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  • July Board of Directors: Strategic Plan Updates Continue to Focus on Showing Value of PT Services

    The Board at its July meeting developed updates to APTA's Strategic Plan. The Strategic Plan, last updated in July 2011, outlines goals, objectives, strategies, and metrics for the next 1-3 years that will support achievement of Vision 2020. The plan includes a number of key decisions made by the House of Delegates in June 2012.

    Final wording of the 4 outcomes and their supporting objectives is in process and will be shared with members once the Strategic Plan has been adopted by the Board in December. The 4 outcomes are in the areas of:

    • Effectiveness of care to improve quality of life;
    • Patient- and client-centered care across the lifespan;
    • Professional growth and development; and
    • Value and accountability.

    Through small-group exploration, generative discussion, and prioritizing, the Board and key APTA staff identified several focused objectives that APTA can target for budgeting resources over the next 1-3 years.

    Key to the planning process was consideration of 2012 House decisions such as Physical Therapist Responsibility and Accountability for the Delivery of Care (RC2-12) and Feasibility Study for Transitioning to an Entry-Level Baccalaureate Physical Therapist Assistant Degree (RC20-12).

    Updates from the APTA strategic planning process will be posted to APTA.org, at www.apta.org/StrategicPlan, as they become available.

    July Board of Directors: Association Management Services Examined

    The Board of Directors, in an effort to improve the services provided to components, engaged in a discussion at its July meeting about APTA's association management services (AMS) to sections, chapters, and assemblies. APTA provides paid services to components with AMS such as membership management, meeting planning, and publishing.

    The presentation and discussion focused on the history and trends of components’ use of the services. It also proposed business model options that APTA could consider. A model that would make services through AMS available to as many components as requested service was deemed most desirable. The financial objective of this model would be to break even.

    Components seeking information about APTA's AMS program can contact Catherine Langley, director of association management services, at catherinelangley@apta.org.

    NQMC Launches Personalization Feature

    Users now can personalize the Agency for Healthcare Research and Quality's National Quality Measures Clearinghouse (NQMC) to accommodate specific interests and receive alerts on new and updated content. Through "My NQMC" recently searched terms and measure summaries will appear on the home page directly below the main search box. Users who save favorite measure summaries and organizations have the option to receive weekly e-mail alerts when favorite summaries have been updated or withdrawn from the site, or summaries associated with a favorite organization have been published, updated, or withdrawn from the site.

    Instructions on personalizing NQMC and setting up e-mail alerts are available on this FAQ page.

    APTA Moves Forward With Development of Clinical Practice Guidelines

    As part of APTA's strategic objective to reduce unwarranted variation in care, 32 association members representing 11 sections participated in a clinical practice guidelines (CPG) workshop on July 25-27 with the goal of developing a process to successfully complete and publish CPG. Joe Godges, PT, DPT, MA, OCS, and Sandra Kaplan, PT, PhD, facilitated the workshop, which included a presentation of a CPG development methodology and interactive discussion on how to apply the methodology to successfully develop CPG for the physical therapist profession.    

    Workshop participates were chosen following a call to sections in April to submit nominations for a guideline lead and, if indicated, key team member(s) who had defined a key clinical question or topic they would like to address with CPG. Through the call, 13 topics were identified for CPG. They include falls, deep vein thrombosis, vestibular neuritis, carpal tunnel syndrome, lymphedema and pediatric acute lymphoblastic leukemia, and determining a review process for the current Orthopaedic Section guidelines.

    CPG development is part of APTA's evidence-based documents initiative, which stems from motions from APTA's Board of Directors. The initiative aims to provide structure, process, and resources for the development of evidence-based documents that facilitate the translation of research findings into physical therapist practice. In addition to CPG, the initiative supports the development of position statements, clinical summaries, technical summaries, critical appraisal summaries, and guidance statements.    

    CPG Workshop - 7/26/12
    Sandra Kaplan, PT, PhD (left), and Joe Godges, PT, DPT, MA, OCS (seated on right), facilitated APTA's first workshop on developing clinical practice guidelines.  

    Evidence Supports APTA's Stance on PTs' Role in Reducing Readmissions

    New evidence shows that there is a significant opportunity for continued improvement in communication and care coordination in hospitals' efforts to reduce readmissions. According to authors of a study published July 18 in Journal of American College of Cardiology, the linking of inpatient and postdischarge (eg, outpatient, home care, or skilled nursing facility) providers and information is "central to effective continuity of care."   

    Physical therapists (PTs) serve an important role in patient care transitions and care coordination and can help reduce readmissions by providing recommendations for the most appropriate level of care to the health care team prior to and during care transitions. Additionally, APTA's position Physical Therapist of Record and "Hand Off" Communication supports communication practices that improve patient/client safety. For more information on the Hospital Readmissions Reduction Program, which begins in 2013, and to find clinical practice and patient education resources to reduce readmissions, visit APTA's Hospital Readmissions webpage

    Free full-text of Contemporary Evidence about Hospital Strategies for Reducing 30-Day Readmissions is available in Journal of American College of Cardiology. Highlights of the study are available from the Commonwealth Fund.  

    New Partnership to Prevent Health Care Fraud

    A new partnership among the federal government, state officials, leading private health insurance organizations, and other health care antifraud groups will share information and best practices in order to improve detection and prevent payment of fraudulent health care billings.

    The partnership will enable those on the front lines of industry antifraud efforts to share their insights more easily with investigators, prosecutors, policymakers, and other stakeholders. It will help law enforcement officials to more effectively identify and prevent suspicious activities, better protect patients' confidential information, and use the full range of tools and authorities provided by the Affordable Care Act and other essential statutes to combat and prosecute illegal actions.

    One innovative objective of the partnership is to share information on specific schemes, such as frequently used billing codes and geographical fraud hotspots, so that action can be taken to prevent losses to both government and private health plans before they occur. Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in 2 different cities. A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide health care data to predict and detect health care fraud schemes. 

    Visit APTA's Compliance webpage for information and resources to help keep compliant with federal requirements.

    CMS Releases IRF and SNF Payment Updates for FY 2013

    Late yesterday, the Centers for Medicare and Medicaid Services (CMS) released the 2013 payment updates for inpatient rehabilitation facilities (IRF) and skilled nursing facility (SNF) settings. Both of these notices set forth payment rates for these settings in Fiscal Year (FY) 2013 and do not make any substantive changes to policies regarding the provision of physical therapy.

    The IRF prospective payment system (PPS) update provides a 1.9% increase to the market basket rate for 2013 that results in an overall estimated economic impact of $140 million in increased payments to IRFs during FY 2013. The notice also includes the continued implementation of quality measures for IRF settings. Overall, no IRFs are estimated to experience a net decrease in payments as a result of the updates in this notice.

    The SNF PPS update provides a 1.8% increase to the market basket rate for 2013, which results in an overall estimated economic impact of $670 million in increased payments to SNFs during FY 2013. In addition, the rule discusses recent data regarding the implementation of group therapy allocations and the change of therapy OMRA.

