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  • Don't Miss Out: 4 Events at NEXT You Have to See for Yourself

    With APTA's 2018 NEXT Conference and Exposition now less than a month away, it's time to start making the tough decisions about your trip to Orlando. No, we're not talking about nailing down how many pairs of flip flops to pack and trying to figure out whether sunscreen can actually expire (it can, btw, so please be careful). We're talking about which sessions and events to attend once you arrive for the June 27-30 event.

    With hundreds of options to choose from, it won't be easy. But there are 4 events—2 lectures, 1 panel discussion, and 1, well…something else—that should be on your "can't miss" list.

    Luckily, PT in Motion News breaks it down.

    What: The 49th Mary McMillan Lecture—Wisdom and Courage: Doing the Right Thing
    When: Thursday, June 28, 10:00 am–11:00 am
    Why it's a can't-miss: One-of-a-kind inspiration and education from a physical therapy thought leader

    First and foremost, being named a McMillan lecturer is one of the most distinguished honors that APTA confers, so you know that you'll be hearing from an individual who has made a mark on the profession. This year's lecturer is no exception: Laurita M. Hack, PT, DPT, PhD, MBA, FAPTA, is a leader and former APTA Board of Directors secretary who has focused on some of the most foundational elements of the physical therapy profession, including the development of clinical expertise and physical therapy education. Hack will explore the complexities of decision-making in a profession that aims to transform society, from the elements of cognitive psychology that help explain how decisions are formulated to the challenges involved in actually carrying out the decisions we make. Decide to attend.

    What: 2018 Rothstein Roundtable—Physical Therapy Decreases Opioid Use: What Will It Take to Change Policy?
    When: Friday, June 29, 8:00 am–9:30 am
    Why it's a can't miss: Smart and lively exchange on challenges and opportunities facing the profession from people who know a thing or two

    The event's namesake, Jules Rothstein, was known for his love of thoroughly exploring (some might say arguing) all sides of an idea. The Rothstein Roundtable lives up to that reputation by bringing together a diverse panel of experts—some physical therapists, some from other professions—for a conversation on some of the big issues in the profession. Not everyone agrees with each other, but that's part of what makes for great discussions. Moderator Anthony Delitto, PT, PhD, FAPTA, keeps the panelists on their toes by asking provocative questions at just the right time, and then stepping back and letting them have at it. This year's topic: How can the profession use data supporting physical therapy's role in decreasing opioid use to actually change health care policy?

    What: The 23rd John H.P. Maley Lecture—Lifecourse Health Development of Individuals With Chronic Health Conditions: Visualizing a Preferred Future
    When: Friday, June 29, 10:00 am–11:00 am
    Why it's a can't-miss: Insights on emerging trends and perspectives in physical therapy that you won't hear anywhere else

    The Maley lectures are delivered by speakers who have made significant contributions to clinical practice in the physical therapy profession, and they have covered everything from pain management to wearable technologies. This year the topic is an expansive one: "lifecourse health development," an emerging model that embraces nonlinear, person-in-environment concepts related to working with individuals with chronic health conditions. The lecturer, Robert Palisano, PT, ScD, FAPTA, senior editor of Physical Therapy for Children, has been instrumental in developing and applying this model in physical therapy through research, teaching, and writing. He will describe the model in the context of physical therapy and discuss innovative roles for physical therapists and physical therapist assistants in the future.

    What: The Oxford Debate—Is Good Nutrition the New Tradition?
    When: Friday, June 29, 5:00 pm–6:00 pm
    What it's a can't miss: Just…trust us. You've got to see this.

    Imagine bringing together 2 opposing teams of renowned physical therapists and physical therapist assistants to engage in a thoughtful, respectful debate about a challenging issue in the physical therapy profession. Now imagine the complete opposite of that, and you're getting close to the NEXT Oxford Debate experience.

    Sure, the renowned debaters are onstage, and, yes, there's a topic and opposing teams, but that's where the similarities end. Watch otherwise highly regarded professionals compete for your support by engaging in all manner of behavior that can include song, dance, skits, costume-wearing, and other, more…let's just say undefinable forms of performance, interspersed with an occasional point about the topic at hand. Your job as audience member is to support a team though noise-making and by physically moving from one side of the room to the other—and you're encouraged to change allegiances as often as you feel necessary to maintain the atmosphere of near-anarchy. Charles Ciccone, PT, PhD, FAPTA, serves as moderator and judge of the event while delivering jokes that you won't soon forget, regardless of whether you want to or not. The topic of this year's debate is whether the practice of physical therapy should incorporate nutrition as an essential part of patient and client management. The audience is bound to eat it up.

    Missed advance registration for NEXT? No worries: onsite registration will be available.

    CDC: Rates of Outpatient Rehab Poststroke Low in Several States

    Despite its proven effectiveness at helping individuals recover from stroke and its important role in preventing future events, outpatient rehabilitation poststroke is still underutilized in many states, according to a new study from the US Centers for Disease Control and Prevention (CDC). Researchers found that in the states analyzed, about 1 in 3 patients received outpatient rehab after experiencing a stroke, a rate that the CDC says is "suboptimal" at best—and rife with disparities.

    The latest findings are based on 2 studies—a 2013 survey of 20 states and the District of Columbia, and a follow-up study of 4 of those states in 2015 (Maine, Georgia, Oregon, and Iowa). Researchers found that in 2013, 31.2% of stroke survivors reported receiving outpatient rehabilitation, poststroke, with state percentages ranging from a low of 23.1% in Oregon to a high of 43.6% in Minnesota.

    The 4 states selected for comparison between 2013 and 2015 did record some improvement in rates of outpatient rehab, but none broke the 50% rate: Oregon rose from 22.7% in 2013 to 39.7% in 2015, with similar increases in the other 3 states, from 24.2% to 31.8% in Georgia, 28.4% to 31.3% in Maine, and 41.7% to 49.8% in Iowa.

