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  • Your NEXT Photos Could Make It to Print

    Picture this: your photographs published in PT in Motion magazine.

    The newly redesigned PT in Motion is inviting all attendees to the NEXT Conference and Exposition to become a volunteer photographer. Snap a few great pictures of goings-on, take a few creative selfies, grab a couple candid shots, and e-mail them to the magazine. You just might see your work published in the September issue alongside coverage of NEXT.

    Although a professional photographer will be covering the major events, that’s only going to scratch the surface. We’re looking for additional coverage of all aspects of NEXT: sessions, special events, attendees, views in and around the hotels and convention center, and anything else that grabs your attention or the attention of others.

    The call for photographs is part of PT in Motion's efforts to encourage greater member involvement in the look and content of the magazine, from article themes to photography.

    PT in Motion will not consider any submissions that don’t meet these 2 requirements:

    1. Include with your submissions the time and location, names of people you can identify in the photo, and your full contact information, so PT in Motion can get back to you with any questions or concerns.
    2. Photos must be high resolution. Be sure to set your camera or phone to a high resolution setting (3 MB or greater).

    E-mail your best shots with your contact information to: PTinMotionMag@apta.org.

    Summaries of New CMS Rules Now Available

    APTA members now have access to summaries of the latest proposed rules from the US Centers for Medicare and Medicaid Services (CMS).

    The new resources, all pdf files, focus on CMS rule changes to inpatient rehabilitation facilities (IRFs), Medicare's acute care hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system, and the Medicare Skilled Nursing Facility (SNF) prospective payment system (PPS).

    The summaries are part of an extensive set of APTA resources on Medicare coding and billing.

    APTA Participates in White House Concussion Summit

    Need confirmation of physical therapy's role in education, prevention and treatment of concussion in youth sports? Would an invitation from the White House do?

    APTA President Paul A. Rockar Jr, PT, DPT, MS, and APTA staff were on hand for a May 29 gathering at the East Wing of the White House during which President Barack Obama announced new public and private sector commitments to increase awareness of concussions in youth sports, and to encourage more research into the topic. APTA was among the groups invited to attend the event.

    The association has a long history of support for concussion education and research, and shared its "planned commitment to action" with the White House and summit attendees. That commitment includes member education; the development of multi-disciplinary treatment standards; interprofessional collaboration to raise awareness; the development of new prevention, identification, and rehabilitation tools; and the creation and dissemination of concussion-related resources for parents and coaches.

    APTA has also advocated for policy changes and guidelines on the state and federal level, and has worked with the Centers for Disease Control and Prevention (CDC) on the issue of concussions. Two APTA members serve on the CDC Pediatric Traumatic Brain Injury Guideline Workgroup.

    "Physical therapists provide a unique contribution to the concussion care management team, particularly in the areas of balance and vestibular evaluation and rehabilitation," said Rockar in an APTA news release. "We continue our commitment to research, education, prevention, education, and treatment. We are honored today to be invited by the White House to participate in this summit and look forward to future work with other stakeholders involved in addressing this important issue."

    Check out APTA's practice-focused resources on concussion, including a TBI webpage, a series of podcasts, a PT's guide to concussions, online learning opportunities on when to return to sport, and information on managing concussions with an interprofessional team. Members can also access evidence-based practice research through PTNow.

    Help Identify Physical Therapy's 'Top 5' Unnecessary Procedures

    APTA is asking its members to choose wisely in order to help consumers do the same.

    This week, all APTA members were invited by e-mail to participate in a survey that will help the association identify the "top 5 things physical therapists (PTs) and patients should question," for consideration to be included in the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign. This high-profile effort aims to educate consumers on health care procedures that tend to be done frequently, yet whose usefulness is called into question by evidence. The survey is now available online.

    APTA is among the first 3 nonphysician provider organizations to be invited to join this project, which is being promoted by Consumer Reports and has already garnered media attention.

    The association's work to create a physical therapy-related list began with a call for suggestions from members. A member expert panel reviewed over 170 suggestions and narrowed the list down to 9 candidates, basing its choices on Choosing Wisely requirements that the tests or procedures have been called into question through generally-accepted evidence, yet are frequently done.

    Members have until June 3 to complete the survey. The top 5 questioned procedures will go to the APTA Board of Directors before being submitted to the ABIM Foundation for final approval. Members who missed the initial e-mailed survey link are being advised to be on the lookout for a reminder e-mail coming soon. (Not receiving e-mails from APTA? Update your e-mail preferences or check your spam folder.)

    Choosing Wisely is a consumer-focused effort that is not intended to influence payment or coverage decisions. Instead, the initiative is designed to foster conversations between patients and health care providers about the care that is truly necessary for the individual health care consumer.

    Once approved by the APTA Board of Directors and accepted into the program, APTA's Choosing Wisely list will become a feature of its Integrity in Practice Initiative, a broad effort to eliminate fraud, abuse, and waste from health care and strengthen the good reputation of physical therapy. The effort was the subject of a feature article (members-only access) in the February issue of PT in Motion.

    Focus on Specific Interventions May Limit New Study Questioning Effectiveness of Physical Therapy on Hip OA

    A new study comparing physical therapy with a sham procedure in the treatment of hip osteoarthritis pain and disability contains some interesting findings—and some notable limitations.

    The research, published in the May 21 issue of JAMA (abstract only available for free), followed the progress of 102 individuals with diagnosed hip osteoarthritis (OA) and accompanying pain and disability, half of whom received physical therapy treatments and home exercises "typical of current practice," and half of whom received a "sham" procedure involving application of an inactive gel. The results, according to the authors, showed that physical therapy was not more effective than the sham treatment at any evaluation point during the study.

    "Unfortunately, as a physiotherapist, the findings weren't what we hoped for," said lead author Kim A. Bennell, PhD, in an interview with JAMA. "We found that the active physical therapy program was equally beneficial as the sham program at both the 12-week timepoint and the 9-month follow up. There is a benefit to going to physical therapy, but the benefits are not related to the specific effects of our treatment."

    Those conclusions might not be as sweeping as they sound at first blush, according to Kathleen Mangione, PhD, PT, FAPTA, physical therapy professor at Arcadia University and former PTJ editorial board member. While she believes the study was soundly constructed, she thinks the research may be saying more about exercise selection and dose than about the efficacy of physical therapy. "This is a well-done study looking at the specific effects of manual therapy and unsupervised exercise prescribed by PTs, but it is not a definitive study on physical therapy and hip osteoarthritis," she said.

    "A recent systematic review by Juhl found that supervised aerobic and strength training exercises for the knee, 3 times a week, reduced pain and lowered self-reported disability for patients with knee osteoarthritis," Mangione added. "What the JAMA article describes was a program that was in large part passive."

    In the study, 8 physical therapists (PTs) with 5 or more years of clinical experience delivered 2 kinds of treatments to patient participants—an "active" program and the sham program. The active group attended 12 physical therapy sessions over 10 weeks (twice weekly the first week, once weekly for 6 weeks, then about once every 2 weeks until week 11 or 12). The first sessions were for 45–60 minutes, with the rest lasting 30 minutes.

    According to authors, all active group participants received manual therapy techniques that included hip thrust manipulation, hip-lumbar spine mobilization, deep tissue massage, and muscle stretches. Participants were also prescribed 4 to 6 home exercises to be performed 4 times a week, and received education and advice. Where appropriate, some participants also received walking sticks, and PTs involved in the study were permitted to engage patients in "optional techniques and exercises depending on assessment findings," though few did.

    Participants in the sham group received the same amount of clinician contact as the active group, but the treatment consisted of application of an inactive ultrasound gel, with no manual therapy or home exercise instructions. Instead, participants were instructed to self-apply the gel for 5 minutes 3 times a week during the 6-month follow up period.

    Authors state that among the 2 groups, improvement in pain was statistically significant but not significantly different, with both groups showing notable gains. Similarly, function assessments among the groups improved at nearly identical rates, with the sham group slightly outperforming the active group. Researchers used the Western Ontario and McMaster Universities Osteoarthritis Index to measure function.

    "The absence of significant between-group differences despite the use of skilled therapists and excellent adherence rates to home exercise (85%) suggest that the active physical therapy program was truly ineffective," the authors state. Instead, authors believe improvement—at least in the sham group—may be linked to the placebo effects of contact with a clinician, benefits that are "more from indirect effects you get from contact with a practitioner," Bennell said in the JAMA interview.

    Mangione cautions against generalizing from the study. "I don't think we can say physical therapy isn't effective. I think we can say 4 specific manual therapy techniques and a home-based program of unsupervised stretching and infrequent strengthening was not more effective than the sham therapy," she said. "Physical therapy is a complex biobehavioral intervention and to lump all of physical therapy together—especially when the only physical therapy … in this study was 4 manual therapy techniques—is oversimplifying what physical therapy is and what PTs do."

    Research-related stories featured in News Now 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.

    UnitedHealthcare Announces FLR Requirements Starting August 1

    UnitedHealthcare announced in its May bulletin that the Medicare outpatient therapy functional reporting requirement would apply to UnitedHealthcare Medicare Advantage plans beginning August 1 (the announcement can be found on page 46 of the bulletin).

    G-codes and severity/complexity modifiers will be required on contracted physical therapist claims with dates of service on or after August 1, 2014. Claims that do not include the appropriate G-code and modifiers will be rejected.

    APTA offers a functional limitation reporting webpage that provides resources to help members meet this reporting requirement.

    Wikipedia Medical Information Popular But Often Wrong

    When it comes to medical information, Wikipedia's popularity may be exceeded only by its inaccuracy.

    A new study has found that among Wikipedia entries on the most costly conditions, 90% contained errors—a problem made even more troubling given the website's popularity generally, and the fact that 47% to 70% of physicians and medical students admit to using it as a reference.

    In the May issue of the Journal of the American Osteopathic Association (.pdf), authors of the study write that "most Wikipedia articles on the 10 most costly conditions in the United States contained assertions that are inconsistent with peer-reviewed sources," and that "these assertions on Wikipedia represent factual errors."

    For the study, authors identified Wikipedia articles addressing heart disease, cancer, mental disorders, trauma-related disorders (concussion), osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes, back problems, and hyperlipidemia. Two reviewers—internal medicine residents or rotating interns—then read each article, identified all assertions made in the article, and verified the accuracy of the assertion by finding concordance in peer-reviewed resources.

    In the end, reviewers identified "statistically significant discordance" between the Wikipedia articles and the peer-reviewed sources in all areas except concussion. Authors were unsure why the concussion entry withstood scrutiny, other than to speculate on the possibility that "the contributors to this particular article were more expert."

    In an editorial (.pdf) accompanying the article, Lori Fitterling, MLS, reference librarian for the Kansas City University of Medicine and Biosciences, writes that the study "adds credence to the message librarians have heralded: medical professionals should be educated about and engaged in the critical analysis of online information. In other words, information literacy should provide a basis for evidence-based practice."