    The updated payment rates for IRFs and SNFs are effective October 1. Both notices will be published in the Federal Register on August 2. In the coming week, APTA will conduct a full analysis of the notices and provide a summary to members.

    APTA Launches Collaborative Care Models Community Page

    APTA recently launched a Collaborative Care Models discussion forum in APTA Communities to allow members to discuss issues related to new collaborative care models under health reform, such as accountable care organizations (ACOs), patient-centered medical homes, and bundled payments. APTA is working to support members in their success within these models, and welcomes any questions for discussion within this community. In addition, the association wants to connect you with your peers who are working within similar models, allowing you to share both your opportunities and challenges.

    Members who are participating in a health care model that incorporates a patient-centered medical home or ACO, or implements bundled payments are encouraged to share their experiences and best practices, including tools or processes that have led to their successful participation. Members who are not practicing in 1 of these models, but are interesting in doing so, can post any questions or discuss any barriers that they are experiencing. APTA also will provide answers to frequently asked questions in this forum.

    To access the community, go to APTA Communities and click on the "Collaborative Care Models" link on the left-hand side. Don't forget to sign up to receive alerts when new postings become available. Additional information regarding these models of care can be found at www.apta.org/ACO. If you have further questions, contact advocacy@apta.org.

    New in the Literature: Guillain-Barré Syndrome (Europa Medicophysica. 2012 July 20. [Epub ahead of print])

    Authors of a recently published systematic review say it provides "good" evidence to support multidisciplinary rehabilitative intervention in adults with Guillain-Barré syndrome (GBS) and "satisfactory" evidence for physical therapy in these patients. Evidence for other unidisciplinary interventions is limited or inconclusive.

    For this review, the authors searched Medline, EMBASE, CINAHL, AMED, PEDro, LILACS, and the Cochrane Library up to March 2012 for studies reporting outcomes of GBS patients following rehabilitation interventions that addressed functional restoration and participation. Two reviewers applied the inclusion criteria to select potential studies and independently extracted data and assessed the methodological quality. Included studies were critically appraised using the GRADE methodological quality approach. Formal levels of evidence of each intervention were assigned using a standard format defined by the National Health and Medical Research Council.

    Fourteen papers (1 systematic review, 1 randomized controlled trial, 1 case-control study, 5 cohort studies, and 6 case series/reports) that described a range of rehabilitation interventions for people with GBS were evaluated for the "best" evidence to date. One high-quality randomized controlled trial demonstrated effectiveness of higher intensity multidisciplinary ambulatory rehabilitation in reducing disability in people with GBS in the later stages of recovery, compared with lesser intensity rehabilitation intervention for up to 12 months. Four observational studies further demonstrated some support for improved disability and quality of life following inpatient multidisciplinary rehabilitation up to 12 months. Evidence for unidisciplinary rehabilitation interventions is limited, with "satisfactory" evidence for physical therapy in reducing fatigue, improving function, and quality of life in people with GBS.

    The gaps in existing research should not be interpreted as ineffectiveness of rehabilitation intervention in GBS, the authors say. Further research is needed with appropriate study designs, outcome measurement, type of modalities, and cost effectiveness of these interventions.

    Editor's Note: According to the full text article, "multidisciplinary rehabilitation" may include physical therapy.  

    New App Serves as Guide to NLM Mobile Resources

    The National Library of Medicine (NLM) has released a new mobile app that is intended to make information broadly available and serve as the authoritative guide to NLM mobile resources. Users can find NLM mobile resources by type (website vs application), device (Android, Apple iOS, or Blackberry, or tag (descriptive tags assigned by NLM used to categorize the resource, such as "drugs" or "disasters").

    Visit the NLM Mobile webpage to explore the app. Users can save the app to their home screen for those times when they have no wireless connection or cell signal. The index of NLM mobile resources is available for offline browsing. The app will be updated with the latest information once the device is reconnected to the Internet.

    Charter Class Graduates from APTA Education Leadership Institute

    The inaugural class of 13 participants graduated from APTA's Education Leadership Institute (ELI) on July 19. The first cohort completed a yearlong higher education leadership program that consisted of 9 online modules provided by nonphysical therapy content expert faculty; 3, 2-day face-to-face interactive mentorship sessions with ongoing mentorship provided by experienced physical therapy program directors throughout the year; higher education mentorship provided administrators within participants’ institutions/organizations; implementation of a personal leadership development plan; and implementation of an institution-based leadership project. ELI graduates cultivated a shared learning community and network with opportunities to integrate curriculum content within their current and future education leadership roles and responsibilities.

    The goal of ELI is to develop physical therapist and physical therapist assistant education program directors with the leadership skills to facilitate change and improvement in the academic environment of the 21st century, think strategically to creatively implement solutions in education to respond to changes in health care and society, and engage in public discourse that advances the physical therapy profession. The institute’s shared partners in the promotion, support, and implementation of ELI include the Academic Council, Education Section, and PTA Educators Special Interest Group. More information about ELI can be found on APTA's website.

    July 26, 2012 - 1 
    ELI graduates are identified from the back row from left to right: Karen Abraham, PT, PhD (Shenandoah University, VA - Education, Orthopaedic, Women’s Health Sections); Amy Heath, PT, DPT, OCS (Temple University, PA - Education, Orthopaedic Sections); Kevin Brueilly, PT, PhD (Lynchburg College, VA & Wingate University, NC - Education Research, Acute Care Sections); Stephanie Kelly, PT, PhD (University of Indianapolis, IN - Education, Geriatrics, Health Policy & Administration, Neurology, Research Sections); Kevin Chui, PT, DPT, PhD, GCS, OCS (Sacred Heart University, CT - Education, Orthopaedic, Geriatrics Sections); Jill Horbacewicz, PT, PhD, OCS (Touro College, NY - Education Section); Mary Dockter, PT, PhD, MEd (University of Mary, ND - Education, Women’s Health Sections); Denise Bender, PT, JD, MED (University of Oklahoma Health Sciences Center, OK - Education, Geriatrics Sections); Diane Heislein, PT, DPT, MS, OCS (Boston University, MA - Education, Orthopaedic, Oncology Sections); Katherine Harris, PT, PhD (Quinnipiac University, CT - Education, Acute Care, Clinical Electro & Wound Management, Oncology Sections); Terri Dinsmore, PT, DPT (Clarke State Community College, OH - Education Section); Julia Chevan, PT, PhD, MPH, OCS (Springfield College, MA - Education, Research, Orthopaedic, Health Policy & Administration Sections); and Erin Conrad, PT, DPT, MS, OCS, MT, FAAOMPT (University of St Augustine for Health Sciences, FL - Education, Orthopaedic Sections)  

    CBO Updates Costs of ACA Insurance Coverage Provisions

    The insurance coverage provisions of the Affordable Care Act (ACA) will have a net cost of $1,168 billion over the 2012-2022 period—compared with $1,252 billion projected in March 2012 for that 11-year period—for a net reduction of $84 billion, the Congressional Budget Office (CBO) announced yesterday.