    Within those lackluster results there was even more bad news for younger adults, women, Hispanics, adults with less than high school education, and non-Hispanic persons of other than black or white races, who all recorded below-average rates of outpatient rehab. Overall, men reported a 33.8% rate of outpatient rehab in 2013, compared with a 29.1% rate for women. Within race/ethnicity categories, the highest rehab rate was recorded in the black non-Hispanic group, at 39.8%. Second was the white non-Hispanic group, with a 30% rate in 2013.

    Authors of the report acknowledge that efforts to increase the number of individuals poststroke who receive assessment and referral for rehabilitation have been successful, with current rates estimated at 90%—but they also point to the reported rates of actual participation in outpatient rehabilitation as a sign of an obvious disconnect.

    "Improving coordination of care to support assessment, referral, and, ultimately, participation in rehab is needed," authors write. "The continued underutilization of outpatient stroke rehab might be related to lack of patient access to outpatient facilities, ineffective referral from health care providers, high out-of-pocket costs, lack of health insurance coverage, or lack of knowledge and awareness of benefits…"

    Researchers cite several limitations to the CDC study, including inaccuracies due to possible patient misreporting of various rehab settings, lack of information on stroke severity, and smaller reporting numbers in some states. Authors also caution that the findings should not be considered nationally representative.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Study: Seeing a PT First for LBP Lowers Overall Costs, Reduces Chances of Later Opioid Prescription

    A new study has added to the growing body of evidence that beyond its effectiveness as a treatment for the pain itself, there are additional benefits to receiving physical therapy for low back pain (LBP) as a first-line approach: doing so could save money and dramatically reduce the chance of receiving an opioid prescription down the road.

    The study, published in Health Services Research (abstract only available for free), tracked private insurance information from nearly 150,000 patients for 1 year after an initial visit for LBP. Researchers were interested in identifying any differences in the kind of health care used and how much it cost over the course of a year among patients who saw a physical therapist (PT) first, those who saw a PT at a later time after an initial visit with another provider, and those who never visited a PT during the study period. To qualify for the study, patients had to have no prior history of LBP, back surgery, or other conditions that may have caused back pain.

    The conclusion: patients with LBP who received care from a PT first experienced lower out-of-pocket, pharmacy, and outpatient costs after 1 year and reduced their likelihood of receiving an opioid prescription by 87% compared with patients who never visited a PT. The PT-first group also was associated with a 28% lower probability of having imaging services and 15% lower odds of making a visit to an emergency department. The results caught the attention of National Public Radio, theOrlando Sentinel, and other media outlets.

    The cost savings for the PT-first group weren't across the board, however; researchers found that patients who visited a PT first recorded higher provider costs during the study period, a difference authors believe may be related to "a higher frequency of visits that are common for physical therapy care." However, authors point out, those higher costs are offset by the lower outpatient and pharmacy costs among the PT-first group.

    Another wrinkle: the PT-first group was associated with a 19.3% higher probability of later hospitalization. Again, the researchers weren't particularly surprised.

    "Having inpatient hospitalization is not necessarily a bad outcome for a patient," authors write. "PTs provide care that aims to resolve LBP by addressing musculoskeletal causes first, but if this problem does not get resolved, PTs may refer patients appropriately for more specialized care." Additionally, they point out, the hospital costs themselves were not significantly different from the non-PT and later-PT groups, suggesting that "seeing a PT first did not necessarily result in additional costly complications."

    Authors point to the drop in opioid prescriptions as an especially timely finding, writing that "Opioid overdoses have reached epidemic proportions, and opioids have not been found to significantly improve health outcomes. First-line, nonpharmacological methods to treat LBP have been recommended in the literature; this study suggests that [physical therapy] may be a positive alternative."

    As for prevalence of visiting a PT first for LBP, researchers found that 8.7% of patients were PT-first, 80% of patients made no PT visits, and 11.5% visited a PT at a later time after the initial diagnosis of LBP. In addition to PTs, the most common provider types seen at the first point of care were chiropractors (49.6%), orthopedists (9.4%), and acupuncturists (7.8%). A general grouping of "other providers" were seen by 15% of the patients studied. Those visiting a PT first were more likely to be female, younger, in an open-network insurance plan, and to have fewer comorbidities.

    Researchers believe that given the results of this and other studies, it's time states and insurers take a closer look at their direct access provisions to make it easier for patients to receive the more effective, safer, and lower-cost care that a PT can offer—and then make efforts to educate their residents and beneficiaries on the availability of PT services.

    "Some patients who may benefit from seeing a PT early, however, do not have access, sometimes because of regulatory and health insurance restrictions and, often, patient awareness," authors write. "Given the findings of this study, states should consider reviewing their laws that restrict direct access to physical therapy services and insurers should assess their policies."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Major Overhaul of VA Choice Could be On the Way—But Health Net Won't Be Around For It

    Some big changes may be in store for Veterans Affairs (VA) patients and providers, as Congress moves toward approval of an expansion of care options for VA patients and the VA announces that it's ending a relationship with Health Net Federal, a major contractor for the VA Choice program.

    The most far-reaching decision is the advancement of a bill named the VA Mission Act. That bill, already approved in the US House of Representatives and likely to pass in the US Senate, would commit $52 billion to the creation of a new program that would overhaul VA Choice, the program created in 2014 to increase access and reduce wait times for VA patients by allowing greater use of non-VA providers.

    The VA Choice program faced criticism that it has fallen short of its aims, and is set to run out of money in late May or early June 2018. If signed into law, the Mission Act would provide funding while the program is retooled. The Trump administration has already indicated support for the legislation.

    Once up and running, the new program would allow veterans to access private sector care in instances in which long travel times, long wait times, or a VA facility's poor service prevent the patient from receiving adequate care. The program would also allow up to 2 walk-in visits per year at non-VA clinics, according to a report in the Military Times.