    "Would I want my physician to consult Wikipedia about my condition? No," Fitterling writes. "Physicians and medical students, spend your time consulting a credible, peer-reviewed, evidence-based resource. And if you do not know how to do this, let your reference librarian teach you."

    APTA is actively engaged in building the infrastructure that can connect physical therapists (PTs) and physical therapist assistants (PTAs) with accurate peer-reviewed information to inform evidence-based practice through its PTNow website. Additionally, the association offers the extensive—and recently revamped—MoveForwardPT.com website that provides timely and accurate health information to consumers.

    Both PTNow.org and MoveForwardPT.com have editorial boards that guide and review content, and APTA’s lead librarian provides assistance to help members optimize their searching experience of the PTNow ArticleSearch.

    Research-related stories featured in News Now 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.

    Move Forward Radio Calls for Patient Stories

    Physical therapists watch incredible patient success stories unfold every day. Now it’s time to share those stories with a wider audience.

    APTA is seeking current or former physical therapy patients and clients to share their stories for upcoming episodes of Move Forward Radio, APTA’s official consumer-oriented radio show and podcast.

    Do you know of an inspirational physical therapy success story? E-mail Katie Kissal with basic details of the patient’s condition and age during treatment, as well as a brief description of the patient’s story (the patient’s condition before physical therapy and afterward). Do not include in the e-mail your patient’s name or any other identifiable information that would violate HIPAA’s patient privacy protections.

    Also, do not use the comments section of this post to volunteer for this opportunity.

    In the past, Move Forward Radio has shared the stories of a school teacher who found relief through dry needling, a dentist who reduced his dependency on pain medication for arthritis of the neck, and a personal trainer who learned to run again after nearly losing her foot in a water skiing accident, among others. Current LPGA star Natalie Gulbis and former NFL lineman Don Davey also discussed their experiences with physical therapy.

    If your suggested patient story is selected, APTA staff will contact you to arrange an interview with you and your patient. The story may also be used for a print version of "Patient Stories," also featured on MoveForwardPT.com.

    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 podcasts via iTunes.

    PTNow Blog: Are We There Yet?

    When it comes to drawing inferences for clinical practice, research design can really be an obstacle. That's the issue explored in the most recent PTNow blog post.

    The post looks at research from the Netherlands that seeks to identify categories of interventions that are effective in addressing lumbopelvic pain during pregnancy. And although the study's authors may believe that they have arrived at a basis for some standardization, other experts believe that research to date hasn't included enough direct comparison among individual approaches to make any definitive recommendations.

    What's your opinion? Read the PTNow blog and join the conversation.

    FLR Processing Fixes May Decrease Rejections

    The US Centers for Medicare and Medicaid Services (CMS) has implemented several fixes that should decrease the number of rejections in the processing of functional limitation reporting (FLR) claims. APTA became aware of claims processing errors and delays in payment soon after the FLR system was implemented, and has worked extensively with APTA members and Medicare officials over the last several months to resolve these issues.

    According to CMS, accurately submitted FLR claims should process in the typical 14-day timeframe, and FLR claims with errors should now reject quickly from the system. Providers can then resubmit previously rejected FLR claims once their most recent FLR claims are processing normally. The fixes apply to claims submitted on or after May 6, 2014.

    In correspondence with CMS Administrator Marilyn Tavenner (.pdf), APTA requested that CMS "take immediate action to remedy this situation and ensure that the financial burden caused by the FLR claims processing problems do not hinder patient access to care.” APTA offers multiple resources on FLR reporting at its FLR webpage.

    WHPA: To Grow Worldwide, Professional Regulation Needs to Be Responsive

    As health care professional regulation's prominence increases worldwide, regulatory models will need to develop in ways that are sensitive to regional differences and changes in the overall health care landscape. That was the challenge presented to physical therapists (PTs), physicians, nurses, dentists, and pharmacists at a recent international conference sponsored by the World Health Professions Alliance.

    While attendees to the May 17–18 conference in Geneva, Switzerland, stressed the importance of diverse approaches to individual regulatory frameworks, the WHPA members also agreed that the shared goals of professional regulation should be "person-centered, involving patient care, patient rights, and patient safety," and should "take into account social and economic welfare and professional practice," according to a WHPA press release.

    "It is clear that there is no single model for a good regulatory system," said Marilyn Moffatt PT, DPT, PhD, GCS, FAPTA, president of the World Confederation for Physical Therapy (WCPT), "but all should ensure that physical therapists and other health professionals provide safe and competent services. Regulatory bodies also need to understand the day-to-day realities of the health professions they are seeking to regulate."

    The WHPA conference on regulation was held immediately preceding the World Health Organization's (WHO) World Health Assembly in Geneva. APTA is a member of WCPT.

    VA Will Use More Private Care to Reduce Delays

    In an effort to respond to criticism that the US Department of Veterans Affairs (VA) has subjected veterans to excessive and potentially deadly waits for care, the VA has announced that it will increase veteran access to private hospitals and clinics.

    As reported in the Los Angeles Times,Huffington Post,Washington Post, and other media outlets, the May 24 announcement from VA Secretary Eric Shinseki stated that VA centers are enhancing capacity wherever possible, and that in areas where expansion isn't an option, the agency will increase use of non-VA care.

    In 2013, about 10% of the department's spending—$4.8 billion—was for non-VA care. The recent announcement did not include cost estimates for the increase in use.

    Critics of the VA say that delays in care have become excessive, that the delays themselves were covered up, and that in some cases patients died while waiting for care. An initial review has not revealed an instance in which a delay resulted in a patient's death, according to the VA.

    Move Forward Radio Discusses ACL Injury Prevention in Youth Athletes

    The latest episode of APTA’s Move Forward Radio includes advice to help youth athletes avoid an increasingly common injury: anterior crucial ligament (ACL) tears.

    Citing a recent clinical report in Pediatrics, the episode notes that while incidence of ACL injury has increased among youth athletes, research suggests that risk of ACL injury can be significantly reduced with a basic neuromuscular training program.

    Podcast guest Julie Eibensteiner, PT, DPT, CSCS, who has worked with numerous college and elite soccer players both as a physical therapist and a coach, urged parents to be more assertive in demanding the implementation of these programs for their youth athletes.

    “Too often I think parents feel like they’re a passive player in their child’s sport experience,” Eibensteiner said. “We need to get these [neuromuscular training] programs in place. Parents need to be asking, ‘Why aren’t these programs happening?’”

    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. Ideas for future episodes and other feedback can be e-mailed to katiekissal@apta.org.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Follow MoveForwardPT on Facebook, Twitter, and Pinterest, and share these resources with your friends and followers.

    Initiative to 'Re-Align' Care Debuts

    A new initiative to develop a model of care for older adults with complex chronic conditions will focus on a "realignment" toward patient-defined treatment goals. The project, which has received $750,000 in grant funding, is now in planning stages.

    Called CaRe-Align, the model being developed seeks to "incorporate the best available evidence for involving patients in their own care and facilitating communication and coordination between and among primary care and specialty care clinicians," according to a press release. The 18 month planning project is funded by the John A. Hartford Foundation and the Patient-Centered Outcomes Resource Institute (PCORI).

    The project is being led by Mary Tinetti, MD, of Yale University and Caroline Blaum, MD, of NYU School of Medicine, and includes a panel of over 50 patients, clinicians, family caregivers, and other health care stakeholders. The Hartford Foundation plans to test the model in the next phase of this initiative.

    A CaRe-Align website is in the works. Meanwhile, project organizers are updating progress through the Hartford Foundation blog.

    APTA is engaged in its own project to foster innovation in models of care. Check out the association's Innovation 2.0 webpage to find out how physical therapists are taking on the challenge of rethinking delivery and payment.

    'Magic Wand' Could Be the Future of Diabetic Foot Ulcer Treatment

    A wandlike device and a system that delivers a localized dose of antibiotics could be the next phase in the treatment of diabetic foot ulcers. Both methods are now entering human trial stage, according to an article in Medscape news (free registration required to view story).

    The WoundWand is a debridement device that uses radio energy to precisely dissolve soft tissue, a process that has been used to perform tonsillectomies for several years. The device itself has been used in Australia, and researchers are now recruiting 60 patients for clinical trials.

    Also ready for clinical trial is Osprey Medical's "Limb Recovery System" (LRS), a percutaneous system that can isolate an infected lower limb from the larger circulatory system using catheters, thus allowing higher doses of antibiotics than possible through other delivery methods. Researchers recently reported success with the approach in a 5-patient study. The 20-patient trial is expected to be completed by the end of 2014.

    APTA emphasizes the importance of prevention, wellness, and disease management, and offers resources on diabetes for physical therapists and their patients through its Move Forward.com 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.

    Do you have patients or clients with a recent type 2 diabetes diagnosis? The American Diabetes Association is offering a free guide called "Where Do I Begin," that helps patients and clients understand the fundamentals of the disease and the steps that can be taken to live with it. The booklets are being offered at no charge and can be ordered online.

    First Case of MERS Transmission Inside US Reported; APTA Offers MERS Resources

    The US Centers for Disease Control and Prevention (CDC) announced last week that the first reported transmission of Middle East Respiratory Syndrome (MERS) in the US occurred between an Illinois resident who contracted the virus from the man who had the first reported case in the US.

    Because physical therapists (PTs) and physical therapist assistants (PTAs) are often in close contact with patients and clients in settings where infectious disease can be present, APTA has posted information on the MERS virus and transmission as part of its infectious disease control resources.

    According to a press release from CDC, the Illinois man came in close contact with the individual from Indiana before the infected individual had been diagnosed with the virus. A subsequent health department investigation revealed that the Illinois man tested positive for MERS antibodies, although he has not developed symptoms and is reported to be "feeling well."

    The MERS virus is believed to have originated in the Arabian Peninsula and, until this week, reported cases in the US were in individuals who had recently returned from that region. The infection has a 30% mortality rate, and there is no vaccine or specific treatment for the virus.

    The CDC announced that the news of the transmission inside the US has not changed the agency's recommendations for the general public, travelers, and health care professionals.

    Scientific Statement: Exercise Crucial in Stroke Recovery

    When it comes to patients poststroke, physical activity and exercise is simply good medicine that needs to be prescribed for all survivors, according to a scientific statement recently released by the American Heart Association (AHA) and the American Stroke Association (ASA). The statement asserts that exercise and activity programs not only reduce risk of subsequent stroke, but also strengthen independent living abilities, maintain or improve cognition, and reduce depression.

    The statement (.pdf), which appears in Stroke, says that stroke survivors often develop a "chronic sedentary lifestyle" after a stroke, which leads to further decline and a greater incidence of other cardiovascular events. "What is particularly disconcerting is that many of these stroke survivors have the ability to undertake higher levels of physical activity but choose not to do so," authors state.

