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  • Down Syndrome Clinical Summary Discussion Now Available for Viewing

    The clinical summary on Down syndrome available on PTNow is not only a great resource on its own, it's also a great springboard for lively discussion. See for yourself by checking out the video from a recent Google+ "hangout" sponsored by PTNow.

    In a discussion that ranged from the use of to the need for "culture change" in attitudes about physical activity and obesity, to the importance of communicating appropriate motor milestones to the families of children with Down syndrome, moderator Mary Tischio Blackinton, PT, EdD, CEEAA, GCS, clinical summary author Kathy Martin, PT, DHS, and pediatric physical therapist and educator Tracy Stoner, PT, DPT, PCS, connected the dots between evidence resources and day-to-day practice.

    The panel answered presubmitted questions, but also set aside time to provide an overview of the summary, and the ways the summary's content is enriched through PTNow, which allows readers to access references and other supporting materials while reading the summary itself. More on the discussion—including information about a future presentation focused on orthotics—can be found at the PTNow blog.

    Free Webinar to Focus on Prevention and Interprofessional Education

    Physical therapists (PTs) and physical therapist assistants (PTAs) have an opportunity to learn how 2 emerging issues can intersect during an upcoming webinar on prevention curricula in interprofessional education.

    The September 9 webinar, sponsored by the federal government's Healthy People 2020 initiative, will focus on ways to access resources for developing curricula and collaborative learning experiences to improve prevention and population health education across various health professions. Faculty from the University of Texas Medical Branch and Duke University will be on hand to discuss their own experiences with expanding education in these areas. The 90-minute presentation will begin at 1 pm ET.

    The webinar is free, and participants can register online. Healthy People 2020 also archives its webinars for viewing at a later time.

    PT Researcher Lets Seniors Take a Trip

    A new method being tested in Chicago aims to "vaccinate" individuals who are elderly against falls—by tripping them.

    Actually it's not as weird as it sounds. The Associated Press (AP) reports that University of Illinois-Chicago researcher and physical therapy professor Clive Pai, PT, PhD is using a specially-built moving walkway that can suddenly shift under a user's feet, tripping them up and—Pai hopes—triggering subconscious learning that will help prevent future falls. Users are outfitted with a special harness that prevents them from actually falling during the training.

    The AP story quotes Pai as saying that the approach could work as a kind of "vaccine against falls."

    Pai's preliminary research on the approach was published in the September 2013 issue of the Journal of Biomechanics (abstract only available for free). In that study, he exposed 73 community-dwelling older adults to 24 slip exposures, and concluded that the "perturbation training did alter [their] spontaneous gait pattern," which "enabled them to improve their volitional control of stability and their resistance to unpredictable and unpreventable slip-related postural disturbance."

    Pai's research is continuing under a 5-year grant from the National Institute on Aging, according to the AP report. The grant-funded project aims to include 300 participants.

     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.

    Medicare Payment Data: What PTs Need to Know

    Health care utilization and cost data released in the name of "transparency" continue to make headlines, and physical therapists (PTs) need to have a solid grasp of what's already out there—and what's to come—in order to help patients, clients, and other stakeholders understand what all the information means in context. The September issue of APTA's members-only PT in Motion magazine provides a starting point for getting a handle on this fast-growing trend.

    In this issue's "Compliance Matters" section, Gayle Lee, JD, APTA senior director of health finance and quality provides a quick history of the push for transparency and an analysis of one of the most dramatic data releases to date—2012 Medicare payment figures for some 880,000 health care professionals, including nearly 38,000 PTs, searchable by provider name and National Provider Identifier (NPI) number.

    Lee asserts that "the dataset is insufficient to draw meaningful conclusions about the billing practices or quality of care of individual PTs," and provides a list of limitations that prevent the presentation of complete picture. The article also looks at PT payments in particular and includes a chart showing the top 10 procedures in physical medicine and rehabilitation services in 2012 by total payments.

    "It is clear that consumer outcry for price transparency will not abate," Lee writes. "Not only will the federal government release more information in the future, but private insurers are expected to follow suit."

    Hardcopy versions of PT in Motion are mailed to all members who have not opted out; digital versions are available online ahead of print to members.

    CIMT Can Be Effective for Children with Cerebral Palsy

    A newly published meta-analysis of randomized controlled trials (RCTs) supports the use of constraint-induced movement therapy (CIMT) for children with cerebral palsy as an effective intervention for upper-limb function, albeit one whose effectiveness isn't necessarily a slam dunk over other dose-equivalent approaches.

    The study, e-published ahead of print in Clinical Rehabilitation (abstract only available for free) looked at 27 RCTs between 2004 and 2014 that included 894 participants with cerebral palsy ranging in age from 2.4 to 10.7 years. The majority of studies focused on a 5 day per-week intervention over the course of 2 to 3 weeks, and restraints included slings, gloves, mittens, and casts.

    Authors write that the studies showed a medium effect of CIMT on arm function—results that they describe as "similar to the effect of [CIMT] when used in adults with stroke." When they applied the International Classification of Functioning, Disability and Health (ICF) model to the results, they found that CIMT resulted in medium improvements to activity level immediately after the intervention and to participation level during follow-up.

    Effectiveness was also affected by location of the intervention, according to the study, with home-based settings producing better results than clinic or camp-based settings. "The natural environment … offered less distress during [CIMT] practice for both children with cerebral palsy and their parents," authors write. "Further the training schedule can be tailored to fit into the family's daily routine."

    The CIMT approach didn't fare as well when a longer follow-up time was used, authors write, "consistent with the logical assumption that the [CMIT] effect could not be maintained over time." Additionally, when compared to dose-equivalent groups, the groups receiving CIMT showed only "slightly better" results, as opposed to the "large effect" noted when compared to interventions that were not dose equivalent.

    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.

    FDA: Beware of Dietary Supplements That Claim to Speed Concussion Recovery

    Think those claims that dietary supplements can help speed concussion recovery sound too good to be true? You're right. And the US Food and Drug Administration (FDA) agrees.

    This week, the FDA released a consumer update on companies that market dietary supplements that purport to heal—and in some cases prevent—concussions. The advertising has received more attention with the start of fall school sports, and the agency is stepping up its enforcement actions to warn companies when their claims are false.

    "We're very concerned that false assurances of faster recovery will convince athletes of all ages, coaches, and even parents that someone suffering from a concussion is ready to resume activities before they are really ready," said Gary Coody, FDA's national health fraud coordinator. "Also, watch for claims that these products can prevent or lessen the severity of concussions or [traumatic brain injuries]."

    Because the dietary supplement market is a crowded one that requires no product registration, "products making false claims can slip through, at least for a time," according to the FDA.

    The supplements are available in some retail outlets, but companies also rely heavily on social media for their advertising. Frequently, the supplements include tumeric and high levels of omega-3 fatty acids.

    The bottom line, according to Coody, is that "there is no dietary supplement that has been shown to prevent or treat [concussion]. If someone tells you otherwise, walk away."

    Keep up with APTA's work on concussion and TBI: check out the association's position on the role of physical therapists in concussion management, visit APTA's Concussions webpage, connect with resources on the Traumatic Brain Injury webpage, and direct patients to the Physical Therapist's Guide to Concussion, located on APTA's MoveForwardPT.com consumer website.