    In another move related to VA Choice, VA announced that it will be allowing its contract with Health Net Federal to expire on September 30, 2018. The company is the contractor for VA Choice services in regions that include all or portions of 37 states

    VA has not announced a new contractor for the regions now served by Health Net, nor has it provided any guidance on what providers currently contracted with Health Net should be doing to prepare for the change. For its part, Health Net issued a statement that it will "remain focused on program performance improvements" and "will continue to work collaboratively with VA to ensure providers receive prompt and timely payments during this period of transition." The company stated that it will provide updates on the transition on its Veterans Affairs webpage.

    ATPA regulatory affairs staff will continue to monitor the progress of the legislation and transition from Health Net, and will share updates through PT in Motion News and other resources.

    Study: Home Is a Better Bet Than Hospitals for Achieving More PA Poststroke

    There's no place like home for engaging in the levels of physical activity (PA) that can aid in recovery poststroke—at least compared with the current hospital setting—according to a small study from Australia.

    For the study, researchers used accelerometers and self-reports to track the PA and sitting time of 32 participants (mean age of 68, 53% male) who had experienced a stroke, comparing data gathered during their last week in the hospital with data gathered during their first week home. Participants were also assessed in a number of areas during their final week in the hospital, including physical function, functional independence, pain, anxiety, and depression.

    The researchers were interested in finding out if an individual's environment plays a role in PA poststroke—something they describe as "pivotal" to recovery—and whether other factors, such as depression, have an effect on any changes in PA levels. Results were e-published ahead of print in theArchives of Physical Medicine and Rehabilitation(abstract only available for free).

    They found that environment does seem to make a difference—and a fairly big one at that. While the amount of time spent awake didn't change much from hospital to home (13.1 hours a day in the hospital vs 13.5 hours per day at home), the amount of PA achieved—and time spent in sedentary behaviors—varied significantly. Participants sat for an average of 45 fewer minutes a day at home than they did in their last week in the hospital, were upright for 45 more minutes a day, spent 12 more minutes a day walking, and completed an average of 724 additional daily steps.

    The results were similar when adjusted for demographic variables and didn't seem to be significantly affected by any of the secondary factors assessed in the hospital, save one—depression, which when present was associated with no gains in PA at home.

    The researchers don't pin the improvement to any single factor but speculate that "the home environment may provide greater opportunity for activities of daily living such as cooking, cleaning, social and community activities, and there may be fewer external restrictions such as hospital routines and safety concerns around mobilization."

    Authors of the study also believe the gap between home and hospital PA poststroke could be closed if hospitals were to take more cues from the home environment.

    "Physically, cognitively, and socially enriched stroke rehabilitation environments appear to increase activity by 20%," they write. "Wards [that] include communal areas to promote more time spent upright, and the need to transport patients further for personal care may create opportunities for activity. The low activity levels in [the] hospital and at home found in our study, and in prior reports…indicate that there is clearly more work to be done in promoting activity after stroke."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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    APTA Weighs in on Opioid Use Disorder, Opioid Poisoning, Among People With Disabilities

    APTA has contributed to an effort that may help shed light on an often-overlooked facet of the opioid crisis—the impact of opioid use disorder on people with disabilities. While final directions have not been laid out, the comments are helping to shape further calls for research on some important considerations for this population, such as barriers to addiction treatment, difficulty in accessing nonpharmacological pain management, and the relationship between traumatic, disabling injury and opioid misuse.

    The project is the work of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), a branch of the US Department of Health and Human Service's Administration for Community Living (ADL). The institute hopes to use comments it received from 50 invited respondents, including APTA, to define next steps in research and education. Other groups that responded included the American Association of Nurse Practitioners, the American Psychological Association, and the National Council on Independent Living. In addition, NIDILRR sought comments from consumers, research teams, clinicians, and community organizations.

    The effort is an attempt to address what NIDILRR describes as the "paucity of research focusing on people with long-term disabilities and their likelihood of developing an opioid use disorder." In an interim report, the institute identified 3 key themes that emerged from the initial call for comment. They are:

    People with disabilities are more likely than the general population to misuse opioids but less likely to receive treatment. NIDILRR authors cited one study's estimation that among Medicaid beneficiaries, people with disabilities had a higher incidence of opioid use disorder than did those without a disability (6.4% vs 4.2%) but a lower rate of receiving an approved treatment medication for opioid misuses (11% vs 32%).

    Barriers such as physical accessibility to treatment centers, limited insurance coverage, and policies that withhold opioid prescriptions without offering alternative pain management approaches are more prevalent among people with disabilities. In many rural areas, treatment facilities require long travel, and, once there, those with disabilities can find physical access challenging. Additionally, treatment that focuses primarily on denying or restricting the use of opioids creates treatment gaps that often can lead to secondary health issues, including blood pressure problems, heart palpitations, and falls.

    People with disabilities who have had a serious traumatic injury are at greater risk for opioid poisoning. Traumatic injuries that result in long-term disability can create secondary health conditions that often are treated with opioids. Such treatment exposes this population to an even greater danger of opioid misuse and death from opioid poisoning. One study cited by NIDILRR estimated that 70%-80% of all patients with traumatic brain injuries are discharged with a prescription for an opioid.

    NIDILRR says it is exploring funding opportunities "to generate new knowledge and promote its effective use to address the opioid crisis and its impact on people with disabilities." Future possible funding areas include more research on prevalence of opioid use disorder in this population, individual and environmental risk factors, factors associated with improved access to treatment, and the effects of government policies and programs on health care access and treatment.

    Advanced Cancer Patients Can Benefit From Structured Exercise, Say Researchers

    Incorporating structured exercise into supportive care can help improve the lives of patients with advanced cancer, say researchers in an article e-published ahead of print in the Archives of Physical Medicine and Rehabilitation (abstract only available for free). In an analysis of previous studies, authors found that both aerobic exercise and resistance training improved many cancer side effects.

    Authors evaluated 25 studies, for a total of 1,188 participants, that measured the efficacy of exercise interventions on physical function, quality of life, fatigue, body composition, psychosocial function, sleep quality, pain, and survival. All studies used more than 1 session of structured exercise as the primary intervention and specified the "frequency, intensity, time, or type" of exercise. More than 80% of participants in each study had been diagnosed with "advanced cancer that is unlikely to be cured." Some studies used control groups, and some did not.