    The projected net savings to the federal government is a result from the Supreme Court's decision allowing states to choose whether or not to expand eligibility for coverage under their Medicaid programs. The reductions in spending from lower Medicaid enrollment are expected to more than offset the increase in costs from greater participation in the newly established exchanges. CBO and the Joint Committee on Taxation (JCT) now estimate that fewer people will be covered by the Medicaid program, more people will obtain health insurance through the newly established exchanges, and more people will be uninsured. The magnitude of those changes varies from year to year.

    In 2022, for example, Medicaid and the Children's Health Insurance Program (CHIP) are expected to cover about 6 million fewer people than previously estimated, about 3 million more people will be enrolled in exchanges, and about 3 million more people will be uninsured. These estimates are dominated by the movements of people losing eligibility for Medicaid. However, other smaller shifts in coverage also are expected to occur.

    Federal spending over the 2012-2022 period for Medicaid and CHIP now is projected to be $289 billion less than previously expected, whereas the estimated costs of tax credits and other subsidies for the purchase of health insurance through the exchanges (and related spending) have risen by $210 billion. Small changes in other components of the budget estimates account for the remaining $5 billion of the difference.

    The report issued yesterday does not include the budgetary impact of other provisions of the ACA.

    Additionally, CBO and JCT found that the latest repeal bill (HR 6079) would cause a net increase in federal budget deficits of $109 billion over the 2013-2022 period. Specifically, they estimate that HR 6079 would reduce direct spending by $890 billion and reduce revenues by $1 trillion between 2013 and 2022, adding $109 billion to federal budget deficits over that period.

    Joint Replacement Surgery Linked With Increased Risk of Heart Attack

    Older adults who have total hip replacement (THR) or total knee replacement (TKR) surgery are at an increased risk of heart attack, say authors of a study that included records of more than 95,000 Danish patients who underwent a primary THR or TKR from January 1, 1998, through December 31, 2007. 

    During the first 2 postoperative weeks, the risk of heart attack was substantially increased in THR patients compared with controls (adjusted hazard ratio [HR] 25.5). The risk remained elevated for 2 to 6 weeks after surgery (adjusted HR, 5.05) and then decreased to baseline levels. For patients with TKR the risk of heart attack also was increased during the first 2 weeks (adjusted HR, 30.9) but did not differ from controls after the first 2 weeks. The absolute 6-week risk of heart attack was 0.51% in patients with THR and 0.21% in patients with TKR.

    The authors say the association was strongest in patients 80 years or older. They could not detect a significantly increased risk in patients younger than 60 years. Additionally, a history of heart attack in the 6 months before surgery increased the risk of new heart attack during the first 6 weeks after THR and TKR surgery, but it did not affect the relationship between THR or TKR and heart attack.

    Free, full text of the article is available in Archives of Internal Medicine.

    CARF Webinar: Accessing Evidence for Stroke

    Evidence is increasingly being used as a prerequisite for reimbursement of services and is an ongoing mandate for rehabilitation clinicians. The use of evidence-based practice also can ensure that the most effective treatments are being provided to patients, which is fundamental to cost-effective, appropriate care. On September 18, CARF International will host a 90-minute webinar that will review easy-to-use, easy-to-access options for accessing evidence for stroke rehabilitative services. Upon completion, webinar participants should be able to:

    • Identify reliable research sources on stroke and stroke rehabilitation.
    • Discuss the importance and challenges of knowledge translation.
    • Identify tools that address the concepts of impairment, activity, and participation.
    • Identify tools that clinicians can use to make their patients and clients aware of ongoing clinical trials.

    Register today for Medical Rehabilitation Webinar: Current Stroke Research to Access and Use in Clinical Practice, September 18, noon to 1:30 pm, ET.

    APTA is a member of CARF's International Advisory Committee.

    Lancet Series Highlights Consequences of Physical Inactivity; Calls for Global Action

    The high prevalence and consequences of physical inactivity should be recognized as a global pandemic, according to the fifth and final paper in The Lancet series on physical activity published last week. The article outlines key strategies and resources needed to make physical activity a global public health priority.

    "Although regular physical activity is critical for weight control, it is equally or more important for lowering risk of many different chronic diseases such as heart disease, some cancers, osteoporosis, and diabetes," said lead author Harold W. Kohl, III, PhD, professor of epidemiology at The University of Texas School of Public Health.

    In the paper, the researchers call on ministries of health to "Make physical activity an integral part of an overall disease prevention and health promotion model, including screening for physical inactivity, counseling about physical activity in prevention and disease treatment and management strategies as well as increased investment in comprehensive physical activity promotion policies, action plans, and implementation programs."

    According to Kohl, research on physical activity needs to be its own priority within public health research of noncommunicable diseases. "The response to physical inactivity has been incomplete, unfocused, understaffed, and underfunded compared with other risk factors for non-communicable diseases," he said. "This has put physical activity in reverse gear compared with population trends and advances in tobacco and alcohol control and diet."

    Speaking to members of the National Physical Activity Plan on Friday, Chair Russell Pate, PhD, said, "The Lancet has labeled physical inactivity a global pandemic, and it has documented the enormity of the human and financial costs associated with this public health crisis. Physical inactivity kills, and it is high time we respond to physical inactivity as the lethal force it is." APTA is a member of the National Physical Activity Plan Coordinating Committee

    Other papers in the series address why some people are more physically active than others and how megatrends in information and communication technology and transportation directly and indirectly affect levels of physical activity across countries of low, middle, and high income. Researchers also describe physical activity levels of adults worldwide and review physical activity interventions.

    Call for Comments on Long Term Care Accreditation Program

    APTA members who work in skilled nursing facilities are encouraged to submit comments on proposed requirements for the Joint Commission's Long Term Care Accreditation program. The Joint Commission is in the process of reinventing the program to focus on the most critical issues supporting safety and quality of care for patients and residents in the nursing home setting. Highlights of the new approach are:

    • a single core set of accreditation requirements relating to quality and safety for all nursing homes
    • new accreditation requirements that focus on person-centered care
    • a new optional certification module for special programs or services, such as post acute care (including rehabilitation services), memory care, and other critical specialties

    An online survey of the proposed requirements is available until August 13.The survey is organized into 3 areas—core requirements, person-centered care requirements, and post acute rehabilitation services requirements (optional certification). 

    Prostheses Not Meeting Needs of Farmers and Ranchers

    Artificial hands, arms, legs, and feet, and other prostheses used by agricultural workers with a major limb amputation are not durable, affordable, or adaptable enough for their lifestyles, says a Medical News Today  article based on a study published online in Disability and Rehabilitation: Assistive Technology.