    The research team was led by Sandra A. Billinger, PT, PhD, FAHA, and co-chaired by Ross Arena, PT, PhD, FAHA

    The report describes the "vicious circle of decreased activity" in patients who experience stroke, many of whom have moderate to severe disability and/or dementia before suffering the stroke. Typically these patients are already inactive and intolerant of exercise, which contributes to the risk of initial stroke. After the stroke, they face an even more daunting challenge to engage in appropriate exercise and activity.

    The statement emphasizes the importance of "multidimensional" exercise prescriptions that are customized to the circumstances of individual patients and are based on medical history, physical examination, and a thorough understanding of the patient's home environment and support systems. Authors recommend exercise as soon as possible after the stroke event, and mobilization within 24 hours. The statement also encourages the use of strength training and aerobic exercise in addition to work with balance and flexibility, in a program that aims to return the patient to activity levels that are equal to or exceed prestroke levels.

    Authors also write that for an exercise prescription to be truly effective, health care providers need to understand the patient motivators and barriers to continuing an exercise program in ways that alter lifestyle. The statement suggests that involvement in group exercises and a desire to carry out daily tasks were particularly strong motivators, but says that this may not be the case for all patients.

    Overall, the statement urges providers to find an appropriate, patient-centered path to achieving the crucial goal of adequate exercise and activity. "Clearly, there is an urgent need to bridge these treatment gaps by developing and implementing approaches that provide all stroke survivors with access to effective, comprehensive stroke risk-reduction interventions, including exercise," authors state.

    APTA offers resources to physical therapists (PTs), including a podcast, around care of patients with limitations in functioning after a stroke, and has created a PT's "guide to stroke" at Move Forward.com as well as a pocket guide to physical fitness for survivors of stroke for PTs. APTA also cites the role of physical activity in stroke reduction in resources aimed at patients, physical therapists, and policymakers. Members can provide their patients with a handout on stroke prevention (.pdf, listed under "Neurology"), and can share information on this topic with others by downloading resources at APTA's Issue Briefs webpage.

    Research-related stories featured in News Now 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.

    Major League Baseball Will Investigate Rise in UCL Tears, Possible Link to Youth Sports

    With Major League Baseball (MLB) on track to see a record number of pitchers undergoing Tommy John surgery for ulnar collateral ligament (UCL) injuries, experts are beginning to investigate the reasons behind the "epidemic"—including the possibility that more intensive youth sports are a major contributor to the problem.

    Last week, star pitcher Jose Fernandez underwent the surgery, becoming the 18th pitcher to receive the procedure in 2014. Since Fernandez, that number has risen to 20, a rate that already exceeds season averages for 2000 – 2011. On May 18, a panel of MLB researchers convened to begin looking at the causes for the rise, and will be considering the link between increased UCL tears and youth sports intensity.

    A recent article in the Washington Post explored the jump in Tommy John surgeries and interviewed experts who agreed that the ever-increasing speed with which pitchers throw is putting enormous strain on the ligament. While 100-mph fastballs have been achieved partly due to a better understanding of biomechanics, they say, a large contributor has to do with the intensity of youth sports programs. Some high school-aged pitchers are now throwing hard year-round, and suffering increased overuse injuries because of it.

    The Post article describes a youth baseball culture in which young pitchers play from March through the fall and then attend special camps and tournaments the rest of the year, with some even receiving regular individual training. The lack of sustained rest starts the pitchers on a path to injury that is surfacing as a full UCL tear earlier and earlier in their careers, with many high school-aged athletes now undergoing the procedure.

    The problem is further complicated by a perception that Tommy John surgery is a risk-free guaranteed way to actually improve a pitcher's performance. In the Post article, sports orthopedist James Andrews—himself an experienced Tommy John surgeon—is quoted as saying "There's a myth that there's a 100 percent success rate and pitchers come back throwing harder. It's not true. If pitchers come back throwing harder, it's not because of the ligament. It's because of the rehab and core-strength training."

    APTA offers resources on UCL tears and the role of the physical therapist in treatment through its MoveForwardPT.com website. The increase in elbow injuries in professional baseball was among the topics discussed in a recent episode of Move Forward Radio.

    New APTA Resource Focuses on Minimalist Running Debate

    Barefoot and minimalist running is getting attention again, and APTA now offers resources for runners who want to get the latest information on the benefits and risks of this trend.

    The debate over minimalist running shoes was rekindled earlier this month when shoe maker Vibram announced that it had reached a $3.75 million settlement in a class action suit that claimed the company made false scientific claims about the advantages of its "FiveFingers" glove-like running shoe popular with minimalist runners. The company will put the money into an escrow account for consumer refunds, and has agreed to stop making claims that the shoe is effective in strengthening muscles or reducing injury, unless these benefits are proven by new scientific evidence.

    Runners interested in the current evidence on the practice can visit APTA's new resource called "Barefoot and Minimalist Running: What Do We Know?" on MoveForwardPT.com, the association's official consumer information website. The webpage includes information on injury prevention, faster running, and foot muscle strengthening.

    APTA provides additional resources for runners in its Health Center for Runners webpage that includes symptom and condition guides, podcasts, videos, and more.

    Wasteful Care in Medicare 'Substantial and Widespread'

    Medicare beneficiaries "commonly" undergo tests and procedures that are of little benefit and could cost the system more than $8 billion a year, according to authors of a new study of 1.36 million beneficiaries. Though researchers say that the findings are "consistent with the notion that wasteful practices are pervasive in the US health care system," gauging the actual magnitude of the problem—and pinning down costs to Medicare—is not easy.

    The study, published in the May 13 issue of JAMA Internal Medicine (abstract only available for free), analyzes the use of "low value" services in cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing, and surgical procedures by way of 26 claims-based measures applied to Medicare claims from 2009. The services were chosen based on recommendations in the American Board of Internal Medicine (ABIM) Foundation's "Choosing Wisely" campaign, as well as other agencies. APTA is 1 of the first 3 nonphysician groups that will be participating in the Choosing Wisely campaign.

    The 26 services researchers selected for the study "provide little to no clinical benefit on average" and included procedures such as cervical cancer screening for women 65 and older, bone mineral testing at frequent intervals, preoperative stress testing, EEGs for headache, and PSA testing for men 75 years and older.

    Researchers used 2 screening approaches that had different "sensitivity" levels. They found that low-value procedures and tests occurred at the rate of about 80 services per 100 beneficiaries at the more sensitive analysis level, or about 21.9 million instances in 2009.The less sensitive analysis dropped use rate to about 33 services per 100 beneficiaries, with 9.1 million instances experienced by 25% of beneficiaries.

    Depending on the approach used, authors write, the prevalence of low-value services could amount to a per-beneficiary annual cost of either $310 or $71, which translates into Medicare costs of either $8.5 billion or $1.9 billion.

    "Even when applying narrower versions of our limited number of measures of overuse, we identified low-value care affecting one-quarter of Medicare beneficiaries," authors write. "Despite the limited number of services we examined, their frequency and correlations with one another suggest substantial and widespread wasteful care."

    One of the strongest findings of the research, according to the authors, is just how much more work needs to be done to develop a solid approach to analyzing low-value services. "Many quality measures have been developed to assess underuse but few to assess overuse," authors write.

    Research-related stories featured in News Now 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 CMS Rules Target Consumers, Quality Reporting

    The US Centers for Medicare and Medicaid Services (CMS) has released a final rule (.pdf) on Exchange and Insurance Market Standards for 2015 and beyond that the agency claims is "aimed at giving consumers additional tools to evaluate their options and find plans that best meet their needs and budget." A summary of the rule is also available for download.

    The rule covers a range of issues including consumer notices, state restrictions on navigators, the Small Business Health Options Program (SHOP), and cost sharing. The changes, which will be implemented beginning in 2015, address the following areas:

    • The final regulation clarifies situations under which state restrictions of consumer assistance personnel (navigators, assisters, and certified application counselors) are preempted by federal law. It also imposes new federal restrictions on the consumer assistance personnel and authorizes civil money penalties on those who violate their federal obligations, breach the confidentiality of patient information, or assist in enrollment fraud. The final rule recognizes that states may regulate these personnel as long as the state regulations do not conflict with federal law or prevent the personnel from carrying out their responsibilities.
    • The new rule requires issuers to use standardized notices when renewing coverage or discontinuing products. The rule also addresses when insurance plans can modify coverage and when that modification constitutes termination of coverage.
    • For 2015, the maximum annual limit on cost sharing will be $6,600 for individual coverage and $13,200 for family coverage.
    • CMS reaffirms in the final rule its commitment to permit employee choice in the federal SHOP exchange beginning in 2015.
    • SHOP exchange rules will be modified to provide for an annual open enrollment period for all SHOPs aligned with the open enrollment period for the individual market.
    • The final rule provides additional guidance on the exchange quality reporting system. A number of state exchanges already report quality information on qualified health plans (QHPs), and the federal exchange intends to begin doing so in 2016 for the 2017 coverage year.
    • The US Department of Health and Human Services will be allowed to consult and share information concerning QHP insurers with other state and federal regulatory and enforcement agencies as necessary. The rule requires HHS to give insurers a 30-day notice setting out alleged violations and giving an opportunity to respond before the imposition of civil money penalties.

    PTNow Blog: Come and Get It

    In direct violation of the "what happens in Vegas" edict, the current PTNow blog is revisiting a popular giveaway from the 2014 Combined Sections Meeting (CSM): a handy "at a glance" reference on functional limitation reporting g-codes and severity modifiers.

    The postcard-sized version "was eagerly snapped up by nearly every attendee" who passed the PTNow booth in the exhibit hall, according to the blog. The new version can be easily downloaded to your smartphone or tablet.

    New PT in Motion to be Revealed June 1

    In just 2 weeks, APTA members will receive the premier issue of the redesigned PT in Motion magazine.

    Both the appearance and the content have been updated to make it more lively, readable, and valuable. Articles will be crisper, with additional resources and tools to enhance physical therapy practice and activities. The first issue of the redesigned magazine will feature evidence-based practice in outpatient settings and a look at PTNow, APTA’s clinical practice website.

    As for PT in Motion’s departments and columns, you’ll find some—such as the former “This is Why” (now titled “Defining Moment”)—expanded to better tell the stories of physical therapists. Others are being tightened up and supplemented with extra resources that allow readers to follow up on suggestions and guidance.

    Coming soon: enhanced integration of PT in Motion with other APTA websites and social media, all designed to give you the information you want in the ways you want it. Stay tuned!

    Gala Tickets Still Available – But Not for Long

    Ask Cinderella—missing out on a party is a drag. Fortunately if you act before May 21, there's still a chance for you to get in on the fun without having to rely on spells with limited shelf life doled out by fairy godmothers.