    Their findings include:

    Physical function. In 83% of studies, participants who exercised experienced significant improvements in physical function, including exercise capacity, aerobic capacity, and muscle strength.

    Quality of life. In 55% of studies, exercise resulted in significant improvement in at least 1 measure of quality of life.

    Fatigue. Half of the studies reported that exercise improved at least 1 measure of fatigue.

    Psychosocial function. At least 1 measure of psychosocial or cognitive function was reported as having improved with exercise in 56% of studies.

    Body composition. In 56% of studies, exercise improved at least 1 measure of body composition, including lean body mass and body fat percentage, though not BMI, fat mass, or body mass.

    Sleep quality. In all 4 studies including this area, participants who exercised reported significant improvements compared with control groups.

    Pain.Of the studies measuring pain, 2 found significant improvements after exercise interventions.

    Survival. No studies examining survival rates found a significant improvement as a result of exercise.

    Because "decline in physical function has been reported as one of the most debilitating symptoms associated with advanced cancer," authors write, "interventions targeting improvements in this domain are of utmost importance."

    While authors note that exercise "appears to be an effective adjunct therapy in the advanced cancer context," they recommend that future studies use standardized protocols to report consistent outcomes measure assessment—one limitation they observed. Authors also suggest that future research should "compare different frequencies, intensities, durations, and types of exercise" to "determine the optimal exercise dose to enhance outcomes for specific cancer diagnoses."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    2018 House of Delegates Motions, Background Papers Posted

    Now available to APTA members: the complete first packet of motions, accompanied by background papers, to be considered by the 2018 APTA House of Delegates (House) when it convenes June 25-27, 2018, in Orlando, Florida.
    Called "Packet I With Background Papers," the compilation contains 57 motions to the 2018 House of Delegates, including 4 bylaws amendments. This packet replaces "Packet I Preview." Besides minor editing and formatting changes and the addition of background papers, the new packet does not differ from the earlier version in any ways that affect the scope of motions.
    Proposed amendments to APTA bylaws are:

    • RC 53-18 Amend: Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates, Section 3: Voting Delegates, A. Qualifications of Voting Delegates, (1) Chapter Delegates
    • RC 54-18 Amend: Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates, Section 4: Nonvoting Delegates, A. Qualifications of Nonvoting Delegates, (1) Section Delegates
    • RC 55-18 Amend: Bylaws of the American Physical Therapy Association, Article VIII. House of Delegates, Section 4: Nonvoting Delegates, A. Qualifications of Nonvoting Delegates, (2) PTA Caucus Delegates
    • RC 56-18 Amend: Bylaws of the American Physical Therapy Association to Allow Sections to Vote in the House of Delegates

    Delegates wishing to amend a motion within Packet I With Background Papers should schedule a virtual Reference Committee appointment on Friday, June 8, or schedule an onsite appointment for Sunday, June 24 or Tuesday, June 26. For more information, refer to Make an Appointment with the RC found in the House Hub file library.
    Contact APTA's Justin Lini with any questions.

    PTs From the US Selected to Speak at International Physical Therapy Congress

    A total of 13 physical therapists (PTs) from the US will be among the main speakers at the World Confederation for Physical Therapy (WCPT) Congress to be held in Geneva May 10–13, 2019.

    The American PTs will contribute to focused symposia on a wide range of topics including education research, the application of evidence to individual patients, improving mobility of hospital patients, big data, cancer survivor rehabilitation, and diversity in physical therapy. Each focused symposium is organized by a convener who leads an international group of speakers through linked research-focused presentations. A complete list of all symposia is available at the WCPT Congress website.
    "There were some very difficult choices; however, we are proud to present the focused symposia that we believe represent the best possible combinations of a range of timely topics with relevance to clinicians, educators and researchers, delivered by excellent speakers from all over the world," said WCPT International Scientific Committee Chair Charlotte Häger in a press release.
    Details about the symposia and the program for WCPT Congress 2019 may be found at the WCPT congress webpage.

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

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

    Bravery, persistence, DPT: Brandon Hsu, SPT, faced down leukemia and chemotherapy-induced encephalopathy but never lost his passion for the profession. Now he's a newly minted DPT. (University of Southern California News)

    Pitching good posture: Judy Seto, PT, DPT, helped New York Mets pitcher Robert Gsellman correct bad postural habits made worse through video-gaming. (New York Times)

    From North Dakota to Peru—and back again: Sierra Steckler, PT, describes what it was like to provide physical therapist services in Peru. (Wahpeton, North Dakota, News-Monitor)

    When it's time to go: Carrie Pagliano, PT, DPT; and Laurie Kilmartin PT, DPT, offer advice to new and expecting moms on relieving constipation. (Parents)

    This is your PT speaking: Amanda Brick, PT, DPT, passes along tips for sitting comfortably on long airplane trips. (Bustle.com)

    Shinful behavior: Heather Moore, PT, provides guidance on exercises to ease and prevent shin splints. (Philadelphia Inquirer)

    Mix it up, parents: Shondell Jones, PT, DPT, stresses the importance of children engaging in a variety of physical activities and not focusing solely on 1 sport. (KWX-TV10, Waco, Texas)

    Crack your back? Just…don't: Jeffrey Yellin, PT, warns about the dangers of "unskilled" back-cracking. (Elite Daily)

    Blood flow restriction basics: John Corbo, PT, DPT, explains how blood flow restriction is used in physical therapy. (WCCO4, Minneapolis)

    Sole searching: Robert Gillanders, PT, DPT, discusses how finding the right shoe can reduce foot pain. (Self)

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

    CDC: Falls-Related Deaths in the US Rose 31% in 10 Years

    Among US residents age 65 and older, the rate of death from falls continues to climb steadily, having increased by 31% between 2007 and 2016, and growing at a particularly rapid rate among those aged 85 and above. The latest statistics, included in a report from the US Centers for Disease Control and Prevention (CDC), point to a need for more widespread falls screening and prevention efforts including physical therapy, authors say.