    Researchers conducted interviews with 40 American farmers and ranchers with amputations to gather information about how current and past prostheses were used, prosthetic failures, and their ability to complete farm tasks while using a prosthesis. They also interviewed 26 prosthetists who provide services to farmers and ranchers.

    The study found that:

    • Farmers' prostheses seem to deteriorate faster and fail more frequently than those of nonfarmers with amputations.
    • Farmers reported many falls and secondary injuries due to use of their prosthesis.
    • Farmers make additional changes in routines, farm equipment, and in attitude to successfully return to farming after an amputation.
    • In addition to inadequate medical insurance coverage for devices, some farmers in rural areas have to travel great distances to get to a prosthetist's clinic, which also adds to costs.
    • Prosthetists are not typically trained about the needs and lifestyles of farmers and ranchers and may prescribe inappropriate prosthetic choices. However, some prosthetists reported that farmers had unrealistic expectations of their prosthesis.

    The study is part of a larger research project at the Northwestern University Prosthetics-Orthotics Center that aims to design educational materials tailored to the specific needs of farmers and ranchers with amputations and work with prosthesis manufacturers to develop and reengineer more robust products and components. Results of this ongoing research could benefit people with amputations who work in other physically demanding professions such as the military, construction, forestry, commercial fishing, mining, and manufacturing, the article says.

    Private Health Care Purchasers Begin Shift to Value-based Payment Model

    Prominent national and regional business and labor health care purchasers are working together to change the way they and other private purchasers pay for health benefits to be based on the value, rather than the volume of services delivered by health care providers. The effort, known as Buying Value, takes advantage of major reforms in Medicare. By 2017, the Centers for Medicare and Medicaid Services will attach 9% of Medicare payments to some form of value purchasing.

    Buying Value is a collaboration of 18 diverse organizations that either represent or are themselves large health care purchasers—including Fortune 500 corporations, union health funds, and national and regional business coalitions. National consumer organizations also are also involved.

    The initiative is designed to encourage and assist private purchasers in making the switch from the traditional health care purchasing model of paying for care based on the number of individual tests or procedures performed, to a payment model based on the value or outcome of the overall care.

    The Buying Value project will develop a toolkit to help private purchasers rethink their health plans, as well as launch a public database showing different payment methods that purchasers can use to drive improvements in health care quality and safety. Organizers also will provide education and presentation materials and offer guidance on avoiding antitrust issues present in active purchasing. In addition to creating tools and resources that can be used by health care purchasers to guide their benefits plans, Buying Value organizers will conduct outreach at the local level to educate regional purchasers and consumer organizations.

    In order to facilitate and simplify alignment between private purchasers and Medicare, Buying Value has secured Medicare's commitment to support a common set of core measures for value purchasing in both areas. Development of the core measure set is under way at the independent Measures Application Partnership under a Medicare contract. The first phase of the project is due to be completed by October 1.

    APTA Collaborates With Wal-Mart on PTA Coverage

    At APTA's urging, Wal-Mart Corporation has changed its policy to cover services delivered by physical therapist assistants (PTAs). Effective July 1, Wal-Mart's medical plan, BlueAdvantage, will pay for services delivered by PTAs as long as they are under the direct supervision of a physical therapist (PT) and the claims are billed by the PT. These claims will be subject to the same coverage criteria as the plan’s physical therapy coverage criteria.

    Wal-Mart's previous coverage policy stated, "Therapy is covered when prescribed by a physician and provided by a licensed physical therapist or occupational therapist."

    APTA Increases Annual Donation to Foundation

    Starting in 2013, APTA will increase its donation to the Foundation for Physical Therapy to help support the Foundation's mission to fund physical therapy research and develop the next generation of researchers. 

    During its January conference call, APTA's Board of Directors (Board) voted unanimously to increase the donation noted as "percentage of dues" from 2% to 2.5% indefinitely. In dollars, that increase amounts to about $76,000 annually.

    In a letter to the Board, Foundation President Bill Boissonnault, PT, DHSc, said, "The additional funding comes at a critical time for the Foundation, allowing us to continue funding our current initiatives, and at the same time build for the future."  

    New in the Literature: Vestibular Rehabilitation for Concussion (Physiother Res Int. 2012 July 12. [Epub ahead of print])

    Understanding the prescription patterns of expert clinicians may elucidate the vestibular-related impairments of individuals after concussion and may provide a resource for therapists who may be starting vestibular rehabilitation programs for management of individuals with concussion, say authors of an article published online in Physiotherapy Research International. 

    For this study, the authors conducted a retrospective chart review of vestibular rehabilitation home exercise programs prescribed by physical therapists for 104 participants who were diagnosed with concussion. Each of the exercises was classified by exercise type, duration, and frequency. Frequency counts of the most common exercise types were recorded. Exercise progression patterns were examined by determining how exercise types were modified from visit to visit.

    Eye-head coordination exercises were the most commonly prescribed exercise type (in 95% of participants), followed by standing static balance exercises (in 88% of participants), and ambulation exercises (in 76% of participants).

    The authors add that future research should be directed to relate outcomes to the exercise prescription patterns to improve quality of care.  

    APTA members Susan L. Whitney, PT, PhD, NCS, ATC, FAPTA, Anne Mucha, PT, MS, NCSLaura O. Morris, PT, NCS, and Patrick J. Sparto, PT, PhD, are coauthors of the article.

    TBI, Chronic Pain Present Challenges During PTSD Treatment

    A new report from the Institute of Medicine examines the treatment needs of service members and veterans who have post-traumatic stress disorder (PTSD) and how certain comorbidities can affect treatment for PTSD.

    The report's authors classify the conditions that are most likely to interfere with effective PTSD-specific treatments, and whose treatment should be integrated into a comprehensive treatment program for PTSD, into 3 categories: psychiatric; medical, which includes chronic pain, traumatic brain injury (TBI), and amputation; and psychosocial. They note that the "prevalence of co-occurring psychiatric and medical conditions and psychosocial issues differs among the varied cohorts and subpopulations of service members and veterans …  and that the treatment needs of different groups will be different."

    In addition, the report examines the effect of PTSD on long-term health outcomes, including cardiovascular disease, inflammatory and autoimmune diseases, and diabetes mellitus.

    Of the service members and veterans who have served in Iraq and Afghanistan and screened positive for PTSD symptoms, about 40% have received a referral for additional evaluation or treatment, and of those referred, about 65% go on to receive treatment, the report says. 

    Earlier this year, APTA was invited by the Office of the First Lady to participate in the Joining Forces Initiative—a comprehensive national effort to mobilize all sectors of society to give the nation's service members and their families the opportunities and support they have earned. As a provider that specializes in treating injuries that affect a vast number of returning service members and veterans, APTA is uniquely positioned to help ensure its practitioners have the best, most up-to-date information on TBI, PTSD, and postcombat depression.

    Read about APTA's commitment to the initiative, and access educational and advocacy resources on the management of wounded service members, on APTA's Joining Forces webpage. 