    'Intensive' Counseling Could Help Lessen CVD Risk in Individuals Who are Overweight or Obese

    Behavioral counseling that promotes physical activity and a healthy diet has been found to be beneficial for adults who are overweight or obese with a risk of cardiovascular disease (CVD), according to a recent report from the US Preventive Services Task Force (USPSTF).

    In an article published August 26, the USPSTF cited "adequate evidence" that behavioral interventions "have a moderate net benefit" for this group, and that potential harm is "small to none." The conclusions were reached after the task force reviewed 74 clinical trials, most of which studied combined counseling on diet and activity through multiple contacts over 9 to 12 months. The interventions were not focused specifically on weight loss, and trials conducted exclusively with persons who have diabetes were excluded.

    The USPSTF review of intermediate and longer-term health outcomes found that behavioral counseling resulted in "small but important changes in health behavior outcomes and selected clinical outcomes after 12 to 24 months." These clinical outcomes included decreases in total and LDL cholesterol, blood pressure, fasting glucose levels, and weight. Additionally, authors write, "the reduction in glucose levels was large enough to decrease the incidence of a diabetes diagnosis."

    The interventions studied by USPSTF for the most part included educational and supportive components, with a focus on behavior change through individualized plans. The counseling was performed by "specially trained professionals" that included "dietitians or nutritionists, physiotherapists or exercise professionals, health educators, and psychologists," according to the report. The interventions could be applied to a large portion of the US population—according to the USPSTF report, nearly half of all Americans have at least 1 CVD risk factor, and 70% are overweight or obese.

    The task force writes that more research is needed on the effectiveness of less intensive counseling, as well as the ways the interventions affect outcomes and behavior after 2 to 3 years. Other needed areas of study include the effectiveness of interventions for physical activity alone, and "trials examining the interaction or potentiation of clinical counseling and community-based lifestyle interventions," authors write.

    Check out APTA resources that emphasize the importance of collaborative approaches to behavior change in patients and clients at the behavior change webpage, including podcasts, measures, and guidance on how to facilitate the change process.

    Protest Dismissed, CMS Will Move Ahead With RAC Contracts

    The Centers for Medicare and Medicaid Services (CMS) will move ahead with awarding new contracts to Recovery Audit Contractors (RACs) now that the US Court of Federal Claims has ruled against the last standing protest opposing the new arrangements. The protest, leveled by CGI Federal, Inc, led CMS to suspend RAC reviews while the case was being decided.

    The new RAC contracts are expected to contain changes to the audit process announced in February. According to CMS, the changes are designed to "result in a more effective and efficient program, including improved accuracy, less provider burden, and more program transparency." Planned changes include a mandatory 30-day wait for discussion before a claim is sent to Medicare Administrative Contractors (MACs) for collection, a requirement that RAC contingency fees will only be awarded after the second level of appeal has been exhausted, and a rule that additional documentation request (ADR) limits be adjusted based on the provider's compliance rate.

    According to a recent article in Inside Health Policy, several protests were launched against the CMS effort to award new contracts, with all but the CGI protest being dismissed or withdrawn. Initially, CMS moved to wind down activities of the current RACs, but as the CGI protest lingered, the agency announced that it would restart the program under the current auditors. The Inside Health Policy article reports that those restarted program contracts had not yet been signed when the court ruled in favor of CMS, allowing CMS to refocus on awarding new contracts.

    APTA is working with CMS officials to produce more effective review systems that would reduce administrative burden, improve communication among their contractors, focus investigation and review efforts on the highest risk cases, and minimize disruption to providers. APTA expects to receive more information from CMS in the coming weeks on how and when RAC reviews will resume, including specific information on therapy cap manual medical review.

    APTA and WebMD Partner to Provide PT Perspective

    WebMD and APTA are working together to make it easier than ever for the public to understand how physical therapists (PTs) and physical therapist assistants (PTAs) can help address a wide range of health issues.

    Under a new content partnership, APTA members and APTA Media Corps experts will provide content to WebMD's "Answers" page, a popular area of the WebMD website that allows consumers to post questions and connect with relevant health information. APTA will provide new content to the page at least once a month, and will link content to the association's MoveForwardPT.com consumer-focused site.

    APTA has partnered with WebMD in other efforts, including providing WebMD with PT experts to serve in the fibromyalgia, multiple sclerosis, pain management, and sports medicine communities. WebMD also offers a page focused on physical therapy and pain management.

    2014 House of Delegates Minutes Posted

    Minutes of the 2014 House of Delegates (House) have been posted on the House webpage and within the 2014 Archive folder of the House community. The minutes provide information on how the House revised and voted on all motions and bylaw amendments brought forward this year.

    Newly adopted or amended House policies, standing rules, and bylaws will be posted to the Policies and Bylaws area of the APTA website in September.

    Early ROM Exercise a Mixed Bag for Patients After Arthroscopic Rotator Cuff Repair

    According to a new meta-analysis of randomized controlled trials, early passive range of motion (ROM) exercises for patients with arthroscopic rotator cuff repair can speed recovery—but only in certain ways, and only on the right patients. When applied to those with large-sized tears, early exercise can actually cause improper healing, and even lead to subsequent injury.

    Researchers reviewed 6 randomized clinical trials that included a total of 482 participants who received arthroscopic surgery for degenerative rotator cuff tears and underwent either early passive range of motion exercises 1 day to 1 week after surgery or a "traditional" rehabilitation program that began exercise 6 to 8 weeks after surgery. Follow-up assessment periods ranged from 6 to 24 months, with the latest assessment for most of the trials at 1 year after surgery. Results of the study were e-published ahead of print in the August 20 issue of the American Journal of Sports Medicine (abstract only available for free).

    While the findings identify benefits of early ROM exercise, particularly in terms of gains in shoulder forward flexion, authors note that early ROM exercises did not demonstrate any superiority when it came to external rotation degrees or overall shoulder function. "Our findings indicated that the benefits of early ROM exercise were specific to the dimension of applied shoulder movement and were likely to prevent shoulder stiffness through rapid ROM restoration," they write. Overall, "early ROM exercise is likely to be better than a delayed protocol in ameliorating postoperative shoulder stiffness." Still, they note, early ROM exercise did not improve overall shoulder function over delayed implementation.

    However, they warn, the approach isn't for everybody, and can actually create problems for patients with rotator cuff tears greater than 3 cm, which is a risk factor for failed surgery. In cases of such failed surgeries, early ROM exercise can actually result in improper healing and contribute to subsequent tear.

    While early ROM exercise can help patients at low risk of improper healing and higher risk for stiffness, authors write, patients at higher risk for improper healing should not undergo the early intervention. Authors add that they favor a delayed protocol for patients at low risk of both improper healing and stiffness "in consideration of the lower cost and similar efficacy in shoulder function recovery to that of early ROM exercise."

    In the end, they write, the choice to engage in early ROM exercise depends on clinical judgment that balances benefit and risk. "A proper choice of either rehabilitation protocol should be established based on an assessment of the risks between recurrent tears and postoperative shoulder stiffness," authors write.