    The deadline to purchase tickets to the Foundation for Physical Therapy's 35th anniversary gala is May 21. It's your last chance to get in on a special celebration of physical therapy research to be held at the Westin Hotel in Charlotte, on Thursday, June 12, 7:30 pm-12:00 am. Tickets are $150 for individuals and $100 for students, and can be purchased by calling 877/585-6003.

    In addition to honoring this year's Foundation service award winners (.pdf) and top fundraising schools in the Miami-Marquette Challenge, the gala will commemorate 35 years of Foundation efforts to support physical therapy research.

    Stem Cells Restore Movement to Mice With MS-Like Symptoms

    Although far too early to know if the treatment will be effective on humans, researchers have been able to restore movement to mice disabled by a multiple sclerosis (MS)-like condition by using human stem cell transplants. The recovery was quick, long-lasting, and present even though the stem cells themselves had been rejected by the mice.

    According to the study's authors, mice disabled by a virus that mimics MS began walking 10 to 14 days after receiving spinal injections of human neural stem cells, and continued to walk and engage in other movements after 6 months. The findings were e-published ahead of print on May 15 in Stem Cell Reports (.pdf).

    Of particular importance, authors write, is the fact that the actual stem cells were quickly rejected by the mice. They believe that stem cells and T cells acted as triggers to generate myelin sheaths and reduce inflammation by the mouse body itself. "These reports are consistent with growing evidence that transplanted stem cells rarely differentiate into cells of neural lineage, and their efficacy often appears to be through delivery of trophic factors … or by modulating inflammation," they write.

    The researchers theorize that the key to the process may be linked to the presence of regulatory T cells (tregs) in the stem cells. Stem cells that had been stripped of tregs did not produce the same effects in the mice.

    "Multiple sclerosis … is … an attractive target for cell therapy because of the lack of long-term therapeutic benefit from current treatment," the authors write. "There is growing evidence that long-term survival of transplanted cells is not required for beneficial effects."

    Research-related stories featured in News Now 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.

    Abstract Reviewers Needed for International Congress

    ATPA members have a unique opportunity to help shape the content of the largest international physical therapy conference.

    The World Confederation for Physical Therapy has announced that its International Scientific Committee (ISC) is now recruiting reviewers of platform and poster abstracts submitted for possible presentation at the next WCPT Congress taking place in Singapore May 1 – 4, 2015.

    In order to qualify for consideration to be a reviewer, members must complete an online questionnaire by July 31. WCPT also recommends that potential reviewers sign up to be included in the congress database to receive regular updates on the event. The review process will begin November 10 and all reviews must be completed by December 1.

    The number of abstracts sent to reviewers will depend on their area of expertise and the number of submissions received. WCPT estimates that reviewers will receive no more than 30 abstracts.

    MoveForwardPT.com Adds ‘Inspired’ Resources

    Enhancing a kid's mental and physical development can be child's play—literally.

    Parents looking for fun, easy-to-implement play activities that can help their children develop can now find them at MoveForwardPT.com thanks to a new partnership with The Inspired Treehouse, a collaborative venture founded by a pediatric physical therapist (PT) and 2 occupational therapists.

    In a recent Move Forward Radio podcast, Lauren Drobnjak, PT, Pram Braley, OT, and Claire Hefferon, OT, describe how they developed ideas for inexpensive activities that parents can use to enhance their child’s physical and mental development.

    "The 3 of us work in a school district with families who have significant economic and health care disparities," Hefferon said. “We wanted to sort of use The Inspired Treehouse as a way to archive and organize all of our activity ideas for kids. We have them in files sitting around in our house and we thought this would be a fun way to get it out there to more people.”

    MoveForwardPT.com, APTA’s official consumer information website, will feature selected content from The Inspired Treehouse in a section called "Activities to Promote Development in Children," which is among the many resources provided in its Health Center for Children.

    Help raise awareness of the benefits of physical therapy by sharing MoveForwardPT.com resources with your patients and clients. Link to resources from your website, share them on social media, or print them for use in your clinic.

    Big Insurance Companies Will Release Data in 2015

    Three of the largest commercial health insurance companies in the US will be sharing price data to provide consumers with a "transparent and comprehensive destination to make more informed choices about health care," according to the creator of a new online database.

    UnitedHealthcare, Aetna, and Humana announced that they will partner with the nonprofit Health Care Cost Institute (HCCI) to create an information portal that will aggregate pricing data from those companies as well as from Medicare Advantage and Medicaid plans where permitted by state law. According to a press release from HCCI, the database will be operational by 2015, and will likely include data from additional insurance companies that are expected to sign on to the program between now and then.

    A recent Forbes magazine article reports that the system will provide "three tiers" of information: 1 containing average price information for an episode of care, available to any consumer; another more detailed set of data available to customers of the participating companies; and a third even more in-depth compilation available to employers.

    "Voluntarily making this information available will be of immeasurable value to consumers and other health system participants as they seek to manage the cost and quality of care," said HCCI Executive Director David Newman in the press release.

    Justin Moore, PT, DPT, APTA vice president of public policy, practice, and professional affairs believes the data release is great news not just for consumers, but for physical therapists (PTs) and physical therapist assistants (PTAs).

    “Access to data is critical in this new era of health care, and APTA applauds the leadership of 3 major insurers in beginning the process toward improved transparency," Moore said. "We believe this kind of information will empower consumers in their selection of health care services and providers, and has the potential to demonstrate the value physical therapy provides our health care system every day."

    CDC Webinar on Activity for Adults With Disability Includes PT Perspective

    On the heels of a US Centers for Disease Control and Prevention (CDC) report that stresses the importance of physical activity in the lives of people with disabilities, the agency is offering a webinar to help health care providers learn how to effectively deliver this information to patients—and part of that learning will include a physical therapist's perspective.

    The free program, titled "More adults with disabilities need physical activity – how can health professionals help?" will feature panelists from the US Public Health Service; the National Center on Health, Physical Activity, and Disability; the Exercise is Medicine Program; the Special Olympics; Paralympics; the Amputee Coalition; and APTA by way of Lisa Culver, PT, DPT, MBA, senior specialist in clinical practice for the association.

    The 1-hour program will begin at 2:00 pm ET on May 20. Participants can register online.

    The program is being provided as a follow-up to a recent CDC report asserting that adults with disabilities who are inactive are at a 50% higher risk of developing chronic disease than adults with disabilities who engage in 2.5 hours of moderate aerobic activity per week. The study found that these individuals are 82% more likely to become active if appropriate activity is recommended by their health care providers.

    The webinar is being jointly sponsored by the CDC and the Association of University Centers on Disabilities.

    View Highlights of Membership Matters Week

    There are dozens of reasons to be an APTA member.

    Need proof? Check out highlights from APTA’s Membership Matters Week, including photos and social media posts from members across the country.

    The 7-day campaign, April 14-20, was designed to raise awareness about the value of membership – for the individual, the association, and the profession of physical therapy at large.

    The Membership Matters section of the APTA website includes numerous evergreen resources to help members discuss the importance of membership with their peers year-round, including testimonials, FAQs, and tips on promotion.

    Graphics from the campaign are available to download in online-friendly .jpg versions, as well as print-friendly .eps versions.

    Did you miss Membership Matters Week? It’s not too late to download the “I’m an APTA member because …” sign, or share the resources above, and join the Membership Matters movement.

    Webinar Looks at Clinical Decision-Making in Home Health

    Physical therapists (PTs), physical therapist assistants (PTAs), and other health care providers can get the latest insights on clinical decision-making and the use of valid outcomes and measures in the home health environment through a free webinar being offered on May 21.

    The Alliance for Home Health Quality and Innovation's "Home Health After Hip and Knee Replacement: Physical Therapist Decision-Making" webinar will focus on the challenges and opportunities of the home health environment, and will feature a case illustration using an individual with a lower extremity joint arthroplasty. Roger Herr, PT, MPA, COS-C, APTA Board of Directors member, and Lisa Culver, PT, DPT, MBA, senior specialist in clinical practice for APTA, will be the featured presenters. Speaker bios and more information on the webinar can be found on the Alliance webinar page.

    The presentation is set to begin at 3:00 pm ET. To join the webinar, visit http://fuze.me/24341983 and select "launch" in the browser; to participate in the audio conference, call 201/479-4595* and enter room number 24341983#. Alternative access can be obtained by calling 855/346-3893.

    The Alliance for Home Health Quality and Innovation is a nonprofit organization with membership that includes nonprofit and proprietary home health care providers, academic experts, and 3 major trade associations for home health care (the Visiting Nurse Associations of America, the National Association for Home Care and Hospice, and the Partnership for Quality Home Healthcare).

    All VA Medical Centers to Undergo Audits

    In advance of congressional testimony set to begin this week, US Veterans Affairs Secretary Erik Shinseki has announced that his agency will conduct "face-to-face" audits of all Veterans Affairs (VA) medical centers across the country.

    According to a May 8 statement from VA spokesman Drew Brookie, the audits are being conducted "to ensure a full understanding of VA's policy and continued integrity in managing patient access to care," and were planned before members of Congress and the public began calling for the reviews.

    Shinseki is scheduled to testify before the Senate Veterans Affairs Committee in the aftermath of a report alleging that 40 or more veterans died due to delays in care at a Phoenix, Arizona, VA hospital. The findings and comments from Shinseki, members of Congress, and others have been widely reported in the media, including CNN, the Washington Post, and CBS News.

    The House Veterans Affairs Committee has also issued a subpoena for Shinseki to testify.

    Second US MERS Case Results in Quarantines, 1 Hospitalization

    The second reported case of Middle East Respiratory Syndrome (MERS) in the US has surfaced at an Orlando, Florida, hospital and has prompted a quarantine of 19 health care workers and hospitalization of another after the employees came into contact with the infected individual. Health officials believe the second confirmed US case—another health care worker who had returned from Saudi Arabia—was contracted through close contact in a health care environment.

    In a press release, the US Centers for Disease Control and Prevention Director Tom Frieden, MD, PhD, described the second case as "not surprising" given the increase in reported cases in the Arabian Peninsula. The CDC continues to describe the MERS risk to the public as "very low," and is not recommending that US residents change travel plans.

    The 19 individuals quarantined and 1 hospitalized were employed at Dr. P Phillips Hospital or the Orlando Regional Medical Center, and came into contact with the infected individual. The employee who was hospitalized "developed symptoms" but test results had not been received by the time of a report in the Palm Beach Post. The CDC is urging all health care workers to follow the CDC's recommendations for infection control.

    For more information on MERS protocols, visit the CDC webpage on interim prevention and control recommendations around MERS. Although it does not address MERS specifically, APTA's infectious disease control webpage helps physical therapists (PTs) and physical therapist assistants (PTAs) understand the protocols for reducing risk of disease transmission. APTA staff will continue to monitor the situation and add resources as they are needed.