    Move Forward Brand Ads Running On SiriusXM Radio This Week

    The Olympics are just around the corner, and APTA is taking the opportunity to promote the physical therapist's role in helping athletes of all abilities maintain a mobile and active lifestyle. Be sure to listen for APTA's Move Forward radio ads running this week on SiriusXM radio leading up to the Olympic Games. The ads, part of APTA's ongoing branding campaign, are running all week on the following channels: SiriusXM Stars (includes numerous shows such as Rosie O'Donnell and TMZ); CNN; MSNBC; CNBC; Oprah Radio; and Martha Stewart Living Radio. Listen to the ads through APTA's website.   

    APTA Improves 'Extra' Features Based on Member Feedback

    In response to initial member feedback, APTA has made some navigational adjustments to its inaugural issue of PT in Motion Extra—a new complement to APTA's monthly member magazine, PT in Motion. An instructions page will now help you navigate through the issue, and arrows guiding you within and between articles have been revised to be more intuitive. Other responses to the survey at the end of the issue indicate that the most popular article among readers was "Robotic Devices Help Patients Walk, Reach." 

    Learn the Essentials: Register Today for Post-acute Care Compliance Seminars

    Recent policy changes and new federal regulations could have serious implications for members of the physical therapy profession who offer services in home health and inpatient rehabilitation settings, and in skilled nursing facilities.

    APTA's 2-day post-acute care compliance seminar will provide essential information to physical therapists, physical therapist assistants, and their administrative staff that can be used to improve practices and ensure compliance with federal regulations and laws.

    Participants will be able to meet and talk with nationally known experts about documentation, patient assessment and classification, compliance with Medicare regulations, and emerging issues in health care reform.

    Seating is limited. Register now to reserve your place at the October 12-13 seminar in Charlotte, North Carolina, at the Hyatt House Charlotte City Center, or the November 9-10 seminar in Dallas, Texas, at The Adolphus Hotel. For registration and course information, visit APTA's Learning Center.

    Information and Advocacy Resources Available on Essential Health Benefits

    APTA's Essential Health Benefits (EHB) webpage provides an overview of this new benefit package, established under the Affordable Care Act, which ensures that certain health plans offered in the state Health Insurance Exchanges (exchanges) provide a baseline of coverage, benefits, and services to their enrollees.  

    Most health plans that will be offered in exchanges, with some exceptions, must cover 10 categories of benefits in order to be certified and offered in the exchanges. Of particular interest to physical therapists is the rehabilitative and habilitative services and devices category. Although rehabilitative services will be mandatory services in most Qualified Health Plans, states will most likely impose annual visit limits, caps, or other restrictions for therapy services as current employer-sponsored plans do. Therefore, it is imperative that physical therapists continue to educate state legislators, state policy makers, and consumers of the value, benefits, and cost savings of physical therapy services.

    Find background information on essential health benefits, a map of Medicaid and exchanges coverage by state, resource for state and chapter advocacy efforts, and more on this 1-stop resource page.   

    2013 HH PPS Highlights Now Available

    Details of the proposed rule for the 2013 home health prospective payment system (HH PPS) are available in a new highlights document on APTA's Medicare Payment and Policies for Home Health webpage. Find out how the Centers for Medicare and Medicaid Services (CMS) proposes to update payments, modify the physician face-to-face requirement, and implement new therapy coverage requirements regarding functional reassessments. The summary also outlines changes that CMS proposes to the HH PPS grouper, updates to quality reporting, and revisions to requirements and sanctions for compliance and noncompliance for home health agencies regarding state survey and certification.

    Foundation Annual Report Available Online

    Check out highlights from last year, read a message from the president, and view a Legacy Gala video in the Foundation for Physical Therapy's 2011 Annual Report. The report also includes information on the Scientific Review Committee, grant and scholarship awardees, Foundation service awards, and donors.   

    Highlights of 2013 Proposed Physician Fee Schedule Available Online

    A new APTA document provides highlights of the provisions in the 2013 proposed physician fee schedule rule that will affect physical therapy. Available to members on the Medicare Physician Fee Schedule webpage, the document covers changes that will affect payments, data collection on function, new codes and updates to codes, changes to the Physician Quality Reporting System, claims and registry reporting, and more.   

    Move Forward Radio Program: Preparing for the London Games

    To offer a glimpse into how athletes prepare to compete in the Olympic and Paralympic Games, APTA will host a 1-hour program on Move Forward Radio called "Reaching the Top of Your Game" on July 17, 7 pm-8 pm, ET.

    Amber Donaldson, PT, DPT, M Physio (Manip), SCS, CSCS, manager of the United States Olympic Committee Sports Medicine Clinic in Colorado Springs, Colorado, will join other APTA members, including Scott Weiss, PT, DPT, ATC, CSCS, physical therapist for the US Sailing Team and owner of Bodhizone for Human Performance and Sports Physical Therapy based in New York City, and Denise Hutchins, PT, International Paralympic Committee Athletics Classifier and vice chair of Wheelchair and Ambulatory Sports, USA. People across the country can listen online and call in to the show to ask questions or submit them in advance via Twitter by tweeting @MoveForwardPT and using the hashtag #MoveForward.

    Read APTA's press release for more information about the physical therapists who work with these elite athletes. 

    New in the Literature: Hand Grip Strength Test (Am J Phys Med Rehabil. 2012 Jun 29. [Epub ahead of print])

    The handgrip strength (HGS) test might be an important correlate of health in breast cancer survivors, and could be recommended as an adjuvant method of evaluation, which may help with efficiency of clinical practice, say authors of an article published online ahead of print in American Journal of Physical Medicine and Rehabilitation 

    In this cross-sectional study of 95 breast cancer survivors, researchers assessed outcomes for HGS; heart rate variability; pressure pain threshold of the neck, shoulder, hand, and tibia of the affected side; and fitness level (6-minute walk test, neck-shoulder mobility, vertical jump, sit-to-stand test, and trunk curl test). Participants completed the Fatigue Piper Scale and Profile of Mood States questionnaires and the neck-shoulder visual analog scale. Correlation was conducted to examine the relationship of HGS with pain, fitness, fatigue, and mood.

    The authors observed a fair relationship of HGS with shoulder pain and a moderate to fair relationship with fitness (rho range, 0.24-0.56). The relationship between HGS and heart rate variability (high-frequency domain) was weak (rho=0.23). Likewise, the relationship between HGS and Profile of Mood States subscales ranged from weak to fair (rho range, -0.22 to -0.36). HGS showed a weak relationship with Fatigue Piper Scale (rho range, -0.28 to -0.35). Passive shoulder flexion, fatigue, and vertical jump were independent and significant predictors of HGS (R2 = 0.466).

    Call for Comments: Upcoming CAPTE Program Reviews

    The Commission on Accreditation in Physical Therapy Education (CAPTE) invites comments from the physical therapy community regarding the physical therapist and physical therapist assistant programs scheduled for review at CAPTE's November 2012 meeting. Comments will be accepted until September 1. 

