likely to receive an x-ray compared with the early group. Rates of CT scans were small—only 7% of all patients—but the late group was more likely to receive the imaging. There were no significant differences between the early and delayed groups related to CT scan rates.
    • At the end of 1 year, the average adjusted total health care cost for the early group was $1,853—about $1,000 less than the cost for the delayed group ($2,917) and less than half the cost associated with the late group, which averaged $4,026.
    • The median episode-of-care (EOC) for all 3 groups was 155 days, with the early group reporting the shortest median EOC, at 49 days, compared with the late group median EOC of 319 days. The groups reported no significant differences in the median number of physical therapist visits (3) over a median 22 days.
    • Among the 3 groups there were no significant differences in the prevalence of depression, anxiety, fibromyalgia, or obesity. The late physical therapy group tended to have more participants with low back pain, chronic or generalized pain, substance abuse, and tobacco use.

    "Current trends in health care costs are becoming unsustainable for payers and patients and are not resulting in improved outcomes," authors write. "The findings from our study indicate that consulting a physical therapist early for neck pain, within 14 days of an index visit, may provide an opportunity to mitigate downstream health care utilization while containing costs."

    Authors note that the increased odds of diagnostic testing and invasive treatments they found in their neck pain study is similar to patterns other research has uncovered in the treatment of low back pain (LBP), albeit with increased comparative risk. They speculate that this could have something to do the available evidence on the treatment of neck pain as a discrete condition.

    "In our study, providers may be more likely to use diagnostic testing or more invasive treatments prior to initiating physical therapy, potentially due to the lack of preponderance of evidence for treating neck pain," authors write. "Conversely, early physical therapy consultation may shield patients from this utilization pattern."

    Authors acknowledge that their study is limited to a single group of insured patients, in a single geographic location, using a single health care system, and that results "cannot be interpreted as causal or widely generalizable." Still, they write, the association they uncovered bears further study.

    "Future studies need to further explore improving earlier access to physical therapy for patients with neck pain," authors write. "Specifically future studies need to determine the effect of early physical therapy consultation within the primary care setting or through direct access in a formal randomized controlled trial."

    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.

    PT in Motion Magazine Looks at PTs in Primary Care

    Think the idea of the physical therapist (PT) as a primary care provider is some kind of far-off, pie-in-the-sky concept? Don't tell that to Tony Bare, PT, DPT, ATC; or Rebecca Byerley, PT, DPT; or Kaiser Permanente of Northern California, for that matter. They're already doing it—and doing it successfully.

    This month in PT in Motion magazine: Associate Editor Eric Ries takes an in-depth look at PTs in the primary care space, where they assume roles that range from a "roving PT" member of a multidisciplinary primary care team (the Kaiser approach), to a clinician in private practice who is often a patient's first point of contact with the health care system. Bare and Byerley are examples of the latter, both of whom have thriving practices in very different settings.

    The article features various PTs' perspectives on what it takes to provide primary care and outlines what APTA is doing to promote the concept. Ries also covers the longstanding use of PTs as primary care providers in the military and interviews PTs for their perspectives on the barriers to adopting a similar model in the civilian world, as well as the broad cultural hurdles that will need to be overcome to make the primary care PT more common.

    "Deepening Physical Therapy's Footprint: PTs in Primary Care" is featured in the December-January Issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them one of the benefits of belonging to APTA. Also in the December-January issue: APTA’s Emerging Leaders and the Catherine Worthingham Fellows of the American Physical Therapy Association share their views on such professional issues as the role of research, networking, education, mentors, and the future of the profession. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Study: Clinic Ball Pits Carry Bacterial Risks

    It's no secret that when it comes to their potential for bacterial awfulness, the children's ball pits often found in fast food restaurants are the stuff of a germaphobe's nightmares. Now it turns out that if not properly maintained, ball pits in physical therapy clinics are capable of inducing shudders too.

    In a study recently published in the American Journal of Infection Control (abstract only available for free), researchers tested 6 ball pits in inpatient and outpatient physical therapy clinics in Georgia to find out what, if anything, those pits were harboring at a microbial level. Authors hope that the study will help to spark a conversation about standards for cleaning the enclosures—standards that they say have remained "elusive" to date.

    To conduct the analysis, researchers collected 9 to 15 balls taken from different depths in each ball pit, and then swabbed the entire surface of each ball. Samples were then inoculated on agar plates and allowed to grow for 24 hours at 91.4 degrees Fahrenheit. After the incubation, samples were tested for the number of colony-forming units (CFUS) present. Here's what researchers found:

    • Researchers identified 31 bacterial species and 1 species of yeast, with 9 organisms identified as "opportunistic pathogens." These organisms included bacteria associated with endocarditis, septicemia, urinary tract infections, meningitis, respiratory distress syndrome, streptococcal shock, and skin infections. The variety of yeast found on the balls—rhodotorula mucilaginosa—has "a high affinity for plastics" and has been associated with "multiple cases of fungemia in immunocompromised individuals," authors write.
    • There was "considerable variability" among the clinics, ranging from 36% to 93% of balls tested that produced recoverable CFUs, suggesting that clinics "utilize different protocols" for maintaining their ball pits, according to authors.
    • In the worst instance, bacterial colonization was found at the rate of "thousands of cells per ball, which clearly demonstrates an increased potential for transmission of these organisms to patients and the possibility of infection in these exposed individuals," authors write.

    Lead author and APTA member Mary Ellen Oesterle, PT, EdD, says the results should give clinics pause.

    "Clinics should be concerned about these findings," Oesterle said in an interview with PT in Motion News. "I would not recommend using a ball pit in a clinic until proper cleaning has occurred—and until the clinic verifies that the cleaning procedure effectively cleans the balls."

    Oesterle wasn't necessarily surprised by the findings, both in terms of the presence of pathogens and the variability among clinics. "In my own experience doing early intervention physical therapy for over 10 years, I encountered children who I suspected had contracted infections from ball pits, so this study confirmed something that rang true," Oesterle said. "The variability isn't surprising either," she added. "Each facility has different exposures, environments, and cleaning procedures, so I would expect the results to reflect that."

    And although concerning, Oesterle believes the problem is a solvable one.

    "I don't think it would be that difficult for clinics to reduce risk significantly," Oesterle said. "There are several approaches that may work well—for example, one clinic hangs balls in a mesh bag and disinfects them that way. We would like to do a follow-up study on the best cleaning method."

    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.