    New American Diabetes Association Patient Resource Available for Free to PTs, PTAs

    Physical therapists (PTs) and physical therapist assistants (PTAs) have access to a new free resource for patients and clients recently diagnosed with type 2 diabetes, courtesy of the American Diabetes Association (ADA).

    Called "Where Do I Begin," the 16-page guide helps patients and clients understand the fundamentals of type 2 diabetes and the steps that can be taken to live with the disease. The publication includes information on the role of exercise, proper diet, medicines, and support in managing the condition, and encourages patients to sign up for a free 1-year ADA program called "Living With Type 2 Diabetes."

    The booklets are being offered at no charge. PTs and PTAs interested in obtaining copies of "Where Do I Begin" can order online.

    Innovative Physical Therapy Models Vie for Support at Workshop

    How do you bolster widespread replication of promising models of health care delivery across the country? Feed them to the sharks.

    Although the inhabitants in APTA’s Innovation 2.0 Workshop “tank” resembled friendly dolphins more than bloodthirsty sharks, their valuable feedback gave presenters at the workshop plenty to consider as they now refine proposed models, in search of funding and other support from the association.

    The May 8-9 workshop in Alexandria, Virginia, featured a “Shark Tank” set-up, in which 21 proposed models were presented to expert panelists for questions and critique. These 21 finalists, chosen before the workshop from 60 submitted models, will use the advice to finalize detailed proposals in hopes of being among those chosen by APTA to receive funding and in-kind services to advance their models. In return, APTA will be able to access model data that potentially helps the association develop and disseminate resources that enable members to promote the impact of physical therapy in the emerging health care environment.

    While each proposed model was different, a few common themes emerged:

    • The promise of overall cost savings often was the attention-getter for receiving internal support for a project, even if physical therapy-specific expenditures increased, if they enabled other expenditures to drop.
    • Working to even out health disparities among underserved or disadvantaged populations was an important factor in many programs.
    • Interprofessional collaboration was key in most cases.

    Interspersed between the model presentations, speakers offered their expertise on several relevant topics.

    Alan Jette, PT, PhD, FAPTA, stressed that what we do now won’t be useful unless it becomes the new normal—translating the results from clinical studies to everyday practice. From here, Jette said, we need to plan initiatives to achieve dissemination and adoption of clinical innovations, such as a “PT innovation extension service” or “PT innovation fellowships.” By fostering innovation in this way, not only can initiatives such as the 21 described at the workshop start making a difference now, but, as noted by APTA CEO Michael Bowers in opening remarks, they “will make a difference in years to come.”

    To give presenters and audience alike an example of an innovation that already was taking off, Mary Stilphen, PT, DPT, and Diane Jette, PT, DSc, FAPTA, described the Cleveland Clinic’s “6-Click” initiative, which calls for shortened forms to collect examination data—6 list items only per category such as “functional mobility.” The data gleaned from the time-saving forms, among other things, enabled more physical therapy staff to integrate into the ICU, as they could shift away from higher-functioning patients who didn’t need such a high level of help.

    Meanwhile, Tony Delitto, PT, PhD, FAPTA, explained how to collect data and measure outcomes; Carolyn Oddo, PT, MS FACHE, described characteristics of successful relationships and teams; and Bill Boissonnault, PT, DHSc, FAPTA, shared advice on writing administrative case reports for publication in journals such as PTJ.

    More details on the model selection process, timeline for final decisions, and a list of the 21 presentations up for critique are found on the APTA Innovation 2.0 webpage. Look for more coverage when the winners are announced this summer.

    Concussion Symptoms For Children May Change Over Time, Include Emotional Elements

    Children who experience concussions may find some symptoms fading relatively quickly while others emerge later in a progression that authors of a new study believe should inform how these children are cared for at home and school. This "significant burden of disease" tends to begin with physical symptoms that end soon after the injury, emotional symptoms occurring later, and cognitive symptoms beginning immediately at lasting for 1 month or more.

    The new study, e-published in the May 12 issue of Pediatrics (abstract only available for free), tracked self-reports of 235 patients aged 11 to 22 who presented to a hospital emergency department (ED) with concussion. Patients (or their parents) filled out the Rivermead Post-Concussion Symptoms Questionnaire at or near the time of injury, and then at 1, 2, 4, 6, 8, and 12 weeks afterwards. Authors chose the Rivermead instrument because of its high inter-rater and test-retest reliability, and because the questionnaire asks participants to rate symptoms relative to their own pre-concussion "baseline."

    Authors found that rather than experiencing many symptoms that gradually abated at different rates, patients often experienced a "course of symptoms," with some arising after others have diminished. "Although headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, sleep disturbance, frustration, forgetfulness, and fatigue were the symptoms most likely to develop during the follow-up period that had not been present initially after the injury," they write.

    For example, although fatigue was the second-highest reported symptom at the ED (headache was first) with 64.2% of patients reporting the symptom, another 15.4% of children who did not report fatigue at the ED did list the symptom in later weeks. Additionally, "a substantial number of children" (21.6%) also developed sleep disturbance after initial evaluation. "This finding suggests that children who have a concussion should be warned about the possibility of developing fatigue and sleep issues, and these symptoms should be specifically assessed during follow-up evaluation," authors state.

    Other cognitive and emotional symptoms that developed after initial assessment included forgetfulness (15.8%), poor concentration (13.1%), taking longer to think (11.1%), frustration (17.1%), irritability (14.5%), and restlessness (14.1%). Of patients reporting these symptoms at or after presentation, 18.3% reported taking longer to think as a symptom 28 days after ED assessment, with frustration, irritability, and restlessness still present in 14.7%, 14.2%, and 10.6% of patients respectively.

    "Cognitive symptoms were particularly significant in our cohort," the authors write. "They were present in substantial percentages initially, still went on to develop in many additional patients, and had greater than average duration of symptoms, with the exception of forgetfulness …. These findings support the importance of academic accommodations for children after concussion."

    APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a physical therapist (PT) and offers multiple resources. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and access to evidence-based practice research through PTNow.

    Research-related stories featured in News Now 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.

    'Luke Skywalker' Arm Approved by FDA

    A robotic prosthetic arm that can allow users to perform a range of activities from manipulating keys to power tools has been approved for use by the US Food and Drug Administration (FDA). Dubbed "Luke" after "Star Wars" character Luke Skywalker, the prosthesis is roughly the size, shape, and weight of a human arm and fingers, and is controlled through electrodes placed on muscles near where the arm is attached.

    According to a story from Reuters, the DEKA Arm System now available for sale allowed 90 percent of people using the device to handle small objects such as coins and zippers—in a video posted at phys.org, a study participant is shown picking up individual eggs and placing them in a carton. The prosthesis can be adapted for people with limb loss at the shoulder joint, mid-upper arm, or mid-lower arm, but it cannot be used for limb loss at the elbow or wrist joint.

    A recent press release from the FDA stated that the Pentagon's Defense Advanced Research Projects Agency (DARPA) provided more than $40 million in funding for the project, overseen by DEKA Research and Development Corp. DEKA was founded by Dean Kamen, the inventor of the Segway.

    APTA Launches Redesigned Consumer Website

    Consumers looking for information about treatment by a physical therapist will now have an easier time finding it.

    Last week, APTA unveiled a significant redesign of its official consumer information website, MoveForwardPT.com, which now includes a simplified color palette and a “responsive design” that adjusts to fit tablets and smartphones.

    The redesign also includes adjustments to the site’s navigational architecture, improving access to popular resources like the twice-monthly podcast “Move Forward Radio,” videos, patient stories, and the “Did You Know?” section.

    The backbone of the consumer site remains the ever-growing list of almost 90 symptoms and conditions guides, which are developed by the MoveForwardPT.com editorial board. New to the site is the “Health Centers” area, still in development, which groups the site’s varied resources by audience or activity.

    “This is the most significant redesign of the site since 2011,” said Jason Bellamy, APTA’s director of web and new media. “Content at MoveForwardPT.com has markedly increased in volume and diversity in recent years and, simply put, we’d outgrown the old site and needed the capacity for further expansion.”

    Traffic to MoveForwardPT.com has grown along with the site itself – most recently increasing from 227,704 unique visitors in 2012 to 547,607 in 2013.

    Support from APTA members would help the site reach an even larger audience.

    “MoveForwardPT.com has matured into an expansive resource that members can use to share the value of physical therapy with existing or potential patients and clients,” said Felicity Clancy, APTA vice president of communications and marketing. “The more that members share links to MoveForwardPT.com, via social media or their own websites, the more the site’s traffic will increase, thereby increasing awareness of the brand, as well as the site’s ranking within search engines like Google and Bing.”

    Members with questions about using MoveForwardPT.com resources or contributing to the site’s development should contact Katie Kissal, senior web content specialist for MoveForwardPT.com.

    PTNow Blog: New Podcast Focuses on Realities of Putting Evidence Into Practice

    Putting evidence into practice isn't as simple as handing out a couple journal articles at an in-service training, according to Susan Perry, PT, DPT, NCS. It takes time, follow-up, and a few "clinical champions" who are in it for the long haul.

    Perry shared her perspective on knowledge translation with PTNow Associate Editor Mary Blackinton, PT, EdD, GCS, in the first-ever edition of "All Evidence Considered," a new podcast series from PTNow. Perry recently co-authored the article "Supporting clinical practice behavior change among neurologic physical therapists: a case study in knowledge translation," published in the April 2014 issue of the Journal of Neurologic Physical Therapy (Neurology Section log-in or journal subscription required for full-text access). The podcast can be accessed through a link in the latest PTNow blog post.

    In the podcast, Perry says that although the profession has generally gotten better at accessing evidence-based resources and understanding how to read journal articles, "that's been the end of it—knowing the evidence. I don't believe that we as a profession have progressed to understanding how to use the evidence, even though that's what evidence-based practice is."

    Perry talks about her experiences in implementing non-supported gait training for patients with brain injuries and stroke, and the strategies used to ensure that the evidence was not just shared and tried a few times, but integrated into PT practice at her facility. She says that in order for true knowledge translation to take place, clinician behavior must be tracked over time, with at least quarterly meetings to share progress and barriers with the entire group.

    Equally important, Perry stresses in the podcast, is the presence of one or more "change agents" who can adopt the new idea and lead others to follow through. "You need a clinical champion," she says. "You need someone to make it their business to try this approach."

    What's your opinion on how to apply evidence to practice? Listen to "All Evidence Considered," then join the conversation about Perry's podcast by commenting at the PTNow blog site.

    Watch for the New PT in Motion

    APTA members are in for a surprise come June 1: a completely redesigned PT in Motion magazine that's more lively, readable and valuable to physical therapists (PTs), physical therapists assistants (PTAs), and students.