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

    New Delaware PT Law Includes Telehealth, Dry Needling

    Delaware physical therapists (PTs) have a new scope of practice that includes telehealth, dry needling, and an updated definition of the practice of physical therapy now that a significantly revised PT licensing law has been signed by Gov Jack Markell. Markell signed the bill on August 12.

    Advocated for by the Delaware Physical Therapy Association, the legislation (HB 359) faced opposition from other provider groups, including acupuncturists who were opposed to the inclusion of dry needling in the new definition for physical therapy. In addition to the dry needling and telehealth provisions, the new law includes temporary exemptions to licensure for PTs licensed in another state who are in Delaware for educational purposes, accompanying travelling sports team or performance groups, or responding to declared emergencies.

    “The legislative process was very arduous, and I am grateful for all of our chapter members who attended hearings, met with legislators, and sent emails or made phone calls in support of HB 359," said George Edelman, PT, OCS, MTC, president of the Delaware Chapter, "We are thrilled that Delaware now has a physical therapy statute that reflects 21st century practice."

    "APTA congratulates our Delaware Chapter on this significant legislative achievement," said APTA President Paul A. Rockar Jr, PT, DPT, MS, "Our vision of transforming society by optimizing movement to improve the human experience begins with transforming our state licensure laws to ensure physical therapists can practice within their full scope."

    The Delaware State Examining Board of Physical Therapists and Athletic Trainers—the state's licensure board—is expected to begin work on developing board rules related to the new law this fall.

    For TKA Recipients, All Roads Lead to Similar Outcomes

    The old saying about how "it's the journey, not the destination" may have particular relevance for recipients of total knee arthroplasty (TKA): according to a new study, when it comes to levels of function, TKA recipients whose preoperative condition was mild enough to deem the procedure "inappropriate" ultimately arrive at the same place as patients with more severe preoperative symptoms.

    The research (abstract only available for free), e-published ahead of print in the August 6 issue of Arthritis Care & Research, builds off a previous study that applied a modified Escobar classification system developed in Spain to label TKA recipients as "inappropriate," "appropriate," or "inconclusive" based on radiographic evidence, knee motion and laxity, and scores on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). That study found that 34.3% of the TKAs studied were performed on patients whose presenting conditions were judged to be inappropriate for the procedure.

    In the follow-up study, researchers led by Daniel L. Riddle, PT, PhD, FAPTA, looked at outcomes for 167 patients with primary TKA. Of those TKAs, 47.9% were identified as "appropriate," and 31.3% were classified as "inappropriate," with the remaining 20.8% labeled "inconclusive." Researchers monitored scores from the WOMAC as well as Knee Injury and Osteoarthritis Outcome Scores (KOSS) for both pain and symptoms at 2 months postprocedure, and again at the 1- and 2-year marks. The aim was to quantify both the "journey" to improvement and the ultimate "destination"—exactly how much function related pain and activity limitation was present one and two-years after surgery.

    Researchers hypothesized that because they underwent TKA with less severe symptoms, the inappropriate group would have smaller changes in pain and function, and experience better outcomes at the 1 and 2 year "destination" points than patients whose TKA was deemed appropriate. What they found was nearly the opposite.

    "Persons who were classified as inappropriate had no significant change in pain, function, and knee symptoms over the 2-month postoperative period relative to the preoperative assessment," authors write. "This contrasts to the substantial improvements over the same time period in the appropriate and inconclusive groups. In addition, despite having higher functioning and substantially less pain preoperatively, the destination outcomes … were not statistically different. Overall, improvements in the group classified as inappropriate were small and in some cases did not reach clinical significance 1 year following surgery."

    Authors write that while the study design cannot establish with certainty whether the appropriateness criteria is valid for US patients or whether patients receive TKA only when needed, "our study does … provide evidence to suggest that one or the other (or both) of these inferences is likely to be false." The need at this point, they write, is for further study and "consensus building efforts … to define eligibility criteria for TKA with the goal of reducing variation in patient characteristics and maximizing outcome."

    "To me, the real standout feature in this study was the small amount of improvement in the inappropriate group," Riddle said. "Both groups had essentially the same final outcome, but it was fairly striking how small the actual amount of improvement was for the inappropriate group."

    Riddle acknowledged that the appropriateness logarithm used in the study is "grounded in the notion that TKA is optimal for those that have severe or end-stage knee osteoarthritis," saying that because "TKA has evolved, and rightly so, it makes sense that the potential window for possible candidates would be wider than it used to be."

    Still, Riddle said, as effective as the procedure is, "there needs to be some additional clarity" around who are the best candidates for TKA. "That's why we argue for the need for consensus around clinical standards for TKA, now that the bar has been lowered somewhat," he said.

    Although the study has more to do with appropriateness for a surgical procedure than it does for physical therapy afterward, Riddle believes that there are lessons here for physical therapists (PTs).

    "It's important for PTs to recognize that there are larger variations in the types of patients selected for TKA, and large variation in surgical decisions," he said. Perhaps even more important, he added, is what the study can tell PTs about the dynamics of recovery. "PTs should look at studies like this one as an important reminder to think about outcomes in terms of both the journey and the destination," Riddle said. "They need to think about where their patients end up, and how they get there. Both approaches to outcome assessment are important."

    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.

    Clinical Summary Google Hangout Wants Your Questions

    Despite what your mom may have told you, hanging out can be a very productive use of time: at least that will be the case for the PTNow Google Hangout on August 28, when you can learn about PTNow's clinical summary on Down syndrome directly from the summary's author.

    Kathy Martin, PT, DHS, author of the clinical summary, will answer your presubmtted questions along with Tracy Stoner, PT, DPT, PCS, a pediatric physical therapist in the Department of Physical Therapy at University of Delaware and a research coordinator at Drexel University. The hangout will be moderated by Mary Tischio Blackinton, PT, EdD, CEEAA, GCS, PTNow associate editor for social media.

    The PTNow Google Hangout will not be live, but a recording will made available shortly afterward, allowing users to access the content whenever they want. Because of this, questions need to be submitted in advance.

    There are several ways to forward your questions to the hangout—just be sure to get them in before August 25. You can:

    Redesigned Running Blades May Appear at 2016 Olympics

    After remaining relatively unchanged for the past few years, running blades are undergoing redesign efforts that could help more athletes than ever participate in the Olympics, according to a recent article in co.Exist.

    The article describes a joint effort by Altair, a design company, and Eastman, a chemicals and plastics manufacturing supplier, to rethink the blade-shaped prosthetics used by athletes—most famously by Oscar Pistorious in the Summer 2012 Olympics. According to reporter Ariel Schwartz, the project was taken on by the companies after Paralympian runner Blake Leeper challenged designers to move the concept forward.

    The blades now in testing employ curved bottom plates to better accommodate track corners, "twists" in the blade that can decrease drag force by 57%, and a new attachment system that includes a "fabric shroud" that helps to lock the prosthetic into place. According to the article, the new design meets Olympic regulations and could be seen in the 2016 games.