    During the 10 years tracked in the study, falls-related deaths among US residents 65 and older rose from 18,334 to 29,668—in terms of rates of death from falls, that's an increase from 47 per 100,000 to 61.6 per 100,000 in that age group. Deaths climbed by about 3% per year, according to the report.

    In addition to overall totals and rates, CDC researchers looked at data in terms of demographics and state-by-state variables. Among their findings:

    • In 2016, falls-related deaths per 100,000 were highest among white non-Hispanic US residents (68.7) and the all-ethnicity 85-and-older group (257.9).
    • While death rates increased for all age groups, the 85-and-older category recorded the most dramatic rise between 2007 and 2016, from 9,188 deaths in 2007 to 16,454 in 2016. The 65-to-74 age group recorded 2,594 falls-related deaths in 2007 and 4,479 in 2016; the 75-to-84 age group saw an increase from 6,552 deaths in 2007 to 8,735 in 2016.
    • Men had higher rates of falls-related deaths than did women—73.2 per 100,000 men compared with 54 per 100,000 per women. Researchers believe the gap may be attributable to "differences in the circumstances of a fall," with men tending to experience falls that lead to more serious injuries, such as those sustained in a fall from a ladder or as the result of alcohol consumption.
    • Rates for deaths from falls in the 65-and-older age group varied among states, ranging from 142.7 per 100,000 in Wisconsin to 24.4 per 100,000 in Alabama. Authors aren't sure of the reasons for the variance but suspect that the numbers might be related to demographic variables including differing proportions of older white adults in various states. Another possible explanation cited in the report was the impact of who completes the death certificate: According to the CDC researchers, a 2012 study showed that coroners reported 14% fewer deaths from falls than did medical examiners.

    Authors of the report theorize that the rates of falls-related deaths may be climbing in part because of an aging population and longer survival rates after common diseases including heart disease, cancer, and stroke. Whatever the contributing factors, it's a trend that needs to be addressed, they write: even if the rate were to stabilize, an estimated 43,000 US residents would die from falls in 2030, and if the rate were to climb as it did from 2007 to 2016, some 59,000 individuals may die from falls in 2030.

    "As the US population aged [65 and older] increases, health care providers can address the rising number of deaths from falls in this age group by asking about fall occurrences, assessing gait and balance, reviewing medications, and prescribing interventions such as strength and balance exercises or physical therapy," the report states.

    Better prevention efforts also may result in health care cost savings as well: an earlier report estimated that expenditures on nonfatal falls in the US reached nearly $50 billion in 2015, with medical costs associated with fatal falls coming in at an estimated $754 million.

    APTA provides extensive resources on falls prevention at its Balance and Falls webpage. Offerings include consumer-focused information, online courses, and links to other sources of information, including the CDC and the National Council on Aging. In addition, APTA's PTNow evidence-based practice resource offers a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. The association's scientific journal, PTJ (Physical Therapy) has also published a clinical guidance statement from the APTA Academy of Geriatric Physical Therapy on management of falls in community-dwelling older adults.

    CMS Offers Alternative Dispute Resolution for Some Providers With Unresolved Medicare A or B Appeals

    Providers with Medicare Part A or B appeals that have been waiting for a decision are being offered the possibility of resolving those appeals through a new alternative dispute resolution program from the US Centers for Medicare and Medicaid Services (CMS). However, the requirements around just who can qualify for the service, and under what circumstances, are a bit complex—that's why CMS is urging interested providers to review online resources and register now for a May 22 conference call that will attempt to explain the details.

    Called the "Settlement Conference Facilitation" (SCF) program, the initiative is aimed at providers and suppliers who have claims appeals awaiting decisions in the Office of Medicare Hearings and Appeals (OMHA) or Medicare Appeals Council (Council). In the SCF, "a facilitator uses mediation principles to assist the appellant and CMS in working toward a mutually agreeable resolution" to a claims appeal, according to CMS. The facilitator can't make rulings on the merits of a claim, nor can the facilitator serve as a fact-finder; instead, says CMS, the facilitator "may help the appellant and CMS see the relative strengths and weaknesses of their positions."

    To qualify for the program, a provider must have a National Provider Identifier, cannot have or have had False Claims Act litigation pending against them, and cannot have filed for bankruptcy or expect to do so.

    But those are just the provider qualifications. Determining which appeals would qualify for the program is another somewhat more complicated matter, involving the total number of appeals pending, the dollar amounts involved in those appeals, and the codes used in the initial claim, among other requirements.

    To help make things clearer, CMS offers a webpage on the SCF program and urges interested providers to join a conference call on May 22 at 1:30 pm ET. That call requires free advance registration, which closes at noon on May 22 or earlier if spaces fill up. Questions about the SCF can be emailed to OMHA.SCF@hhs.gov.

    This program is separate from the Low-Volume Appeals Initiative CMS announced in February of 2018.

    APTA Federal Advocacy Forum Brings the Profession's Energy to Capitol Hill

    Wonder if advocacy for physical therapy is still important now that a permanent fix has been applied to the Medicare therapy cap? Just ask the 270 physical therapists, physical therapist assistants, and students from 48 states who converged on Capitol Hill recently to educate legislators and staff about a range of important issues impacting the profession.