    A list of programs scheduled for review is available in this document. Information about how to provide comments is available on CAPTE's website.    

    OAAA Lunch and Learn Series: Findings from Audience Research

    Hear Terry Brady, PhD, senior behavioral scientist at the Centers for Disease Control and Prevention, discuss lessons learned from audience research from primary care practices on July 18,noon to 12:30 pm, ET. Hosted by the Osteoarthritis Action Alliance (OAAA) as part of its Lunch and Learn series, Brady's presentation will focus on how the research was conducted, the key findings, recommendations, and putting the findings into action. Dial-in information and Brady's Powerpoint are available in this invitation from OAAA.

    APTA is a member of OAAA.

    Track-related Injuries on the Rise in Children and Teens

    From 1991 through 2008 more than 159,000 children and adolescents aged 10 to 18 were treated in US emergency departments for track-related injuries, say researchers at the Research Institute at Nationwide Children's Hospital. The annual number of track-related injuries increased 36% during the 18-year study period, increasing from 7,702 in 1991 to 10,496 in 2008.

    According to the study, the most common injury diagnoses were sprains and/or strains (52%) and fractures or dislocations (17%). The study looked at 7 different track-related activities—sprinting, cross country, running, hurdles, relays, stretching and/or drills, and "other" activities. The most common activities being performed at the time of injury were running (59%) and hurdles (23%).

    The most commonly injured body parts varied across activity and across age group. For instance, elementary students were more likely to sustain upper extremity injuries while high school students were more likely to sustain lower leg injuries.

    "With this in mind, track-related injury prevention efforts may need to be tailored by activity for different age groups in order to most effectively address the injury concerns the athletes are facing,” said Lara McKenzie, PhD, principal investigator at the Center for Injury Research and Policy and senior author of the study.

    Free, full-text of the study is available in The Physician and Sportsmedicine.  

    New NIH Program to Focus on Brain's Role in Pain

    The National Institutes of Health (NIH) recently launched a new multidisciplinary research program focusing on the role of the brain in perceiving, modifying, and managing pain. Based in NIH's National Center for Complementary and Alternative Medicine, this collaborative effort will complement basic science and clinical research efforts of other ongoing intramural neuroscience, imaging, and mental and behavioral health research programs.

    NIH has appointed Catherine Bushnell, PhD, an internationally recognized pain and neuroscience researcher, scientific director of the program. Under Bushnell, the program will continue to work toward the development of better ways to safely and more effectively treat chronic pain, and advance research on the intersection and integration of pharmacological and nonpharmacological approaches.

    Research projects will include investigating the role of the brain in pain processing and control, and how factors such as emotion, attention, environment, and genetics affect pain perception. The program also will explore how chronic pain produces changes in the brain that can modify how the brain reacts to pain medications such as opioids.

    North Carolina Enacts Legislation Ensuring Patient Choice and Coverage of PT Services

    Patients in North Carolina soon will have the right to choose their physical therapist (PT) under their health benefits plan and ensure that PT services will be covered. SB 656, sponsored by State Sen Jim Davis (R) and advocated for by the North Carolina Chapter, was signed by North Carolina Gov Beverly Perdue (D) on June 29 and goes into effect October 1. SB 656 specifies that whenever an insurance policy provides for certification of disability that is within the scope of practice of a licensed PT, the policyholder, insured, or beneficiary will have the right to choose the provider of the services.

    According to Chapter President Dean McCall, PT, DPT, OCS, the chapter initiated the legislation after reports began surfacing that some patients were unnecessarily driving more than 90 miles and having to wait 3 to 4 weeks before being seen by other providers, when they could have been seen in their home town by their local physical therapist. In addition, SB 656 states that when any health benefit plan, subscriber contract, or policy of insurance issued by a health maintenance organization, hospital or medical service corporation, or insurer provides for coverage for, payment of, or reimbursement for physical therapist services, the insured or other persons entitled to benefits under the policy will be entitled to coverage or reimbursement for the services.

    CMS Announces 89 New ACOs

    As of July 1, 89 new accountable care organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, DC. In total, 154 organizations now participate in Medicare shared savings initiatives, serving over 2.4 million Medicare patients across the country.

    Federal savings from the Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, could amount to $940 million over 4 years. All ACOs that succeed in reducing the rate of growth in the cost of care while providing high-quality care may share in the savings to Medicare. Five of the new ACOs applied for a version of the program that allows them to earn a higher share of any savings by also being held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase.

    The selected ACOs, announced yesterday by the Centers for Medicare and Medicaid (CMS), operate in a wide range of areas of the country, and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas that they are serving.  

    To ensure high quality of care, ACOs will report performance on 33 measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

    Beginning this year, new ACO applications will be accepted annually. The application period for organizations that wish to participate in MSSP beginning in January 2013 is August 1 through September 6.

    Check out APTA's ACO webpage for resources such as FAQs, podcasts, assessment tools, and summaries on ACO regulations. APTA's video series on innovative models of care illustrates ways physical therapists can play an important role in ACOs and other integrated care models.

    Small Study Shows Wii Effective in Reducing Falls in Patients With Mild AD

    Regular Wii Fit workouts proved as effective as a robust walking routine in reducing the risk for falling in older people with mild Alzheimer disease (AD), says a Medscape Medical News  article based on a study published online June 13 in Journal of Aging Research.

    Researchers at the University of Arkansas for Medical Sciences assessed fall risk with 3 tests of balance and gait in 22 elderly people enrolled in 1 of 2 exercise interventions. Eleven participants were assigned to a supervised walking program, and 11 used the Wii Fit yoga, strength-training, and balance games. Each group exercised 5 times weekly for 30 minutes over 8 weeks.

    The participants were tested with the Berg Balance Scale (BBS), the Tinetti Test (TT), and Timed Up and Go (TUG) test before they began exercising, at the 4-week point, and after 8 weeks. Research participants lived in an assisted-living facility.

    Both groups showed improvements on all 3 tests, with no statistically significant difference between the groups. Both groups began with a BBS score of less than 45, indicating a high risk for falls, and significantly improved those scores over time. But group-by-time interactions failed to reach significance for any measure.

    In an intragroup analysis, at 8 weeks the Wii Fit group showed statistically significant improvements in BBS and TT scores. Wii Fit TUG scores did not reach significance.

    In the walking group, an intragroup analysis showed a significant improvement in TT scores. However, although BBS and TUG scores trended toward improvement, they failed to reach statistical significance.

    Robert P. Friedland, MD, chair and professor of neurology at the University of Louisville, Kentucky, who was not involved in the research, calls the study a "relatively limited observation." He added that the mean age of the participants—79.3 years for the Wii Fit group and 81.6 years for the walking group—rather than the disease probably led to their balance issues.