    Information on 4.5 Million Patients Stolen in Largest Recorded Health Care Cyber-Attack

    The largest recorded cyber-attack on a health care operation has succeeded in stealing information on 4.5 million patients associated with Community Health Systems (CHS), a Tennessee-based company that owns, operates, or leases 206 hospitals in 29 states. Although CHS maintains that the information does not include payment or clinical information, hackers were able to access names, addresses, social security numbers, and other data.

    In an August 18 filing with the US Securities and Exchange Commission (SEC), CHS reports that hackers successfully accessed confidential files in April and June of 2014 through the use of malware that was able to bypass the company's security systems. According to reports from Reutersand the Chicago Tribune, a Chinese group known as "APT 18" is suspected of conducting the attack. CNN reports that the FBI is working closely with CHS to investigate the theft.

    In addition to names, addresses, and social security numbers, stolen information includes birthdates, telephone numbers, and employer or guarantor information on patients who were treated by or received referrals from CHS-affiliated doctors during past 5 years.

    CHS posted a media notice on its website stating that individuals whose information was taken in this cyber-attack "will be mailed a letter informing them about the data breach and how to enroll in free identity theft protection and credit monitoring services." The Health Insurance Portability and Accountability Act (HIPAA) requires companies to notify patients of suspected breaches of health care information.

    Physical Activity Research Opportunities Offered by NIH

    The National Institutes of Health (NIH) has announced 2 research funding opportunities aimed at developing and testing approaches to increasing physical activity in ways that might be applied broadly across the US.

    "Developing Interventions for Health-Enhancing Physical Activity" will provide 2 years of support for research into interventions that increase physical activity, while "Testing Interventions for Health-Enhancing Physical Activity" will provide up to 5 years of support for research into how to test multi-level intervention programs. Applications are due October 4 and October 1, respectively.

    APTA Summaries on Acute Care, Long-Term Care, SNF Rules Now Available

    Want to get the latest on Medicare and Medicaid Service's (CMS) final 2015 rules on acute care, inpatient rehabilitation, and skilled nursing facilities? APTA has you covered.

    APTA members can now access detailed summaries of the latest set of final rules issued by CMS pertaining to payment and other issues related to physical therapist practice.

    For information on acute care and inpatient rehabilitation, visit the association's Medicare Payment and Policies for Hospital Settings webpage (look for the latest summaries under "Acute Care" and "Inpatient Rehabilitation" headers); for a summary of prospective payment system rules for skilled nursing facilities (SNFs), visit the Medicare Payment and Policies for Skilled Nursing Facilities webpage (look for the "APTA Summaries" header).

    New Guide to PT Practice Debuts as Online-Only Resource

    The physical therapy profession's preeminent guide to practice has taken on a new format, added new information and resources, updated others, and is now ready for use. The new online-only APTA Guide to Physical Therapist Practice 3.0 offers more dynamic content while continuing to deliver the most comprehensive description of an evolving profession—and it's free to the public for a very limited time.

    "It was a long process, but we did want to get it right," said Lisa Saladin, PT, PhD, who contributed to the revision of the Guide as former chair and current member of the Board Oversight Guide Work Group. In an APTA video dispatch, Saladin describes how the revisions moved from staff to volunteer subject matter experts to the work group. The end result: a "really dynamic" experience that will deliver current information, and allow users to dive more deeply into evidence-based practice resources and in-depth visual supports through direct online access to PTNow and other offerings. Users will "feel the similarities, but they're going to see the differences," Saladin said.

    The newest version of the Guide is focused on the physical therapist (PT) and physical therapist assistant (PTA), and has moved away from content targeted at policy makers, administrators, third-party payers, and other professionals, who now have access to other resources. An overview of other important similarities and differences between the previous version and Guide 3.0 is included on the Guide webpage.

    The APTA Guide to Physical Therapist Practice, 3.0 is available for free to the public until September 30. After that, the Guide will be free to APTA members and available to nonmembers via an annual subscription. The software supporting the Guide requires no installation, and updates will not have to be downloaded to individual users' computers.

    APTA Responds to Medscape Self-Referral Article

    A recent Medscape article promoting the use of in-office ancillary services (IOAS) by physicians as a way to "boost your income" has prompted a pointed response from APTA that describes how self-referral can increase health care costs and hinder patient access to the most appropriate care.

    "In an era when policy makers, providers, and patients are all looking for ways to bring down health care costs, it appears that your article is advocating the opposite approach by encouraging referrals for the purpose of profit," writes APTA President Paul A. Rockar Jr, PT, DPT, MS. "Respected policy organizations, researchers, and budget analysts continue to provide evidence that show the abusive financial impact of self-referral."

    APTA's comments were in response to a Medscape article titled "9 Ancillary Services That Can Boost Practice Revenue," a how-to piece that encourages physicians to consider adding in-house services including physical therapy to their practices. One health care accountant and business advisor quoted in the article advises doctors that "you could be making money on each service you've been referring out."

    The article describes physical therapy as a service that could be added at an estimated cost of $25,000 "plus the cost of extra space," but could earn "about $500,000 per year." One consultant commenting on the idea of adding physical therapist services warned Medscape readers that "the high investment in equipment and staffing make for low profits," while another countered that the services could be useful "if you had a sports medicine practice or treated a lot of elderly patients."

    APTA's response reiterates the association's opposition to self-referral in general and in particular to physical therapist services being included in the IOAS exception under the physician self-referral prohibition (the Stark self-referral law). The letter goes on to cite Office of Management and Budget estimates that closing these self-referral loopholes under Medicare could save the health care system $6 billion over 10 years.

    "The expansive use of the IOAS exception by physicians in a manner not originally contemplated by the law undercuts the purpose of the law and substantially increases costs to the Medicare program and its beneficiaries," Rockar writes. "Physical therapy is not a same-day service. Your own article points that out when referencing the fact that physical therapy is often provided in multiple follow-up visits."

    The Medscape article concludes by advising its readers that "none of these services is a slam dunk" in terms of potential profits, and that physicians considering adding any service be "ready to be challenged by specialists … who feel that others may not be qualified to provide the service."

    APTA takes a different perspective on self-referral in its response. "APTA's foremost goal is to see patients continue to receive the highest-quality, most appropriate care while protecting limited Medicare resources,"

    Rockar writes. "Closing the self-referral loophole will ensure that both goals are met without hurting true interdisciplinary collaboration."

    In addition to physical therapy, the consultants recommended that physicians consider adding allergy therapy, urgent care, cosmetic services, medication dispensing, radiography, lab testing, weight loss services, and diabetes counseling.


    Concussion Location not Linked to Clinical Outcomes but Points to Need for Safer Tackling in HS Football

    A new study on concussions in high school football has found that the location of the impact on the head may not have much to do with clinical outcomes, but it could have a lot to say about the need for safer tackling.

    A recently published article in Pediatrics describes efforts to examine whether the location of a concussion—front, back, side, or top of head—was linked to the number or prevalence of symptoms, symptom resolution, and return-to-play times for high school football players. Authors write that much like studies that found no links between neuropsychological function and impact location, their study of 1,975 concussion incidents "suggest[s] that impact location is likely of little use in predicting clinical outcomes."