    The meetings took place April 29–May 1, as part of APTA's annual Federal Advocacy Forum in Washington, DC. Attendees discussed several issues, including:

    • The importance of integrating physical therapy into efforts to address opioid abuse
    • Passage of the CONNECT for Health Act (H.R. 2556/S. 1016), which would ease restrictions on the provision of telehealth under Medicare
    • Concerns about H.R. 4508 and its proposed changes to the Higher Education Act (PROSPER), which would affect student loan amounts, forgiveness, and repayment
    • The Sports Medicine Licensure Clarity Act (H.R. 302/S. 808), which would provide portability of malpractice insurance for PTs and PTAs who travel across state lines with professional and collegiate sports teams

    Members also were trained on best practices for advocating through a variety of channels, as well as the role data plays in advocacy. Amy Walter, national editor of the Cook Political Report and former political director of ABC News, was the keynote speaker.

    event also included APTA's annual recognition of outstanding federal advocacy efforts. This year, Linda John, PT, was awarded the Federal Government Affairs Leadership Award for her tireless efforts as an advocate, a Federal Affairs Liaison, a Key Contact, and a mentor. The association also recognized Sen Thom Tills (R–NC) with the APTA Public Service Award for his instrumental role in including physical therapist assistants within the TRICARE system as part of the National Defense Authorization Act in 2017.

    "The level of dedication and engagement at this year's forum was truly impressive," said Jennica Sims, APTA congressional affairs and grassroots specialist. "This kind of energy is crucial in advocacy and helps legislators understand the contribution of physical therapists to ensuring the health and well-being of children, working age adults, and older adults."

    Editor's note: The Federal Advocacy Forum serves as an advocacy recharging station for APTA members—and it's a lot of fun, too. Watch the video below, and check out this #PTTransforms blog post to find out what it's all about.


    APTA-Supported VA Change Will Expand Use of Telehealth for PT Services

    In a potentially game-changing win for physical therapists (PTs), physical therapist assistants (PTAs), and many other health care providers, the US Department of Veterans Affairs (VA) is following through on a proposal to dramatically expand the use of telehealth services across state lines for VA beneficiaries in all US jurisdictions The change, strongly supported by APTA, would also allow these services to be conducted in nonfederal sites, including the homes of VA patients.

    As noted in its final rule released on May 10, VA took this sweeping action because interstate barriers were limiting VA's ability to fulfill its federal mandate.

    "In an effort to furnish care to all beneficiaries and use its resources most efficiently, VA needs to operate its telehealth program with health care providers who will provide services via telehealth to beneficiaries in states in which they are not located, licensed, registered, certified or otherwise authorized by the state," VA writes in its rule. "Without this rulemaking, doing so may jeopardize these providers' credentials…because of conflicts between VA's need to provide telehealth across the VA system and some states' laws or requirements for licensure, registration, certification, that restrict the practice of telehealth."

    In addition to providing comments in strong support of this change when it was proposed in October 2017, APTA met with VA representatives to advocate for the expanded use of PT and PTA services provided via telehealth.

    "Our combined efforts with APTA have helped to create a change that will make a huge difference in the lives of VA patients," said Mark Havran, PT, DPT, president of the Federal Physical Therapy Section. "The patients who will benefit from this new rule are some of VA's most in-need, with many living far from provider facilities or experiencing mobility issues that make travel difficult. Now PTs and PTAs will be better able to provide the services those patients require."

    Some important things to understand about the new rule:

    The rule doesn't expand authority or scopes of practice.
    VA providers must continue to abide by federal law and the practice acts of the provider's state of licensure.

    The rule applies only to VA-employed providers—not to contracted providers such as providers in the Veterans Choice program.
    The limitation to VA-employed providers was necessary to create protections from any actions that might be taken by state professional licensing boards.

    Copays for telehealth services will go away.
    Congress authorized VA to waive copay requirements for telehealth services, which VA did.

    The rule doesn't go into effect immediately.
    The changes will go into effect 30 days after publication in the Federal Register, which hasn't happened yet. Don't expect that publication until sometime in December at the earliest.

    The rule won't solve all the issues with telehealth service delivery.
    VA acknowledges that the change addresses only 1 challenge to telehealth services, and has resolved to continue to work on technical elements that interfere with effective delivery, including patients' and providers' access to technology.

    Telehealth services currently are allowed in the VA system, but only if both the provider and patient live in the same state. Additionally, many VA medical centers restrict telehealth activities to federal property—for both the patient and the provider. The new rule would make it possible for the facilities to lift those restrictions.

    "This rule is a significant step forward in the recognition of therapy services provided through telehealth," said Justin Moore, PT, DPT, CEO of APTA. "APTA was happy to support this change, because we believe VA's vision and leadership in this important component of health care will help to shape the future of patient access."

    CMS Wants to Drop Functional Measure, 2 Quality Reporting Measures From IRF Requirements

    The US Centers for Medicare and Medicaid (CMS) is continuing its trend toward easing administrative burdens and eliminating what it believes may be duplicative quality-reporting activities—this time, by way of a proposed rule for inpatient rehabilitation facility (IRF) payment that would do away with a longstanding functional assessment and 2 outcome measures.

    The assessment slated for possible elimination is the Functional Independence Measure (FIM), part of the IRF Patient Assessment Instrument. According to a CMS fact sheet on the proposed rule, data collected through the FIM are being captured in other parts of the assessment instrument. The use of the FIM dates back to 1987; its use would end October 1, 2019.

    Also up for possible elimination: measures related to methicillin resistant staph aureus (MRSA) infection and the percent of patients assessed and given the seasonal flu vaccine. CMS describes both measures as ones in which costs of reporting outweigh the benefits. The reporting changes would be implemented October 1, 2018.

    Other changes in the proposed rule include:

    • A 0.9% payment increase for FY 2019—about the same percentage increase as in 2018
    • Elimination of reporting requirements related to the rehabilitation physician conducting team meetings remotely
    • Allowance for the postadmission physician evaluation to count as one of the required face-to-face physician visits
    • Removal of requirements for admission order documentation—but not the requirement for admission orders themselves

    Also included in the proposed rule is a general call for feedback on several topics, including ideas for achieving better electronic sharing of data between providers, the possibility of allowing the rehabilitation physician to determine whether a particular patient assessment could be conducted remotely, the training of nonphysician providers relevant to IRFs, and ways that nonphysician IRF provider roles could be expanded.

    APTA will submit comments on the proposed rule by the June 26 deadline.