    The new look was shaped in large part by member comments and suggestions. Look for a more colorful and graphics-based publication, with additional emphasis on resources and tools to help you in your day-to-day activities.

    PT in Motion content continues to evolve as well, and is shaped by the current challenges facing the profession. The upcoming issue of the magazine is a good example of that evolution: because of the growing recognition of the importance of evidence-based practice—and based on member suggestions—PT in Motion will feature stories on evidence-based practice in outpatient settings and on PTNow, APTA’s clinical practice website.

    Next week in News Now: the big changes in store for PT in Motion’s departments and columns.

    NEXT Advance Registration Discounts End May 14

    Beware the ides of May—because if you haven't registered for the NEXT Conference and Exposition by the day before, you'll have missed out on saving some money.

    May 14 is the last day to save on registration fees for NEXT, APTA's spring meeting with a focus on the future of physical therapy being held June 11-14 in Charlotte, North Carolina.

    Registration and housing information can be found on the NEXT webpage along with a schedule of presentations, preconference sessions, and special programs.

    Family Physician Use of LBP Risk Stratification Could Improve Timely Referrals to PTs

    Research from the United Kingdom asserts that family physicians' use of risk-stratified care for low back pain (LBP) has produced "significant improvements in patient disability outcomes" through the application of a system first studied in physical therapist services.

    In an accompanying editorial, authors Timothy S. Carey, MD, MPH, and Janet Freburger, PT, PhD, give "a qualified 'yes'" to the question of whether the system should be attempted in the United States, "where practice acts, third-party payer requirements, and other barriers limit the patient's ability to directly seek care of physical therapists." The research results and editorial appear in the March/April issue of Annals of Family Medicine.

    The project, dubbed "The IMPaCT Back Study," (Implementation to improve patient care through targeted treatment) compared 922 patients presenting with low back pain who received "usual" care with those who received stratified care. This stratified care approach was based on a system developed for a previous study involving physical therapy in the UK. In that study, PTs classified patients as being in a low, medium, or high-risk group for persistent disability and provided treatment matched to the risk level.

    The tool adopted for family physician use consisted of 9 self-report items that addressed function, radiating leg pain, pain elsewhere, depression, anxiety, fear avoidance, catastrophizing, and "bothersomeness." Scores from the assessment placed patients into 1 of the 3 groups. Low-risk groups received education on self-management, advice to stay active, pain medications when appropriate, and reassurance that their prognosis was good. Family physicians referred patients in the medium-risk and high-risk groups to physical therapy, and focused on treatment of the concerns revealed in the stratification tool.

    Researchers compared the usual and stratified treatment groups after 6 months by way of self-report questionnaires and through tracking physician clinical behavior including number of physical therapy referrals, use of tests, medication prescriptions, reconsultations, and sickness certifications. In the end, they found that while aggregated improvement in patient outcomes was "modest" compared with usual treatment, patients in the medium and high-risk groups received more physical therapy and reported marked improvements in self-reported pain and time off work.

    The study's authors believe that the most significant findings have to do with the ways in which stratified care creates a more "targeted" use of health care resources, and results in fewer sick certifications and work days missed—about half of the average time off rates of the usual-care group.

    "Improvements in the management of low back pain are needed, yet changing behavior among family physicians is an identified challenge as clinicians struggle to have the time, skills, or inclination to translate evidence into practice to improve patient care," the authors write.

    While editorial authors cautiously a similar program in the US, they point out that implementation will require careful consideration of the practice competencies of PTs receiving referrals, given that the high-risk group requires psychologically informed physical therapy that employs elements of cognitive-behavioral therapy. "This high-risk protocol … is in its infancy in the field of physical therapy," they write, and may require some expansion of what they describe as "extremely limited" training in this area. The authors also speculate that the system would need to be "adapted" for effective use in the US.

    Still, they write, the low cost of implementation and its similarity to other screening instruments already used in primary care—tools that assess alcohol misuse or depression, for example—suggest that barriers to use are minimal. "These advances don't solve our problems with the large disability burden and high costs of low back pain, but they represent a promising start."

    Research-related stories featured in News Now 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.

    South Carolina Circuit Court Upholds Ban on Physician Referral for Profit

    In the latest chapter in a decade-long battle in South Carolina over the issue of physician-owned physical therapy services (POPTS), a circuit court on April 22 granted summary judgment (.pdf) in favor of the South Carolina Board of Physical Therapy Examiners (SCBPTE) and the South Carolina Chapter of APTA (SCAPTA). In its ruling, the court upheld the ability of physical therapists (PTs) to operate group practices while maintaining the state's ban on PTs working for physician owned groups.

    The case is a sequel to the 2006 opinion of the State Supreme Court in the Sloan litigation involving a practice act clause that prohibits a physical therapist (PT) from dividing revenue with a person who referred a patient. The Supreme Court interpreted the act as prohibiting a PT from working for pay for a physician-owned group if the PT treats patients referred by a physician in the group. SCAPTA has defended the law from several legislative attempts to repeal it.

    The circuit court case was brought by 2 medical doctors and 1 PT against the SCBPTE. The plaintiffs argued that the act’s prohibition should also apply to PTs who work for pay for a PT-owned group if the PT treats patient sent to him/her by another PT in the group. Such an interpretation would prevent PTs from operating group practices. The summary judgment ruled against this interpretation.

    Soon after the case was filed in 2013, SCAPTA entered a motion to intervene in the case, which was granted by the court. APTA provided significant legal resources to the chapter, and the APTA Board of Directors approved a grant to help cover the chapter’s substantial legal bills.

    The battle over interpretation of the law is probably not over—plaintiffs are expected to appeal this decision, which could lead to the case being reviewed in the state supreme court. At the same time, supporters of a repeal of the POPTS restrictions could make another attempt to undermine the entire law.

    WHO: MERS Likely No More Transmissible Than Before, Still a Serious Illness

    The uptick in Middle East Respiratory Syndrome (MERS) cases that caught US media attention when the first case was reported in the United States is most likely the result of seasonal changes, and not due to an increase in transmissibility of the disease, according the United Nations' World Health Organization (WHO). The announcement was made in a May 7 WHO statement that attributes the rise in part "to breaches in WHO’s recommended infection prevention and control measures" in some Saudi Arabian health care facilities.

    MERS is a viral respiratory illness first reported in Saudi Arabia in 2012 caused by a coronavirus called MERS-CoV. Most people who have been confirmed to have MERS-CoV infection developed severe acute respiratory illness, and about 30% of these people died. Recently, the first case of MERS in the US was reported in a health care worker who had just returned from the Arabian peninsula and been in direct contact with an individual with MERS. That health care worker is anticipated to be released from the hospital soon.

    The spread of the virus has been among individuals who were in close contact with patients who were infected. The incubation period is from 2 to 14 days, and researchers believe individuals are not contagious during the incubation period. If a patient is suspected to have the virus, then standard contact and airborne precautions are recommended.

    For more information on MERS protocols, visit the the US Centers for Disease Control and Prevention (CDC) webpage on interim prevention and control recommendations around MERS. Although it does not address MERS specifically, APTA's infectious disease control webpage helps physical therapists (PTs) and physical therapist assistants (PTAs) understand the protocols for reducing risk of disease transmission. APTA staff will continue to monitor the situation and add resources as they are needed.

    Log 'N Blog Still Accepting New Participants

    Proud of that last run you took? Feeling good about that fantastic biking session the other day? Don't keep your accomplishment to yourself—log it, and help physical therapy research while you're at it.

    It's still not too late to join the Foundation for Physical Therapy's "Log 'N Blog" initiative, the physical therapy student-led fundraiser in which teams and individuals compete by tracking their fitness activities. Proceeds from Log 'N Blog are used to support physical therapy research.

    And this year, there's good news for those arriving late to the competition: no matter when you sign up, you can log any activity that began after February 1. The contest will continue until July 31, after which recognition will be given to the teams and individuals with the most miles and activity hours.

    Visit the Log 'N Blog website to sign up and check out the competition.

    CDC: Inactivity Can Increase Risk of Chronic Illness by 50% in Adults With Disabilities

    Adults with disabilities who are physically inactive are 50% more likely to have chronic disease than their physically active counterparts, according to a new report from the US Centers for Disease Control and Prevention (CDC) that urges better patient education.

    While the benefits of physical activity have been thoroughly demonstrated, CDC says, not all patients with disabilities are getting that message from their physicians. The agency estimates that only 44% of adults with disabilities were told by a doctor to get more physical activity. The CDC's findings appear in the May issue of Vital Signs, a monthly report series.

    The May Vital Signs issue recommends that individuals with disabilities get at least 2.5 hours of moderate-intensity aerobic physical activity a week, and provides guidelines for how health care professionals can help to educate patients. The benefits, according to CDC, are clear: while nearly half (46%) of adults with disabilities who are inactive also have 1 or more chronic diseases, that rate drops to 31% if they increase physical activity.

    Other statistics from the report:

    • Adults with disabilities are 3 times more likely to have heart disease, stroke, diabetes or cancer than adults without disabilities.
    • Nearly half of all adults with disabilities get no aerobic physical activity. For adults without a disability, that rate is 26%.
    • Among the categories of disability, 57% of adults with mobility disabilities engage in no aerobic physical activity. The rate drops to 40% for adults with cognitive disabilities, 36% for those with vision impairments, and 33% for adults with hearing disabilities.

    APTA has long supported the promotion of physical activity and the value of physical fitness, and offers a prevention and wellness webpage that links to podcasts on the harmful effects of inactivity. The association also has representatives on the practice committee of Exercise is Medicine and the board of the National Physical Activity Plan Alliance.

    Lower Health Care Increases for Adults 65 and Up May Be Linked to Shift to Home-Based Care

    In an overall spending picture researchers describe as "relatively stable" between 2002 and 2010, health care spending among adults 65 and older grew at a rate lower than all other age groups studied—a slowdown partly attributed to a Medicaid shift away from institutional care settings and toward home-based care.

    The findings, e-published in the May 6 edition of Health Affairs (abstract only available for free), analyzed health care spending over a 9-year period in aggregate as well as by age and sex. Overall, authors wrote, personal health care spending in the US was approximately $2.2 trillion, or $7,097 per person in 2010—an amount that represents an average 5.1% annual growth rate from 2002.

    Although all age ranges and both sexes experienced growth in spending during the study period, spending for adults 65 and older was reported to have the lowest rate of increase of all the age groups, with a 4.1% annual average increase. For adults in the 65 – 84 age range, that rate was even lower, at a 3.9% average.