    Researchers used data from the National High School Sports-Related Injury Surveillance System, High School Reporting Information Online (RIO), a system based on reports from high school athletic trainers over 5 seasons, from 2008 to 2013. The reports include data on impact location, symptomology, and symptom resolution.

    The only factor that did seem to be influenced by the location of the concussion was related to loss of consciousness, which was experienced at twice the rate (8.8%) of concussed players sustaining top-of-the-head impacts compared with all other areas (3.5%).

    The findings underscore the need to emphasize "heads up" tackling, authors write, given that 70.7% of all concussions caused by player-to-player collisions were the result of head-to-head contact. "Concussions from top-of-the-head impacts, and the resulting risks associated with such impacts, may be reduced by enforcing rules prohibiting players from leading with their head," authors write. "Players must never initiate contact with the helmet or make contact while head-down."

    Among other findings in the study:

    • Nearly 10% of all concussions from a player-to-player impact were reported as recurrent concussions, with 23.1% of those recurrent injuries taking place within the same academic year. Recurrence was not related to impact location.
    • Players with recurrent concussions due to side-of-head and top-of-head impacts reported more symptoms than players with new concussions from contact in those areas.
    • Players with recurrent concussions generally had longer symptom resolution and return-to-play times.
    • Player-to-player concussions were sustained most frequently by linebackers (17%), running backs (15.2%), and defensive tackles (9.5%).
    • Back-of-the-head concussions were the type most frequently sustained by quarterbacks, at 2.4 times the rate of other locations.

    Concussion prevention and management—particularly in youth sports—has been a particular focus of APTA over recent years, and APTA continues to educate policymakers on how physical therapists are qualified to detect and manage concussions. For information on federal and state legislation, and APTA's position on the role of physical therapists in concussion management, visit APTA's Concussions webpage. Find more resources on the Traumatic Brain Injury webpage, and direct patients to the Physical Therapist's Guide to Concussion, located on APTA's MoveForwardPT.com consumer website.

    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.

    Continuous Passive Motion Called Into Question

    Although definitive evidence is still lacking, available research trials do not support the value of continuous passive motion (CPM) as a way to reduce venous thromboembolism (VTE) in patients with total knee arthroplasty (TKA), according to a recently published Cochrane Systematic Review. The entire review is available through PTNow.

    The analysis looked at 11 studies involving 808 participants conducted between 1988 and 2010, with individual study participant size ranging from 44 to 150. Of the 11 trials, 5 studies (405 patients) looked at the incidence of deep vein thrombosis (DVT), which can lead to VTE. Combined, those studies found an 18% rate of DVT in the CPM group, compared with a 15% rate for the control group. "The results of this meta-analysis showed no evidence that CPM has an effect," authors write.

    The real problem, according to the review, is that there just isn't enough information available to make any determination about the effectiveness of CPM therapy in reducing VTE. "The statistical power of the included studies on PE [pulmonary embolism] prevention by CPM therapy is weak and it is obvious that there is insufficient evidence to make a conclusion on CPM therapy for preventing PE after TKA," the review states.

    Authors call for more "high quality, randomized controlled trials," and recommend that since DVT can develop in either leg, studies should focus on both. They write that in the currently available studies "a lot of variation exists in the application of CPM, such as the postoperative range of motion, duration of CPM per day, and duration of CPM postoperatively," and recommend that future studies "address an optimal CPM dosage to diminish bias."

    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.

    Youth Sports Concussion Bill Introduced; Includes Physical Therapists

    A bill introduced just before the Senate recessed for August could lead to better management and awareness of some necessary aspects of sports safety, including concussions among student athletes, their families, and their coaches. The legislation recognizes physical therapists (PTs) as health care professionals qualified to make return-to-participation decisions for youth sports concussions.

    Called the Supporting Athletes, Families, and Educators to Protect the Lives of Athletic Youth Act (SAFE PLAY Act), S. 2718/H.R. 5324 was introduced by Sen Robert Menendez (D-NJ) and Reps Bill Pascrell (D-NJ) and Lois Capps (D-CA. The legislation provides for education, awareness, action plans, training, and further research related to health issues associated with sports—including cardiac conditions, concussions, and heat advisories—in which PTs play a role.

    Of note, the SAFE PLAY Act would call for school districts to have concussion management action plans that teach students, parents, and school personnel how to prevent, recognize, and respond to concussions, including assistance in the safe return of student athletes to academic and athletic performance. The legislation encourages the development of guidelines consistent with those to be developed by the US Centers for Disease Control and Prevention's (CDC) Pediatric Mild Traumatic Brain Injury Guideline Work Group, a group supported by APTA that includes 2 APTA members.

    The initiatives proposed in this legislation are crucial to establishing concussion management guidelines, supporting the treatment of concussions by licensed qualified health professionals such as PTs, and providing resources for state and local entities that are engaged in this issue within the youth sports and academic communities.

    Concussion prevention and management—particularly in youth sports—has been a particular focus of APTA over recent years, with the association advocating for continued support of the CDC work group as well as for other legislation addressing these injuries. APTA continues to educate policymakers on how PTs are qualified to detect and manage concussions, and the association was recently invited to attend a White House summit on concussions. Additionally, concussions will be the focus of this year's flash action strategy campaign held in conjunction with the APTA Student Assembly, September 8-10.

    For information on federal and state legislation, and APTA's position on the role of physical therapists in concussion management, visit APTA's Concussions webpage. Find more resources on the Traumatic Brain Injury webpage, and direct patients to the Physical Therapist's Guide to Concussion, located on APTA's MoveForwardPT.com consumer website.

    Ready for World Physical Therapy Day?

    Get ready to celebrate physical therapy as a worldwide profession, and spread the message that physical therapists (PTs) and physical therapist assistants (PTAs) help people take part in society.

    World Physical Therapy Day will take place on September 8, and APTA members still have time to join in the celebration. This year the theme is "Fit to Take Part," emphasizing the PT's role in helping people with long-term illnesses or disabilities fulfill their potential by maximizing movement and functional ability.

    To help PTs get the word out, the World Confederation for Physical Therapy (WCPT) is offering a toolkit that includes designs for banners, stickers, and t-shirts, as well as press releases and informational booklets. New this year: several posters available in Spanish.

    APTA is a member of WCPT.

    Programmed Stem Cells Grow Axons, Connect With Brain in Rats With SCI

    Neurons developed from adult human stem cells and grafted into rats with spinal injuries have produced nerve cells with axons that have grown "virtually over the entire length" of the rat's central nervous system. The success of the cells, derived from an 86-year-old man, support the idea that "intrinsic neuronal mechanisms" can overcome the barriers to growth associated with the injured adult spinal cord.

    "While many experimental efforts have attempted to overcome the inhibitory nature of the [central nervous system], a cell in the proper growth state can still extend axons, even in this inhibitory milieu," said senior author Mark Tusznyski, MD, PhD. The successful growth was reported online in the August 7 issue of Neuron (abstract and video abstract only available for free).

    The procedure began with the conversion of skin cells from a healthy 86-year-old man into induced pluripotent stems cells (IPSCs), which can be programmed to become nearly any kind of cell. After programming the IPSCs to become nerve cells, the cells were grafted into rats with 2-week-old spinal injuries.