    Swedish Study Finds Men Have More Knee Injuries Than Women

    Men have a greater number of knee ligament injuries than women, despite research suggesting that women's knees are more prone to anterior cruciate ligament (ACL) tears and surgeries to fix them, says an article by Reuters based on study in American Journal of Sports Medicine. 

    For this study, researchers included knee injuries across the entire Swedish population, not just among players of particular sports or in certain regions. They used a nationwide database of patients to see how many Swedes had knee ligament injuries and how many had surgical repairs between 2002 and 2009. Overall, 56,659 people in Sweden tore a knee ligament during the 7-year study period—an average of 78 tears for every 100,000 Swedish citizens.

    Men accounted for about 34,000 of the tears, or 60%. Men also had 59% of the reconstructive surgeries associated with knee ligament injuries.

    Swedish women tended to experience ACL injuries at a younger age—between the ages of 11 and 20, versus 21 to 30 for men.

    When the researchers looked just at the age groups with the highest injury rates, men still had far more knee troubles. The numbers worked out to about 144 tears per 100,000 women between 11 and 20 years old, and 225 tears per 100,000 men aged 21 to 30.

    Darin Padua, director of the Sports Medicine Research Laboratory at the University of North Carolina at Chapel Hill, said he was not surprised by the findings. Padua, who was not involved with the research, added that the results help to show that both men and women should be taking part in injury prevention programs, the article says.  

    Hospital Consolidations Driven by Bargaining Power Do Not Lead to Integration

    Physician-hospital consolidation for the purpose of enhanced bargaining power with payers does not lead to true integration or enhanced hospital performance, according to an updated issue brief by the Robert Wood Johnson Foundation (RWJF) that examines the effect of hospital mergers on prices, costs, and quality of care.

    Consolidation between physicians and hospitals is of great interest because of both the potential that consolidation has for creating integration, and the impetus created by the Affordable Care Act's push toward creating accountable care organizations and emphasis on bundled payments. In theory, says the brief, there are substantial gains to be made from consolidation—especially when consolidation leads to integration and the elimination of unnecessary duplication of services.

    However, the brief also points to concerns that consolidation may have adverse impacts on competition. Hospital consolidation generally results in higher prices. When hospitals merge in already concentrated markets, the price increase can be dramatic, often exceeding 20%.

    Additionally, hospital competition improves quality of care. This is true under both administered price systems such as Medicare and the United Kingdom's National Health Service, and market-determined pricing such as the private health insurance market.

    The full 2006 synthesis and updated brief are available on RWJF's website

    CMS Releases Proposed 2013 Physician Fee Schedule Rule

    Today, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2013 Medicare physician fee schedule rule that updates 2013 payment amounts and revises other payment policies. Excluding the 31% projected sustainable growth rate payment cut, the aggregate impact on payment of changes in the rule is a positive 3% for outpatient physical therapy services. Additional proposed policies that will impact physical therapists include implementation of new functional status codes for reporting therapy services, updates to the Physician Quality Reporting System (PQRS) program, and initiatives to promote care coordination.

    As required by the Middle Class Tax Relief Jobs Creation Act of 2012, CMS proposes to implement a claims-based data collection process to gather data about patient function for patients receiving outpatient physical, occupational, and speech therapy services. Therapists would be required to report new codes and modifiers on the claim form that reflect a patient's functional limitations and goals at initial evaluation, periodically throughout care, and at discharge. This data is for informational purposes and is not proposed to be linked to reimbursement. This reporting system is proposed to be implemented on January 1, 2013. Claims will be processed during the first 6 months until July 1, 2013, regardless of the inclusion of the functional limitation codes. Beginning July 1, 2013, all claims must include functional limitation codes to be paid by Medicare.

    CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2013 and beyond. The incentive payment for 2013 will remain 0.5%. The 2013 reporting period data will be used to inform both the 2013 incentive payment (0.5%) and the 2015 payment adjustment (-1.5%). Successful reporting requirements for the program are proposed to remain as they were in 2012 requiring that participants report a minimum of 3 individual measures or 1 group measure via claims based reporting on 50% or more of all eligible Medicare patients, or report a minimum of 3 individual measures or 1 group measure via registry reporting on 80% or more of all eligible Medicare patients. 

    CMS proposes to establish new procedure codes that would allow reporting and payment for additional resources required for a physician and nonphysician practitioner to coordinate a patient's care outside a face-to-face patient encounter in the 30 days following discharge to the community from an inpatient hospital stay and skilled nursing facility stay.

    The public will have until September 4 to submit comments in response to this rule. On behalf of its members, APTA will submit comments in response to the rule. After reviewing public comments, CMS will publish a final rule on or about November 1, which will become effective for services furnished during calendar year 2013. APTA will provide a more detailed summary of the rule in the upcoming week.

    CMS Proposes Revisions Regarding Documentation and Reassessment in Home Health Rule

    In a home health proposed rule issued today, the Centers for Medicare and Medicaid Services (CMS) proposes additional regulatory flexibility regarding therapy documentation and reassessment as well as face-to-face encounter requirements. In addition, the rule would reduce Medicare payments to home health agencies in calendar year (CY) 2013 by 0.1%, or $20 million.

    Proposed revisions regarding documentation and reassessment include:

    • Revising the regulations to state that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment. This would be a change from the current policy that does not allow payment for the late reassessment visit.
    • Amending the regulations to state that in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed by any 1 of the therapy disciplines, therapy coverage would cease only for that particular therapy discipline. Under current policy therapy coverage would cease for all disciplines until reassessments are completed by all therapy disciplines involved in care.
    • Modifying the regulations to clarify that in cases where the patient is receiving more than 1 type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

    CMS proposed to change the regulations to allow a nonphysician practitioner in an acute or post-acute facility to perform the face-to-face encounter in collaboration with or under supervision of the physician who has privileges and cared for the patient in the acute or post-acute facility. This will inform the decision regarding the patient’s homebound status and need for skilled services.

    In addition, this proposed rule includes provisions regarding quality reporting for hospice and provides updates to the home health quality reporting program. This rule also would establish requirements for unannounced, standard, and extended surveys of home health agencies (HHAs) and provide alternative sanctions if HHAs are out of compliance with federal regulations.

    APTA will provide members with a thorough analysis of the proposed rule shortly. The association will submit comments to CMS by the September 4deadline. A final rule will be issued on or around November 1 and provisions will become effective in 2013.

    CMS Issues Outpatient Hospital Prospective Payment System Rule

    The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule today that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning January 1, 2013. CMS projects that total payments to hospitals under the Outpatient Prospective Payment System (OPPS) in calendar year 2013 will be approximately $48.1 billion.

    The OPPS proposed rule includes several proposals that would affect the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. Specifically, the proposed rule would allow updates to the IRF quality reporting program measures based on changes that occur during recognized measure endorsement processes. All IRF quality measures will remain in effect until the measure is actively removed, suspended, or replaced.

    APTA will submit comments in response to the proposed rule by the September 4 public comment deadline. CMS will respond to all comments in a final rule to be issued by November 1. 

