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  • California PTs Rally Against Senate Bill 381

    California physical therapists (PTs) are preparing for a key hearing and possible vote on legislation aimed at prohibiting them from performing joint manipulation. California Senate Bill 381 (SB 381),  authored by state Sen Leland Yee and  sponsored by the California Chiropractic Association, is scheduled  to be heard on Monday, April 15, at  1:00 pm, in the California Senate Business, Professions, and Economic Development Committee in Sacramento. 

    The legislation would prohibit anyone other than a chiropractor, physician, or osteopath from performing joint manipulation in the state and make the term "joint manipulation" synonymous with "joint adjustment." Under SB 381, any health care practitioner other than a chiropractor, physician, or osteopath who performs a joint manipulation in California would be considered to be engaged in the unlawful practice of chiropractic and result in the possible revocation or suspension of the health care practitioner's license.

    The legislation has been introduced under the guise of "public protection," despite that fact that there is no data or evidence suggesting that there is a greater threat to patient safety from physical therapists performing joint manipulation techniques. The performance of joint manipulation by physical therapists is different from a joint adjustment performed by chiropractors. The legislation is part of an ongoing turf battle against qualified physical therapists who perform joint manipulation.

    APTA and its California Chapter strongly oppose SB 381, as treatment interventions do not fall under the exclusive domain of any one specific profession. Physical therapists, chiropractors, medical doctors, and osteopathic physicians are all educated and trained to employ joint manipulation within the scope of their respective licenses and in a manner that protects the public's health, safety, and welfare. Unnecessarily restricting any qualified licensed health care providers whose education and scope of practice includes joint manipulation from being able to provide joint manipulation is anti-competitive, and would diminish patient choice and increase health care costs. 

    California Chapter members are encouraged to contact their state legislator and the members of the Senate Business, Professions, and Economic Development Committee to oppose SB 381 and, if possible, attend the April 15 hearing at the state capitol in Sacramento.

    Meanwhile, the chapter has a number of other contentious legislative battles looming this year: legislation to provide for full patient access (Assembly Bill 1000) was recently introduced  in the California Assembly, while legislation to repeal its current anti-POPTS law (Assembly Bill 1003) also has been introduced.

    Proposed Rule Outlines Navigator Standards

    The Centers for Medicare and Medicaid Services (CMS) released a proposed rule yesterday outlining standards that "navigators" in federally facilitated and state partnership exchanges, also known as marketplaces, must meet.

    Navigators are entities or individuals that will provide accurate and unbiased information to consumers about the exchanges, qualified health plans, and public programs including Medicaid and the Children's Health Insurance Program. For those who are not familiar with health insurance, have limited English literacy, or are living with disabilities, navigators will help ensure that they understand their health coverage options.

    The proposed standards would help ensure that navigators and other assistance personnel will be fair and impartial and will be appropriately trained, and that they will provide services and information in a manner that is accessible.

    CMS also proposes 2 amendments to the existing regulation for navigators that would apply to all navigators in exchanges, clarifying that any navigator licensing, certification, or other standards prescribed by the state or exchange must not prevent the application of the provisions in the Affordable Care Act. The proposal also seeks to make entities with relationships to issuers of stop loss insurance (policies that protect companies against catastrophic claims) ineligible to become navigators, including those who are compensated directly or indirectly by issuers of stop loss insurance in connection with enrollment in qualified health plans or non-qualified health plans. The same ineligibility criteria that apply to navigators would also apply to non-navigator assistance personnel providing services in any federally-facilitated exchanges, including in state consumer partnership exchanges, and to federally funded non-navigator assistance personnel in state-based exchanges.

    In addition to navigators, consumers will have access to assistance through services such as a call center, which will be operated by the Department of Health and Human Services, for obtaining referrals to the appropriate state or federal agencies, in-person assistance personnel, certified application counselors, and agents and brokers. 

    ESPN's Stephania Bell Discusses ACL Tears on Move Forward Radio

    ESPN’s leading injury analyst for fantasy sports joined Move Forward Radio today to discuss one of the most talked-about injuries in professional sports: anterior cruciate ligament (ACL) tears.

    In the latest episode of APTA's consumer-oriented online radio show, Stephania Bell, PT, OCS, CSCS, describes the injury that in recent years has affected elite athletes—ranging from football's Adrian Peterson to baseball's Mariano Rivera and skiing's Lindsey Vonn—and is becoming increasingly common among youth and amateur athletes.

    In the interview, Bell outlines possible similarities and differences between treatment programs for elite and nonelite athletes, and she provides advice for parents of youth athletes about ways to protect against ACL tears, which are more likely to be suffered by girls than boys.

    Over the course of the 37-minute episode, which was a Blog Talk Radio "Staff Pick" for April 4, Bell also describes her path to becoming the face of injury analysis for fantasy sports at ESPN.

    APTA issued a press release about the show and also promoted MoveForwardPT.com's Physical Therapist's Guide to ACL Tear via social media.

    Move Forward Radio airs approximately twice a month. Episodes are featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    APTA members are encouraged to alert their patients to this series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.

    Updated Cochrane Review: Rehabilitation for Long-term Care Residents

    Physical rehabilitation for long‐term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents, say authors of an updated Cochrane review first published in 2009. There is insufficient evidence to reach conclusions about improvement sustainability, cost‐effectiveness, or which interventions are most appropriate, they add. Future large‐scale trials are justified.

    For this update, the authors searched the trials registers of Cochrane entities, trials and research registers, and conference proceedings; checked reference lists; contacted authors, researchers, and other relevant Cochrane entities; and updated searches of electronic databases in 2011 and listed relevant studies as awaiting assessment. They selected randomized studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long-term care residency.

    Two review authors independently assessed risk of bias and extracted data. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. The authors investigated adverse effects, including death, morbidity, and other events. They synthesized estimates of the primary outcome with the mean difference; mortality data with the risk ratio; and secondary outcomes, using vote-counting.

    The authors included 67 trials involving 6,300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of 6 points (7 studies), Functional Independence Measure (0 to 126) scores of 5 points (4 studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (3 studies), Timed Up and Go Test of 5 seconds (7 studies), and walking speed of 0.03 m/s (9 studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3,721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation, say the authors.

    APTA Launches Regenerative Rehabilitation, Genetics Web Resources

    APTA has developed new resources to help physical therapists understand the impact that regenerative rehabilitation and genetics have on physical therapist practice. The Regenerative Rehabilitation webpage includes 2 podcasts, an audio course, and other relevant resources. The Genetics in Physical Therapy webpage provides general information, links to PT in Motion and PTJ articles, and features a 2-part session on genomics presented by leaders in orthopedics and neurology at the 2013 Combined Sections Meeting.