    At the 3-month mark, researchers examined the injury sites to find mature neurons and axonal growth that even extended to the brain and connected with existing rat neurons. Despite the growth and connections, researchers were not able to achieve recovery of function in the rats.

    Though the growth is encouraging, Tusznyski said, "many questions remain" about how to target and control that growth. "Can this, for example, be shaped by rehabilitation?" he asked.

    APTA has several resources on managing patients with spinal cord injury (SCI). Offerings include a clinical summary in PTNow, continuing education courses in the APTA Learning Center, and a "pocket guide" on physical fitness for individuals with SCI.

    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.

    Free Webinar Promotes Falls Prevention Initiative

    Learn how you can participate in Falls Prevention Awareness Day (FPAD), coming this year on September 23, by attending a free webinar on August 21 hosted by the National Council on Aging (NCOA). The webinar will explore:

    • What's new in falls prevention programming and what’s working in communities nationwide
    • How organizations are integrating falls prevention programming into their other offerings
    • Strategies to recruit older adult participants
    • New initiatives for partnering with emergency medical services, community health workers, and others

    More than 40 states are part of a coalition to address this public health issue; many are working closely with physical therapists as key contributors to reducing falls. This year's theme, Strong Today, Falls Free Tomorrow, seeks to unite professionals, older adults, caregivers, and family members to play a part in raising awareness and preventing falls in the older adult population. APTA is among the professional associations and federal agencies that constitute the Falls Free© Initiative. Find ideas for observing FPAD on NCOA's website, including this infographic with 6 steps older adults can take to prevent a fall.

    APTA has a wealth of resources on balance and falls, most of them accessible via the association's Balance and Falls webpage. Also, find a clinical practice guideline on falls and fall injuries in the older adult and a clinical summary on falls risk in community-dwelling elderly people in PTNow.

    PTNow Hosts Google Hangout on Down Syndrome Clinical Summary

    Get firsthand information and answers to your own questions on how to apply PTNow's clinical summary on Down syndrome when PTNow hosts a Google Hangout scheduled for August 28.

    Kathy Martin, PT, DHS, author of the clinical summary, will answer your questions along with Tracy Stoner, PT, DPT, PCS, a pediatric physical therapist in the Department of Physical Therapy at University of Delaware and a research coordinator at Drexel University. The hangout will be moderated by Mary Tischio Blackinton, PT, EdD, CEEAA, GCS, PTNow associate editor for social media.

    Google Hangouts are not live, but recorded and made available shortly after they occur, so questions need to be submitted in advance. There are several ways to forward your questions to the hangout—just be sure to get them in before a deadline of August 25. You can:

    APTA Members Can Save Big on Back-to-School Needs

    Back-to-school shopping just got easier with APTA member value programs.

    APTA members can save an average of 17% on all online or in-store purchases at Office Depot, which has discounted 93,000 products below retail prices. Plus, first-time users receive an additional 15% off online orders of $50 or more. To start saving, download a store discount card or shop online at http://apta.ctcshares.com.

    Have additional back-to-school needs? The APTA Online Mall gives you cash back for online purchases from hundreds of retailers including Target, Kohl’s, Nordstrom, Zappos, and more. Register for an account and start saving today.

    Physical Therapy as Effective as, Less Costly Than Steroids for Shoulder Pain

    A study published online in the August 7 Annals of Internal Medicine (abstract only available for free) has found that when it comes to shoulder impingement syndrome (SIS), physical therapy and steroid injections work equally well, but physical therapy is the less costly option.

    Researchers followed 104 patients with SIS who were split into 2 groups, the first group receiving up to 3 corticosteroid injections (CSIs) of 40 mg triamcinolone acetonide 1 month apart, and the second group receiving physical therapy twice weekly for 3 weeks and prescribed home exercises. Participants ranged in age from 18 to 65.

    After 1 year, researchers monitored changes to Shoulder Pain and Disability scores, as well as Global Rating of Change scores, Numeric Pain Rating Scale scores, and health care use. They found that both groups reported a 50% improvement in pain and disability scores; however, patients receiving CSIs had more SIS-related visits to their primary care provider than the physical therapy group (60% vs 37%) and required additional steroid injections at a rate higher than requests for additional physical therapy in the therapy group (38% vs 20%).

    The research, conducted at a military hospital-based outpatient clinic, is the first to directly compare the effectiveness of 2 common nonsurgical approaches to SIS, according to the study's authors. The study was primarily funded by Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.

    News of the study appeared in Reuters, Healthfinder, WebMD, and Medscape (free access after registration), with the latter 2 publications mentioning possible limitations in the study that include demographic differences in subgroups and the fact that cost estimates were based on a military hospital setting that required no copayments.

    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.

    International PT Conference Offers Registration Discounts

    What in the world is happening to physical therapy? Find out for yourself at the largest international gathering of physical therapists.

    Registration is now open for the 2015 World Confederation for Physical Therapy (WCPT) Congress in Singapore, May 1–4. Attendees who register before the October 2 deadline can save up to 20%.

    The Congress is also accepting abstracts for possible presentation at the meeting. APTA is a member organization of WCPT.

    Australian Study: Physiotherapists Demonstrate 'Weight Stigma'

    A new Australian study asserts that like other health care professionals, physiotherapists stigmatize patients who are overweight and obese, and that this stigma "has the potential to negatively affect physiotherapy treatment."

    The findings were based on a 2-part survey in which physiotherapists commented on 3 case studies and then completed the Anti-Fat Attitudes Questionnaire, a 13-item instrument designed to measure explicit weight stigma. The case studies (docx file) presented a mix of patient characteristics that included weight, and directed participants to read the case studies and respond to questions about attitudes and recommendations—a measure of implicit stigma, according to the authors. Results were published online in the July 30 issue of the Journal of Physiotherapy.

    After analyzing 265 questionnaires and 520 case study responses, authors found that the physiotherapists demonstrated both explicit and implicit weight stigma. As a group, the physiotherapists responding to the questionnaire showed overtly negative attitudes in all 3 areas measured—the characterization of individuals who are overweight as lacking sufficient willpower, an overall dislike of individuals who are overweight, and a fear of becoming overweight oneself. Of the 3, Australian physiotherapists demonstrated the highest stigma when it came to an attitude that individuals who are overweight lack willpower.

    Responses to the case studies also pointed to implicit stigma, though authors write that "there was minimal indication in the clinical parameters tested … that patients in different BMI categories would be treated differently."

    Still, they write, 59% of responses mentioned weight management as part of a treatment or referral strategy, and within that subset, researchers identified common thematic threads that they believe "indicated implicit weight stigma: "use of negative language when describing patients, a "focus on weight management to the detriment of other important considerations," the assumption that weight is "individually controllable," the preference for directive or prescriptive—rather than collaborative—responses, and a failure to recognize the complexity of weight management.

    "The most common responses were simplistic, implicitly negative, and prescriptive advice," authors write. "It was rare for responses to indicate a more complex consideration of weight or explicitly negative/stereotyping attitudes. These findings align with literature about other health professionals."