    New Strategy Group Seeking Input on Physical Therapy PT, PTA Clinical Education Recommendations

    Sometimes, the journey is as important as the destination: that's the thinking guiding a partnership looking at the future of physical therapy (PT and PTA) clinical education.

    The Education Leadership Partnership (ELP), a group comprising representatives from APTA, the Academy of Physical Therapy Education (APTE—formerly the Education Section of APTA), and the American Council of Academic Physical Therapy (ACAPT), was formed in 2016 with a goal of eliminating unwarranted variation in practice by focusing on best practices in physical therapy education. This year, the partnership took another step toward its goal by forming a subgroup that will continue a dialogue with multiple stakeholders that began with the recent work of 2 APTA education-related task forces and an ACAPT Clinical Education Summit held in 2014.

    The new group, called the Clinical Education Strategy Group, is sponsoring an action-planning meeting this fall that will bring together representatives from multiple groups across the spectrum of physical therapy education. Topics for the meeting will include outcome measures, academic clinical partnerships, and essential resources to support clinical education. That meeting will help the strategy group to develop a clinical education research agenda to inform future steps, which likely will include projects and studies with further opportunities for input.

    "The ELP has been committed to transparency and engagement since its creation," said Steven Chesbro, PT, DPT, EdD, APTA vice president of education and task force staff. "The Clinical Education Strategy Group and the upcoming meeting are in keeping with those values and will help us move clinical education forward in ways that are informed by as many perspectives as possible."

    The strategy group was created after the APTA Board of Directors (Board) recommended in November 2017 that the ELP explore clinical education recommendations that a Board-appointed task force had developed. At the time of the board's decision, APTA President Sharon Dunn, PT, PhD, stated that there are "too many unknowns in need of further investigation, and too many factors beyond APTA's direct control" to commit to any recommendations from the APTA task force.

    The APTA Board does not have authority over the ELP and can't formally charge the ELP to take specific actions. Instead, the Board’s action was a demonstration of trust in the ELP and its approach, which involved receiving input from thousands of APTA members and nonmembers in the study leading up to the 2017 board decision. That input came from multiple in-person and online town halls, as well as an online survey, conducted by the ELP.

    That commitment to hearing from as many interested parties as possible is shared by the Clinical Education Strategy Group, according to the group’s co-chair, Donna Applebaum, PT, DPT.

    "As an educational community, we have invested a lot in our current practices around clinical education, with a collective commitment to best practices, and to figuring out when variations and historical practices are acceptable, and when they're problematic for the system," Applebaum said. "That's why it's crucial that we engage with as many stakeholders as possible. We want to get this right, and the only way to do that is by carefully listening, and then evaluating possibilities that balance our hopes for the future of education with the practicalities we face in the present."

    PT in Motion News will continue to follow the activities of the ELP and the strategy group, and will report on developments as they occur.

    Special Olympics Looking for PT, PTA, Student Volunteers

    Calling all physical therapists (PTs), physical therapist assistants (PTA), and physical therapy students: your service is needed at the upcoming Special Olympics US National Games in Seattle July 1-6, 2018.

    The Special Olympics Healthy Athletes program has issued a call for PTs, PTAs, and students interested in participating in the FUNfitness screening event, which provides an opportunity for athletes to be examined in a range of areas including flexibility, functional strength, aerobic conditioning, and balance. The FUNfitness screen was developed as a collaboration with APTA and Special Olympics and is a cornerstone of an APTA-Special Olympics partnership.

    Screening events are open at various times throughout the Olympics, and are preceded by training sessions for volunteers. For more information on FUN fitness, contact Vicki Tilley, Special Olympics global clinical advisor. To register as a volunteer, contact Frank Sebastian or visit the volunteer webpage.

    $9.7 Million PCORI Grant Will Fund Research on Physical Therapy vs CBT for LBP

    A recently announced $74 million grants program includes a $9.7 million award for a project focused on comparing physical therapy with cognitive behavioral therapy in the treatment of chronic nonspecific low back pain. APTA member Julie Fritz, PT, PhD, is the principal investigator for the study.

    The grant to Fritz's research is part of another round of funding sponsored by the Patient-Centered Outcomes Research Institute (PCORI), an independent, nonprofit organization authorized by Congress in 2010. The most recent grants program is intended to support effectiveness research studies on conditions that "impose high burdens on patients, caregivers, and the health care system," according to PCORI.

    Research related to physical therapy remains of special interest to the institute. In 2016, PCORI awarded a $12.5 million grant to a project that is investigating the effectiveness of interdisciplinary teams that include a physical therapist (PT) in pain management, and, in 2015, the group awarded nearly $28 million in support for 2 research projects led by PTs.

    Study: Self-Reported vs Actual Levels of PA Usually Don't Match Up

    In news that may surprise exactly no one, researchers have found that people aged 50 years and older tend to overestimate the level of physical activity (PA) they accomplish—and Americans tend to be more generous with their estimations than people in other nations, or at least more so than people from England and the Netherlands.

    Those findings are part of a study, published in the BMJ Journal of Epidemiology and Community Health, aimed at better understanding the differences between subjective estimations of PA and PA data retrieved from wrist-worn accelerometers. Participants from England, the United States, and the Netherlands were recruited from 3 separate longitudinal studies that asked for self-reports on PA and had subjects wear a Genactiv wrist accelerometer 24 hours a day for 7 days. Researchers then compared the self-reported data on level and frequency of PA with the data recovered from the accelerometers. Here's what they found:

    Self-descriptions of PA levels were fairly consistent—just not very accurate, especially for Americans.
    When it came to describing themselves as "inactive," "mildly active," moderately active," "active," or "very active," all 3 groups reported similar levels of PA, with the Dutch and English slightly more inclined to avoid either extreme.

    But consistency and accuracy are 2 different things. All 3 groups tended overestimate their levels of PA when compared with accelerometer data, with the US participants registering generally larger differences. For example, only 10% of US participants reported being "inactive," while accelerometer data put that figure closer to 38%. Data from Dutch and English participants also showed a gap, though not quite as dramatic as the Americans’: 8% of participants in the Netherlands self-reported as "inactive" compared with an objective data estimate of 20%; 5% of English participants self-reported as "inactive" compared with an objective data estimate of 21%.