    Researchers attribute the slower growth rates to related slowdowns in the use of institutional and hospital care. "This relatively slow growth was mainly the result of states' efforts through the Medicaid program to keep the elderly out of costly institutional care settings by using lower-cost home and personal care services," authors write, citing a "sluggish" 3.3% average annual increase for institutional care. Authors linked the similarly slower increase in hospital use (3.7%) to slower growth in Medicare Advantage payments. Over the same period of time, spending on home health care increased by 7.6% annually.

    Offsetting the slower trend among adults 65 and older were more rapid increases in spending on children, which showed an average annual increase of 5.5% Authors cited increased coverage provided by insurers as well as enrollment increases in Medicaid and the Children's Health Insurance Program as the primary drivers for the increase.

    Other findings in the report:

    • Per capita annual spending remained the highest among adults 65 and older ($18,424 in 2010).
    • Females tended to spend more than males, but the gap is closing mostly due to an increase in prescription drug use by males. In 2002, females spent about 38% more per capita than males in this area; by 2010, that difference was 25%. Authors attribute at least part of the increased male prescription drug use to increases in prescriptions for treatment of HIV, disorders of lipoid metabolism, hypertension, and hyperactivity, all of which "have higher rates of use in males than in females."
    • The recession had a "powerful" effect on health care spending overall. Between 2002 and 2008, per capita health care spending rose at an average annual rate of 5.7%; after the recession took effect in 2008, that rate slowed to 3.4%.
    • Approximately 35% of 2010 health care spending for adults 65 and older was for hospital services, 19% for physician and clinical services, and 16% for nursing and continuing care/retirement facilities and communities. Continuing care facility spending amounted to about 21% of the total in 2002.

    Research-related stories featured in News Now 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.

    WHO Issues Polio Alert

    Not long after reaching a milestone in its campaign to eradicate polio worldwide, the World Health Organization (WHO) has declared a global health emergency and is warning of new outbreaks of the disease. According to an alert released May 5 (.pdf), polio has been spread from Pakistan to Afghanistan, Syria to Iraq, and from Cameroon to Equatorial Guinea.

    The alert states that the outbreaks are unusual in that they have occurred in a low-transmission season. Further, the danger of the outbreaks are heightened by the actual location of the infected countries, which are bordered by "several countries with complex humanitarian emergencies or other major challenges."

    News of the alert—the first of its kind since WHO was empowered to do so—spread quickly, and was reported in major media outlets including CNN, ABC News, and the New York Times. WHO has issued a set of recommendations for leaders of affected countries to require additional precautions and vaccinations for travelers into and out of the country, and to maintain these requirements for at least 6 months.

    The elimination of polio by 2018 is a priority for WHO, which announced earlier this month that India was polio-free. Progress toward the goal has been dramatic, with the number of reported cases reduced to 417 last year.

    Physical therapy's relationship to polio dates back to the early 20th century, when the early physical therapists began working on ways to analyze and rehabilitate victims of the disease. Wilhelmine Wright's classic 1928 book Muscle Function was based on her pioneering work on muscle reeducation of patients with polio.

    Learn more about how physical therapy impacted the treatment of polio and its aftereffects—visit APTA's history webpage for photos, oral histories, and links to other resources.

    Arthritis a 'Significant' Factor in Falls Injury, Rates

    Adults with arthritis are injured in falls at a rate 2.5 times higher than for those without the disease, according to a new report from the US Centers for Disease Control and Prevention (CDC), which described this "growing public health problem" as one that can best be addressed through a falls prevention approach that "involves exercise or physical therapy."

    The findings, published in the CDC's May 2 Morbidity and Mortality Weekly Report, are based on an analysis of falls and falls injury gleaned from the 2012 Behavioral Risk Factor Surveillance System (BRFSS), a phone survey that interviewed 338,734 adults in all US states, territories, and the District of Columbia. Respondents were asked whether they have been told that they have some form of arthritis, gout, lupus, or fibromyalgia; whether and how many times they had fallen in the past year; and whether those falls caused an injury (defined as an event that caused the respondent to limit regular activities for at least a day or see a doctor).

    The results showed that in almost all cases, rates of falls and falls injuries were "significantly higher" among adults 45 years and older with arthritis than those without, with 13.3% of adults with arthritis reporting fall injury, compared with a 6.5% rate of injury on adults without arthritis (median age-adjusted rates across the US).

    Other findings of the study:

    • Unadjusted median state prevalence of arthritis among adults 45 years and older: 40.1%
    • Median prevalence of 1 fall: adults without arthritis – 12.1%; adults with arthritis – 13.8%
    • Median prevalence of 2 or more falls: adults without arthritis – 9%; adults with arthritis – 13.8%

    When adjusted for age, the fall prevalence rate in 46 states was 30% or greater among adults with arthritis, with 16 states having an age-adjusted rate of 40% or higher for this group. Among adults without arthritis, no state had a fall rate higher than 30%.

    "The projected rapid growth in the population aged [65 years and older] and the increase in adults with arthritis (an estimated 67 million by 2030) … demonstrate the need for increasing fall prevention efforts," the report states. "Effective fall preventions can be multifaceted, but the most effective single strategy involves exercise or physical therapy to improve gait, balance, and lower body strength, which have been shown to reduce fall risk by 14%-37%."

    APTA provides continuing education on exercise prescriptions for balance improvement and falls prevention and offers other resources for physical therapists, such as how to develop consumer events on balance, falls, and exercise, information on evidence-based falls programs, and a clinical summary on falls risk in community-dwelling elderly. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as an online community where members can share information about falls prevention.

    Research-related stories featured in News Now 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.

    Tell It Like It Is – Or Isn't

    Get ready for your close-up. Physical therapists (PTs) and physical therapist assistants (PTAs) attending APTA's NEXT Conference and Exposition June 11–14 in Charlotte, North Carolina, have an opportunity to tell the world what physical therapy is—and what it is not.

    APTA public relations staff will be on hand at NEXT to conduct video recording sessions with PTs and PTAs who want to share insights and dispel myths about the profession. Participants must schedule their participation in advance with Jennifer Rondon in the APTA Public Relations Department at jenniferrondon@apta.org, and commit to a 10-minute recording session within 1 of 2 available periods: Wednesday, June 11, 10:30 am–11:30 am, or Thursday, June 12, 2:30 pm–3:30 pm.

    Those selected to participate will receive an e-mail confirmation along with directions on attire and a specific recording location at NEXT. Some of the video captured at NEXT will be used in consumer-educational efforts featured on APTA’s official consumer information website, MoveFowardPT.com.

    CMS Says ICD-10 Will Begin October 1, 2015

    Without much fanfare, the US Centers for Medicare and Medicaid Services (CMS) has announced that use of the International Classification of Diseases, 10th revision (ICD 10) will begin on October 1, 2015—the soonest possible date allowed in a law passed by Congress earlier this year.

    The news came by way of an acknowledgment in the CMS rule on inpatient and long-term hospital payments released earlier this week. In the Request for Public Comments on ICD-10-CM/PCS Transition, CMS writes that “The ICD-10-CM/PCS transition is scheduled to take place on October 1, 2015. After that date, we will collect nonelectronic health record-based quality measure data coded only in ICD-10-CM/PCS.”

    CMS will be issuing an interim final rule that will establish the October 2015 implementation date in the near future. The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through September 30, 2015. CMS also announced that it is cancelling the end-to-end testing program scheduled for July 2014, and will engage in a new testing program next year.

    Originally, the US Department of Health and Human Services set an October 1, 2013, date for implementation of ICD-10 for all HIPAA-covered entities. In spring of 2012, HHS announced that it was moving that date back 1 year, to October 2014. Early this year, Congress included language delaying ICD-10 implementation until some point after October 1, 2015, in Medicare-related legislation that also prevented implementation of the flawed sustainable growth rate (SGR).

    APTA's ICD-10 webpage has resources to help physical therapists understand the transition to the new code set.

    CMS Releases Report on Alternative Payment Systems for Outpatient Therapy

    A long-awaited set of reports on outpatient therapy payment alternatives has been released by the US Centers for Medicare and Medicaid Services (CMS).

    According to CMS, its Developing Outpatient Therapy Payment Alternatives (DOTPA) project had 2 main purposes: "to identify, collect, and analyze therapy-related information tied to beneficiary need and the effectiveness of outpatient therapy services, and to explore payment method alternatives to the current financial caps on Medicare outpatient therapy services." Research for the report began in 2011.

    The report states that "The research presented here does not aim to provide a completed, finalized model for a new payment system. Instead, selected characteristics that exist for an alternative payment system are discussed within the context of [the diversity of outpatient therapy]."

    APTA staff is reviewing the reports and will use the findings to inform its decisions and recommendations around payment policy.

    Proposed CMS 2015 Payment Rules for Inpatient Rehabilitation Include 2.2% Increase

    Inpatient Rehabilitation Facilities (IRFs) will receive an additional $160 million in 2015, according to policy updates recently released by the US Centers for Medicare and Medicaid Services (CMS). In addition to the payment changes, the updates from CMS also make refinements to compliance lists, expand definitions of therapy, add new outcome measures, and create a new section on the patient assessment instruments (PAIs) for IRFs.

    The change to IRF payments amount to a 2.2% increase. The CMS changes will also:

    • Refine the presumptive compliance list for the 60% rule to remove diagnosis codes that solely focus on amputations
    • Provide definitions for individual therapy (1 therapist to 1 patient), group therapy (1 therapist to 2-6 patients performing same or different activities) and co-treatment (more than 1 therapist from different disciplines to 1 patient)
    • Create a new therapy information section on the IRF-PAI to record the number of individual, group, and co-treatment minutes for each therapy discipline for a 7-day period
    • Add an item to the IRF-PAI to record arthritis diagnoses that meet IRF severity and prior treatment requirements
    • Add 2 new outcomes to the IRF Quality Reporting Program for 2017 payment adjustments for noncompliance: Staphylococcus aureus and Clostridium difficile

    The proposed rule is on display at the Federal Register, and comments will be accepted until June 30, 2014. APTA will provide a detailed summary of the rule shortly and will be submitting comments on behalf of the association.

    Clinical Instructor Input Wanted on Clinical Reasoning Skills

    The American Council of Academic Physical Therapy (ACAPT)  is taking a close look at clinical reasoning skills in physical therapist doctoral education programs and needs to hear from clinical instructors.

    ACAPT's Clinical Reasoning Curricula and Assessment Research Consortium has posted a survey for clinical instructors, the results of which will inform its study titled "Exploration of Clinical Reasoning in Doctor of Physical Therapy Education." The consortium estimates that the survey takes about 5–10 minutes to complete.

    Names and other identifiers will not be associated with the information received from the survey. All information will be stored on the principal investigator's university-issued password-protected computer and stored in a locked office.

    Editor's note: A link previously included in this story has been disabled. Clinical instructors interested in participating in this survey should contact huhnka@shrp.rutgers.edu to request access to the survey instrument.