    Though the study is focused on Australian physiotherapists, Lisa Culver, PT, DPT, MBA, APTA senior specialist in clinical practice, believes that the findings underscore an important point for the profession in general. “It's clear from many studies that overweight and obesity stem from much more than diet and exercise," she said. "There are many contextual factors at work here beyond just the individual, and it is important that physical therapists and physical therapist assistants have a positive impact as motivators and advocates for change for our patients and clients."

    "This research begins a critical conversation about physiotherapists and weight stigma," authors write. "There may be value in physiotherapists reflecting on their own attitudes towards patients who are overweight."

    APTA offers several resources that emphasize the importance of collaborative approaches to behavior change in patients and clients in many areas, including weight. Offerings on the behavior change webpage include podcasts, measures, and guidance on how to facilitate the change process.

    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.

    Pediatrics Section and Scoliosis Research Society Emphasize Importance of Early Detection

    The effectiveness of bracing in treating adolescent idiopathic scoliosis (AIS) has been well-established, but early detection is key. That's where physical therapists (PTs) come in.

    The APTA Section on Pediatrics is working with the Scoliosis Research Society (SRS) to develop resources for physical therapists (PTs) on the detection and management of AIS. SRS has already issued Screening Procedure Guidelines for Spinal Deformity.

    Coming soon: More information from APTA on the role of PTs in managing those diagnosed with AIS.

    WCPT Award Nomination Deadlines Coming Soon

    The World Confederation for Physical Therapy (WCPT) is seeking nominations for its awards program that honors physical therapists (PTs) who have contributed to the profession or global health at an international level. The WCPT deadline for nominations is August 31; however, nominations seeking support from APTA must be submitted to APTA staff by August 15.

    There are 4 award categories open to nomination by WCPT’s member organizations, regions, or subgroups: the Mildred Elson Award, the International Service Award, the Humanitarian Service Award, and the Leadership in Rehabilitation Award. Descriptions of the awards and eligibility criteria (.pdf) can be found on WCPT's awards webpage. Nomination forms are required for all submissions and can be obtained by contacting Rene Malone.

    Awards will be presented during the 2015 General Meeting and Congress May 1-4 in Singapore.

    APTA Challenges AHA Report on 'Association' Between CMT and Stroke

    A recent American Heart Association (AHA) statement that cervical manipulation may "play a role" in stroke fails to consider how physical therapist (PT) clinical judgment can reduce this risk, and overlooks the fact that manipulation is associated with far fewer complications than drug-based and surgical interventions, according to a news release from APTA. The AHA statement (.pdf) focused on an analysis of strokes caused by cervical arterial dissections (CDs).

    "Incidents of stroke associated with cervical manipulation are rare," according to the APTA statement, which cites studies from 2002 and 2010 that found "no strong evidence" connecting cervical manipulation therapy (CMT) and adverse events.

    APTA's statement was issued in response to an AHA report that concludes there is a "statistical association" between CD and CMT but does not cite a definitive link. In fact, AHA describes the incidence of CD in patients who have received CMT as "not well established, and probably low," and characterizes evidence as "insufficient to establish the claim that CMT causes CD." In a news release issued by AHA, the report's lead author is quoted as saying that “A cause-and-effect relationship between [CMT] and CD has not been established." Still, he said, “Patients should be informed of this association before undergoing neck manipulation.”

    In its statement, APTA emphasizes the role of the clinical judgment of the PT, supported by a 2-decade history of guidelines for CMT, and a 2012 clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists, an organization that works closely with the Orthopaedic Section of APTA. The framework in particular was designed "to provide guidance for the assessment of patients for the likelihood of stroke in advance of [CMT]," according to the statement.

    APTA also points out that CMT has rates of risk lower than the use of pain relievers or cervical spine surgery, both of which are reported to increase likelihood of a range of adverse outcomes in addition to stroke.

    "The physical therapy community is committed to educating patients and practitioners about the risks and benefits of cervical manipulation," said Timothy W. Flynn PT, PhD, OCS, immediate past president of the American Academy of Orthopaedic Manual Physical Therapists. "[PTs] understand the small risk of stroke associated with cervical manipulation, and they base decisions regarding the select use of this procedure on a detailed and ongoing evaluation and a treatment plan that is consistent with patient preferences."

    State Policy and Payment Forum Registration Closes Aug 29

    August 29 is the last day to register for the 2014 APTA State Policy and Payment Forum set for September 13–15 at the Grand Hyatt in Seattle, Washington.

    This important members-only gathering is designed to equip physical therapists (PTs) and physical therapist assistants (PTAs) with the knowledge and tools to be more effective in legislative, regulatory, and payment advocacy efforts at the state level. Issues that will be addressed at the Forum include copay legislation, health care reform implementation, scope of practice, dry needling, and much more.

    In addition to presentations on current advocacy efforts in the states, the forum will include a case study on state legislation allowing PTs to order imaging, a session on infringement from other providers, and 2 luncheon speakers: Washington State Rep Laurie Jenkins and Mark McClellan, MD, PhD, director of the health care innovation and value initiative at the Brookings Institution.

    Registration is online-only—no onsite registrations will be offered. Visit the forum registration page to sign up and learn more about the forum.

    PTs Sought to Review Musculoskeletal Resource

    Qualified physical therapists (PTs) have an opportunity to contribute to the development of an important work on the current state of musculoskeletal diseases in the US.

    The US Bone and Joint Initiative (USBJI) is seeking reviewers to assist in the revision of The Burden of Musculoskeletal Diseases in the United States (BMUS), a resource that describes the musculoskeletal landscape as reflected in data from the National Center for Health Statistics’ 2008 National Health Interview Survey.

    USBJI is seeking reviewers for the following chapters of the BMUS:

    • The Big Picture
    • Back and Neck Pain
    • Spinal Deformity
    • Arthritis
    • Osteoporosis and Bone Health
    • Injuries (including falls, traumatic, workplace, military, sports)
    • Children and Adolescents
    • Tumors
    • The Older Population (Medicare)
    • Military Population

    APTA members interested in being a reviewer should contact Anita Bemis-Dougherty by August 31 and indicate which chapter(s) of BMUS they are interested in reviewing.

    The USBJI advocates and promotes multidisciplinary, coordinated, and patient-centered care to improve the prevention, diagnosis, and treatment of musculoskeletal conditions. APTA is a founding member of the organization.

    New Trainers Ready to Advance Clinical Instruction

    The physical therapy profession now has 28 more reasons to feel good about the future of clinical training.

    On July 1, 28 physical therapists (PTs) and physical therapist assistants (PTAs) were awarded the Clinical Trainer credential that will allow them to deliver APTA's Credentialed Clinical Instructor Program (CCIP), a training offering that refines clinical instructor skills and provides them with the tools to promote APTA's professionalism core values. The 28 new Credentialed Clinical Trainers will be responsible for conducting and administering APTA's CCIP courses, teaching selected content of the CCIP using active training strategies, and managing the assessment center that awards the APTA Clinical Instructor credential.

    To become a Credentialed Clinical Trainer you must attend APTA's 3-day CCIP Trainer course in Alexandria, Virginia, where you will be instructed on how to provide high-quality, active learning clinical instructor education, how to deliver a competency assessment program, and how to effectively manage, coordinate, and administer the CCIP.