    “Very active” was the only activity level that didn't follow this pattern across all groups. In this category, participants tended to underestimate their activity levels, with 3% of the Dutch and English groups and 5% of the US group describing themselves as "very active" compared with objective data of 20%, 17%, and 14%, respectively.

    PA dropped off dramatically with age—and again, Americans led the way.
    Though researchers focused primarily on participants 50 and older, they did analyze self-reports and accelerometer data from ages 18 and up. They found mostly similar patterns in terms of self-reports and objective data related to levels of PA, but the differences became more stark with age, with participants 65 and older showing steep declines in PA levels. Data from the US revealed the most dramatic disparities, with 11% of participants over 65 self-reporting as "inactive," compared with objective data that put that figure at 60%.

    "It is clear that self-reports and objective measures tell vastly different stories," authors write. "Both across countries and across various socioeconomic and demographic age groups within countries, self-reports vary only moderately or not at all. At the same time accelerometry indicates large differences across certain groups."

    Researchers acknowledged the importance of self-reports, but described the goal of using such reports as a way to compare PA levels across groups as "largely elusive," regardless of whether the evaluation is a simple 5-option approach such as that used in the BMJ study, or any of a number of more complex self-report instruments.

    "The issue is not that simple self-reports of PA are less reliable than the more detailed questions for frequency of various levels of PA," authors write. "Rather the problem with both types of questions is that they are understood systematically differently by different groups…and hence are unsuitable for comparisons across these groups. For that purpose, the use of accelerometry appears indispensable."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    From PT in Motion: PTs Improving the Health of Communities

    Physical therapists (PTs) and physical therapist assistants (PTAs) have long understood the connection between mobility, physical activity, and the prevention of society's most serious health conditions. Some committed PTs say now's the time to start sharing that understanding at the community level.

    Featured in the May issue of PT in Motion magazine: "Reaching Beyond the Clinic," an exploration of how PTs are engaging in community health promotion in a variety of settings. And "variety" is a key word here: as explained in the article, "community health promotion" can be conceptualized in a number of ways, which can in turn create multiple opportunities for PTs and PTAs to make a difference.

    Among the PTs interviewed for the article are Rupal Patel, PT, PhD, who created a 12-week group-based lifestyle program to reduce diabetes risk among Asian Indians; Beth Black, PT, DSc, the co-instructor of a 6-week program for people who have multiple sclerosis; and Jessica Berglund, PT, DPT, chair of APTA's Council on Prevention, Health Promotion, and Wellness, and an employee of a home health company that offers a "7 elements of well-being" program to older adults. Accompanying articles include a list of relevant APTA resources and a report on a new clinical model that helps PTs overcome unease about asking people about their unhealthy habits.

    The article also addresses the question of whether PTs and PTAs should be involved in community health in the first place, and arrives at a definitive "yes." While education and training alone would seem to make the case for PTs stepping into this space—Berglund describes the PT's background as "ideal" for this kind of work—there's also a compelling ethical argument to be made for the profession becoming a leader in community health, according to longtime proponent Janet Bezner, PT, DPT, PhD, FAPTA. Bezner is on the steering committee for the APTA council mentioned above.

    "We can't ignore that [preventable diseases] are harming society and fueling skyrocketing health care costs," Bezner says in the article. "If we don't address them, we're complicit—frankly, we're contributing to the problem."

    "Reaching Beyond the Clinic" is featured in the May issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Printed editions of the magazine are mailed to all members who have not opted out; digital versions are available online to members.

    Coming to NEXT in June? Don't miss "Utilizing Community Collaboration to Reduce Health Disparities," a session focused on the ways PTs have developed and implemented community-based programs.

    Vitamin D Takes a Tumble in New Falls Prevention Recommendations

    The US Preventive Services Task Force (USPSTF) has updated its recommendations for falls prevention in older adults, and this time around, vitamin D supplements are out of the picture, at least for adults aged 65 or older without osteoporosis or vitamin D deficiency.

    As in previous versions of the recommendations, exercise-based interventions still receive the highest support, with a B grade based on studies reviewed by USPSTF researchers. However, the use of vitamin D supplements didn't fare as well, falling from a B grade in the last version of the recommendations to D grade in the latest edition, meaning that the USPSTF recommends against its use.

    The drop is at least partially due to a decision by the task force to exclude studies that involved participants with vitamin D deficiency or insufficiency from its evaluation this time around.

    "With this revised scope of review, as well as newer evidence from trials reporting no benefit, the USPSTF found that vitamin D supplementation has no benefit in falls prevention in community-dwelling older adults not known to have vitamin D deficiency or insufficiency," the report states. The task force clarified that its recommendations around vitamin D also are not intended to apply to older adults with osteoporosis or a history of fractures.

    Conversely, exercise interventions continued to receive strong support due to the solid favorable evidence that continues to mount—even if the approach can't be narrowed to a single or few recommended interventions.

    "Effective exercise interventions include supervised individual and group classes and physical therapy, although most studies reviewed by the USPSTF included group exercise," the report states. "Given the heterogeneity of interventions reviewed by the USPSTF, it is difficult to identify specific components of exercise that are particularly efficacious." While the report does mention exploratory research that seems to indicate that greater falls reduction is achieved through group (vs individual) exercise, exercise with multiple components, and exercise that includes strength training, USPSTF authors write that these results should be "interpreted with caution."

    A third intervention, titled "multifactorial," received the same C grade it earned in the previous report. According to USPSTF, "multifactorial" interventions are customized approaches based on individual falls risk assessments and could include exercise, psychological interventions, nutrition therapy, medication management, social or community services, and referral to specialists such as a neurologist.

    Editor's note: Want more on falls prevention? Check out the falls-related resources at PTNow, including a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. APTA also offers resources on its Balance and Falls webpage.