    CMS Releases Proposed SNF Payment Rules, Report on Alternative Payment Systems

    Medicare payments to skilled nursing facilities (SNFs) will increase by $750 million in 2015, according to the US Centers for Medicare and Medicaid Services (CMS), which recently released a proposed payment and policy update. Along with the update, CMS has issued a report on possible alternatives to the prospective payment system (PPS) used in SNFs. The rule is on display at the Federal Register, and comments will be accepted until June 30, 2014.

    The payment change amounts to a 2% increase for SNFs. In addition the proposed rule seeks to:

    • Revise change of therapy (COT) policies to allow residents formerly but not currently in a therapy resource utilization group (RUG) to be reclassified into a new therapy RUG through the use of a COT other Medicare required assessment (OMRA), though use of the COT OMRA for initial classification of patients into a therapy RUG will still be prohibited
    • Tighten up rules governing how states can use the civil monetary penalty, and increase transparency around how this use is tracked and shared
    • Provide data about the status of the SNF therapy payment research project and therapy utilization patterns captured on CMS minimum data sets

    APTA will provide a detailed summary of the rule shortly and will submit comments on behalf of the association

    In conjunction with the payment and policy updates, CMS also released its initial findings from a project that looked at possible alternatives to the SNF PPS. The report explores 4 alternatives: a patient characteristics model that uses patient information to group patients with similar characteristics, a hybrid model that blends patient characteristics and a resource-based pricing adjustment, a fee schedule model that bases payment on actual therapy use rather than resource use, and a competitive bidding model that prices therapy services through a bidding process.

    As recommended by the consulting firm hired to conduct the analysis, CMS has selected the patient characteristics and hybrid models as a foundation for an alternative system. The development phase will include initial drafting, analysis, feedback from an expert panel, and a final summary. APTA is conducting a thorough analysis of the report and will provide commentary on the report findings to CMS.

    First-Round Innovation 2.0 Project Descriptions Posted

    APTA has posted full descriptions of the 21 promising and innovative models for physical therapy care that will be explored at APTA headquarters May 8 – 9 as part of the association's Innovation 2.0 initiative. The projects entering this phase of the project were selected from almost 60 submissions after evaluation by an expert panel.

    During the upcoming workshop, these 21 models will receive valuable feedback from researchers and other clinicians. The models will then submit proposals with further detail to be considered for the final selection of applicants receiving funding and in-kind services to advance their models and promote the impact of physical therapy in the emerging health care environment.

    Innovation 2.0 is an initiative aimed at bolstering the impact of physical therapy in innovative and emerging models of health care such as accountable care organizations, bundled payment, direct access, patient-centered medical homes, prevention and health promotion, and value-based purchasing.

    APTA Among First Nonphysician Groups to Partner in Choosing Wisely Campaign

    The American Board of Internal Medicine (ABIM) Foundation has announced that APTA will be among the first 3 nonphysician provider organizations to partner later this year in a high-profile national campaign to educate consumers on making informed health care choices. APTA will prepare to join the "Choosing Wisely" initiative by surveying members to refine a list of the top 5 physical therapy tests and procedures that may be unnecessary under certain circumstances.

    The association will join the American Dental Association and the American Academy of Nursing as the first nonphysician provider organizations to be included in Choosing Wisely, a campaign centered around lists of procedures (.pdf) that tend to be done frequently, yet whose usefulness is called into question by evidence. Consumer Reports is partnering with the ABIM Foundation to promote the campaign and helped to create a video describing the effort. According to a press release from the ABIM Foundation, "Consumer Reports will also work with each organization to develop patient-friendly materials based on their lists."

    "Care that is best for the patient has always been a priority for APTA," said APTA President Paul A. Rockar, PT, DPT, MS. "This is why we have chosen to join the Choosing Wisely effort. Choosing Wisely perfectly addresses the patient's role in good health care, and there couldn't be a better fit for what we're trying to achieve with our Integrity in Practice Initiative," a broad effort to eliminate fraud, abuse, and waste from health care and strengthen the good reputation of physical therapy. The effort is the subject of a feature article (members-only access) in the February issue of PT in Motion.

    APTA's efforts to create its Choosing Wisely list are already under way. In March, the association called for input from members and received more than 200 suggestions for possible inclusion. APTA will convene an expert panel to review and rate all member submissions and create a list of approximately 10 potential items that will be narrowed down to 5 by way of an all-member survey. The top 5 questioned procedures will then go to the APTA Board of Directors before being submitted to the ABIM Foundation for final approval.

    "APTA is committed to taking the lead in promoting transparency and education of patients and health care providers for a better and more streamlined health care system," Rockar said. "A well-informed patient is a well-treated patient. We are extremely pleased to be joining this outstanding project."

    Arizona: Dry Needling Now Included in PT Scope

    Arizona now specifically includes dry needling in the physical therapist (PT) scope of practice. The legislation was signed into law by Gov Jan Brewer on April 25.

    The final bill, sought by the Arizona Physical Therapy Association and sponsored by Arizona state Sen Kelli Ward (R-5), was the result of "3 years of challenges, hard work, and debate, including a statewide task force that held numerous meetings and public hearings," according to a press release from APTA.

    Arizona Chapter President Linda Duke, PT, said that “Many legislators, educators, professionals, and patients were involved crafting this bill to satisfy the concerns brought forward from outside the physical therapy profession." Duke gave special recognition to chapter members, the chapter's dry needling task force, and the Manual Physical Therapy Alliance. Duke also singled out chapter members Sara Demeure, PT, MSPT, OCS, and Sean Flannagan, PT, DPT, who were key throughout the process.

    "The American Physical Therapy Association applauds the team effort in Arizona that advocated in support of SB 1154,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. "Working together, we can ensure that the patients we serve have access to the full scope of physical therapist services.”

    The new law includes language that gives the Arizona State Board of Physical Therapy the authority to promulgate rules outlining training and education qualifications for dry needling performed by PTs. Dry needling is recognized as part of the PT scope of practice in a majority of US jurisdictions.

    PT in Motion: Women's Health PTs Taking the Pelvic Floor 'Out of Isolation'

    Putting evidence into practice requires hard work, creativity, critical insight, and willingness to approach information with an open mind—exactly the qualities demonstrated by members of APTA's Section on Women's Health featured in the most recent issue of PT In Motion, the association's member magazine.

    In his article "Making Core Connections," APTA Associate Editor Eric Ries interviews several physical therapists who are making advances in treatment of pelvic floor weakness and related problems. For some of these PTs, their motivation arose from their personal experiences with pelvic floor issues; for others, their new approaches are rooted in a commitment to help a patient population often demoralized by what seemed to be an inescapable condition.

    All of the PTs featured in the article share a high level of energy and "a willingness to hear new information with a very open mind," according to Mary Massery, PT, DPT, DSc, a prominent researcher. "I'll offer women's health PTs ideas, coming from my perspective in cardiopulmonary physical therapy, and instead of saying, 'This can't have any relevance to us,' they ask, 'Could it apply?' and ask me to tell them more."

    The PT in Motion article on women's health PTs appears in the May issue of the magazine. Hard copy versions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Experimental Muscle Regrowth Procedure Involves Physical Therapy

    An experimental approach that uses material from pig bladders to grow new muscle is showing some early promise for victims of volumetric muscle loss, but the success of the procedure depends on physical therapy that begins soon after surgery.

    In the procedure, conducted on only 5 patients, researchers transplanted specially treated extracellular matrix from pig bladders into body areas that had suffered significant loss of muscle. According to the authors, the matrix acts like "scaffolding" that draws a patient's own stem cells to the site when the matrix begins to decay. Researchers say that 3 patients experienced a 20% increase in strength and a 25% improvement in function 6 months after the surgery.

    The research report was published in the April 30 issue of Science Translational Medicine (abstract only available for free). News of the report spread quickly to major media outlets including Reuters, the Los Angeles Times(LAT), National Public Radio, and NBC News.

    While much of the focus of the news reporting was on the use of the matrix tissue, the lead researcher interviewed in the stories stressed that the surgery itself only sets the stage for muscle growth that relies on physical therapy initiated within 2 days after the procedure. Because the stem cells drawn to the site of the matrix can generate a variety of tissues, patients need to engage in physical therapy to train the cells to generate muscle. In the LAT article, lead researcher Stephen Badlyak is quoted as saying "The cells get the idea to say: 'OK. I get it. I'm supposed to line up this way. I'm supposed to be the type of a cell that can bear weight, or contract.' If that doesn't happen when they get there, and they don't get those signals, they can turn into anything else."

    Research-related stories featured in News Now 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.

    PTNow Blog: Since When Is Patient Education Not Physical Therapy?

    According to recent stories in major media outlets, physical therapy "may not help whiplash pain" or may be no more effective than "just one exercise education session." According to the latest blog post in PTNow, recent stories are missing the point.

    "It's not that physical therapy isn't valuable for treating … whiplash," the blog states. "It's that one type of physical therapy intervention (patient education, according to this study) may be just as beneficial and more cost-effective than others."

    The blog also includes thoughts from the lead author of the article that generated so much interest. Zoe Michaleff, PhD, warns that her findings "should not be interpreted as encouragement to abandon exercise or physiotherapy in these patients." Instead, she says, the report should make physical therapists think about the role of patient education in their practices.

    What's your take on patient education? Check out the PTNow blog and join the discussion.

    Proposed CMS Rules for Hospitals Would Cut Payments, Institute Function and Mobility Measures

    A $241 million reduction in payments to acute-care hospitals and a slight payment increase (.8%) for long-term-care hospitals (LTCH) are among the proposed Medicare payment and policy changes for hospitals issued by the Centers for Medicare and Medicaid Services. The proposed rule (.pdf) would also institute functional status quality measures around mobility and function for LTCHs. If finalized, the policies will be effective October 1, 2014.

    The $241 million reduction would affect roughly 3,400 hospitals nationwide, while the .8% increase to LTCHs would affect 435 facilities and amount to an increase of $44 million. Additionally, hospitals that successfully participate in Medicare's quality reporting system and meet the criteria for meaningful use of health information technology will receive a 1.3% payment increase.

    In an acknowledgment of the benefits of early mobilization and rehabilitation, the policies also establish 2 functional status quality measures for LTCHs. One of the measures is focused on increasing the percentage of LTCH patients with admission and discharge functional assessments and care plans that addresses function; the second measure is centered on change in mobility among LTCH patients who require ventilator support. Both measures would be implemented in 2018.

    Also included in the proposed rule is a call for suggestions from providers on ways Medicare might handle reimbursement for short hospital stays. The request for input is being made in response to objections from health care providers on the "2 midnight" rule that CMS has yet to fully enforce. Last month, the American Hospital Association (AHA) announced that it was filing a lawsuit to strike down that rule.

    APTA will submit comments on the proposed rule by the June 30 deadline. The final rule will be released by August 1.