    July Craikcast Now Available

    Enjoy a "diversity of topics" in this month's PTJ as Editor  in Chief Rebecca Craik, PT, PhD, FAPTA, summarizes articles that range from treadmill training for people with Parkinson disease, and transcutaneous electrical nerve stimulation for the management of pain, to parameter selection for hypoalgesia using interferential therapy, and postural and movement experiences on head control in infants.

    International Groups Issue Statement on Diabetes in Older Adults

    A new position paper by 3 international groups addresses 8 domains of interest for older adults with diabetes: hypoglycemia, therapy, diabetes in the nursing home, influence of comorbidities, glucose targets, family/caretaker perspectives, diabetes education, and patient safety. The groups wrote the position paper because "most international clinical diabetes guidelines fail to address issues that are common in the elderly, including frailty, functional limitation, mental health changes, and increasing dependency," says an article by Medscape Medical News.

    The authors, from the International Association of Gerontology and Geriatrics, European Diabetes Working Party for Older People, and International Task Force of Experts in Diabetes, identified major research areas that need to be explored, including:

    • the use of exercise, nutrition, and glucose-lowering therapies in the effective management of type 2 diabetes in older people;
    • practical community-based interventions to reduce hospitalization;
    • methods to decrease hypoglycemia rates in various clinical settings;
    • health economic evaluations of metabolic treatment;
    • interventions to delay/prevent diabetes-related complications that are important in older age, such as cognitive impairment and functional dependence; and
    • development of technical devices that help to maintain autonomy and safety for older people with diabetes.

    The authors note that although functional status and well-being are a major focus of experts in geriatric diabetes, the issue of glucose targets is a fundamental one that needs to be addressed.

    The position paper is published in the July issue of Journal of the American Medical Directors Association.

    Study Shows Promise for Personalized Medicine for Parkinson Disease

    A National Institutes of Health-funded study shows that cells from patients with different types of Parkinson disease have unique drug responses, a finding that suggests that personalized medicine for the disease is possible.

    For this study, researchers collected skin cells from patients with genetically inherited forms of Parkinson disease and reprogrammed those cells into neurons. They found that neurons derived from people with distinct types of the disease showed common signs of distress and vulnerability—in particular, abnormalities in the cellular energy factories known as mitochondria. At the same time, the cells' responses to different treatments depended on the type of Parkinson disease that each patient had.

    Most cases of Parkinson disease are sporadic, meaning that the cause is unknown. However, genetics plays a strong role. There are 17 regions of the genome with common variations that affect the risk of developing Parkinson disease. Researchers also have identified 9 genes that, when mutated, can cause the disease.

    These results hint that induced pluripotent stem (iPS) cell technology could help define subgroups of patients for clinical trials. To date, interventional trials for Parkinson disease have not focused on specific groups of patients or forms of the disease, because there have been few clues to point investigators toward individualized treatments. Although the current study focused on genetic forms of the disease, iPS cell technology also could be used to define disease mechanisms and the most promising treatments for sporadic Parkinson disease.

    New in the Literature: Continuous Passive Motion Post-total Knee Arthroplasty (J Arthoplasty. 2012; 27:193-200.)

    Continuous passive motion (CPM) gives no benefit in immediate functional recovery post-total knee arthroplasty (TKA), and the postoperative knee swelling persisted longer, say authors of an article published in the Journal of Arthroplasty.

    Researchers at the Department of Orthopaedic Surgery, Lilavati Hospital and Research Centre, in Mumbai, India, prospectively assigned 84 patients with TKA to 1 of the 3 standard rehabilitation regimes—no CPM, 1-day CPM, and 3-day CPM. They recorded a Timed Up and Go test, Western Ontario and McMaster Universities Index (WOMAC), and short form-12 (SF-12), in addition to range of motion, knee and calf swelling, pain, and wound healing parameters.

    Standardized and elaborate measurements preoperatively and on postoperative days 3, 5, 14, 42, and 90 showed no statistically significant difference among the 3 groups in each parameter.

    Last Call for PT 2013 Proposals

    The deadline to submit proposals for 90-minute and 3-hour sessions for PT 2013, to be held June 26-29, 2013, in Salt Lake City, is July 9. APTA would like to focus on the areas for programming where latest or emerging ideas are shared and discussed:  

    • delivery of care (medical homes, accountable care organizations)
    • payment (alternative payment models)
    • use of technology in the administration of care (electronic health records, etc)
    • use of technology in clinical care (virtual care, etc)
    • use of technology in entry-level education
    • knowledge translation from classroom to clinic

    The Call for Proposals with further details is posted on the submission site Welcome Page. For questions or to discuss specifics about programming, contact Mary Lynn Billitteri, APTA Professional Development.

    Researchers Find Association Between Brain Response to Injury and Chronic Pain

    Whether a person's injury will lead to chronic pain may depend on the level of communication between 2 parts of his or her brain, says a HealthDay  article based on a study published in the current issue of Nature Neuroscience.

    For the study, the researchers used brain scans to examine the interaction between 2 parts of the brain—the frontal cortex and the nucleus accumbens—in 40 patients who had recent onset of back pain for the first time. The patients were followed for 1 year.

    By analyzing the scans, the investigators were able to predict whether the patients would develop chronic pain with an 85% level of accuracy. Brain regions related to emotional and motivational behavior seem to communicate more in those who develop chronic pain.  

    Although the study showed an association between levels of communication in the brain and chronic pain, it did not prove a cause-and-effect relationship, the article says.

    The Affordable Care Act Going Forward

    With the Supreme Court upholding the Affordable Care Act (ACA), implementation of certain Medicare, Medicaid, and private insurance reforms will continue or begin in the next 2 years. In a June 28 presentation, the National Journal provided a rough timeline, shown below, for implementation of ACA-related reforms.

    APTA staff is reviewing the Supreme Court decision and will provide a more detailed analysis to members in the coming weeks. This analysis will allow APTA to continue to advocate for the profession and patients in areas such as direct access, innovative models of care, and the need for a robust rehabilitation benefit under state health care exchanges. As more information becomes available, look for information bulletins from APTA Government Affairs; follow News Now, Twitter, and Facebook; and visit APTA's health care reform webpage. Hear more in this APTA podcast.   

    ACA Implementation Timeline - 7/3/12 

    Source:  National Journal Editorial Research   

    'Extra' Interactive Content Offers Enhanced Reading Experience

    Test your knowledge, view a video on accountable care organizations, read and post comments on articles, and explore some of APTA's most recent tweets, posts, and pins with PT in Motion Extra—a new complement to APTA's monthly member magazine, PT in Motion. Extra isn't a replica of PT in Motion, it's something more—an interactive digital edition designed for your computer, tablet, or smartphone that puts the "motion" in PT in Motion for an enhanced reading experience. Provide your feedback on this inaugural issue by taking the survey or leaving a comment. Look for the next issue of Extra in the fall.