    This year's CCIP Trainer course was held April 24 to April 26. Participants were reviewed by an advisory work group and notified in June of their Clinical Trainer Credential status. A full list of APTA's trainers may be accessed online.

    The program continues to receive positive reviews from participants, who have described the course as "fantastic," "superb," and one that provides teaching techniques that are "applicable immediately in the classroom." Visit the APTA website for further information on becoming a Credentialed Clinical Trainer or Credentialed Clinical Instructor.

    Top 15 Randomized Trials Being Sought

    Well-conducted randomized trials can have a powerful influence on physical therapist practice. So which ones are the best of the best?

    That's the question the Physiotherapy Evidence Database (PEDro) would like your help in answering.

    As part of the 15th anniversary celebration of the PEDro database, the Australia-based Centre for Evidence-Based Physiotherapy is asking users to nominate studies for a list of the 15 "most significant" randomized trials in physical therapy. Between now and August 29, users are being asked to fill out an online form with the citation details of important trials, and briefly explain why they're making the nomination. Users may nominate more than 1 trial each.

    Staff at the Centre will shortlist the nominations before turning the list over to a panel of experts for final rankings.

    PTJ Ranks #2 Among All Rehab Journals

    Saying that Physical Therapy (PTJ) is an important rehabilitation research journal isn't just an opinion—it's fact. According to Journal Citation Reports (JCR), the frequency with which PTJ is cited in other journals—indicated by something called an "impact factor"—makes PTJ #2 among rehabilitation journals, and #5 among orthopedic journals. Impact factor ratings are used by many researchers to decide where to publish their work.

    PTJ’s impact factor jumped from 2.778 in 2012 to 3.245 in 2013. PTJ’s 5-year impact factor is 3.896 (#3 out of all rehab journals).

    PTJ also was the second most frequently cited journal in 2012 in the rehabilitation category, and the 11th most frequently cited in the orthopedic category.

    The JCR rating isn't the only indicator that PTJ 's prominence is growing. Another rating, called the Eigenfactor score, ranks PTJ third among rehabilitation journals even after excluding self-citation (references from one article in a journal to another article in the same journal). The Eigenfactor score also places PTJ third among rehabilitation journals when it comes to "article influence," a measure of the average influence of a journal's articles over the first 5 years after publication.

    Impact factor rankings can be meaningful to the clinician, according to PTJ’s Editor in Chief Rebecca Craik, PT, PhD, FAPTA. Sometimes articles can be cited for negative reasons, but generally "the higher the impact factor, the more useful the information is," she said in an APTA video dispatch. "It means that scientists are citing that work, or other clinicians who are publishing are citing that work, so it speaks to the value of the material that is presented in these papers."

    CMS Issues Final 2015 Rules for Inpatient Prospective Payment Systems

    The Centers for Medicare and Medicaid Services (CMS) has issued final rules for prospective payment systems for acute care and long term care hospitals whose net effect will be to decrease payments to acute care hospitals paid under the inpatient prospective payment system (IPPS) by $756 million and increase payment to long term care hospitals (LTCHs) by 1.1% under the LTCH prospective payment system.

    Despite a call for comments from stakeholders, the rule avoids making any final changes to the "2-midnight" policy or regarding policies for short stays. The rule also finalizes the use of 5 readmissions measures for assessing readmission penalties, incorporating methodology changes supported by APTA related to hip and knee arthroplasty.

    Among other changes set for 2015:

    • Hospitals in the top quartile for the rate of hospital acquired conditions (HACs)—those with the poorest performance—will have their Medicare IPPS payments reduced by 1%.
    • CMS will distribute $7.65 billion in uncompensated care payments, a decrease from the $8.56 billion estimate in the proposed rule.
    • CMS will assess hospitals’ readmission penalties using 5 readmissions measures endorsed by the National Qualify Forum (NQF): heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and hip/knee arthroplasty. CMS has finalized an updated methodology to take into account planned readmissions for these 5 existing readmissions measures, as well as refinement in the hip/knee arthroplasty readmission measure methodology.
    • CMS provides guidelines for implementing the Affordable Care Act's provision requiring transparency in hospital charges. Under these guidelines, hospitals should either publish a list of their standard charges or their policies for allowing the public to view a list of those charges in response to an inquiry.

    In addition to the changes for 2015, CMS finalized the addition of 2 quality measures related to function for the 2018 long term care hospital (LTCH) Quality Reporting Program. The measures, titled "Functional Outcome Measure: Change in Mobility among LTCH Patients Requiring Ventilator Support;" and "Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function," were supported by APTA.

    APTA participated in the comment period for the 2015 rules when they were proposed by CMS earlier this year, and will be publishing a summary of the changes online in the coming weeks.

    Licensing Exam Committee Deadline August 11

    APTA members have an opportunity to participate in the ongoing development of the profession's licensing examinations, but the application deadline is fast approaching. Members have until August 11 to apply for positions on the Federation of State Boards of Physical Therapy (FSBPT) examination-related committees.

    APTA provides nominees for the Examination Development Committee-PT (EDC-PT), the Examination Development Committee-PTA (EDC-PTA), the Item Bank Review Committee-PT (IBRC-PT), and the Item Bank Review Committee-PTA (IBRC-PTA). Job descriptions can be found on APTA's examination committee call webpage.

    Nominees for the positions must be physical therapists and active APTA members. To be considered, candidates must complete and e-mail a volunteer application(application form is a .doc file at the bottom of the webpage) and resume or curriculum vitae to Kelli Thomas.

    Contact Lisa Culver with any additional questions about this opportunity.

    New Video: PTs in the ED

    You might've read about the value of physical therapy in a hospital emergency department (ED). But there's nothing like hearing from ED physical therapists (PTs) themselves.

    New on the APTA ED webpage—a video in which 5 PTs share their experiences and explain the value of physical therapy services in the ED. In the video the Arizona-based PTs from Flagstaff Medical Center, Mayo Clinic in Arizona, and Carondelet St. Joseph's Hospital in Tucson describe how PTs can respond to a range of presenting problems at EDs, and how the use of a PT in the ED setting can lower hospital admission rates—and costs.

    The video, produced and edited by APTA members Jessica Williman, SPT, and Michael Lebec, PT, PhD, joins a suite of APTA resources on PTs in the ED.

    Fellows Sought for President's Council in Fitness, Sports, and Nutrition

    The President’s Council on Fitness, Sports, and Nutrition (PCFSN) has announced 2 full-time fellowship opportunities. The council is a federal advisory committee that advises the president of the United States through the Department of Health and Human Services (HHS).

    Under the guidance of a mentor, the selected participants may have the opportunity to monitor and evaluate evidence-based physical activity, sports, and nutrition data to determine significant research gaps, best practices, and effective strategies for increasing opportunities for Americans to be active and healthy. They will be part of a team that manages strategic partnerships and related projects to promote PCFSN’s priority programs and initiatives, and may also have the opportunity to support PCFSN’s outreach and education efforts.

    The initial appointment is for 1 year in the Rockville, Maryland, area but may be renewed. Participants will receive a monthly stipend commensurate with education level and experience but do not become employees of HHS or the program administrator, and there are no fringe benefits paid.

    The position requires a master’s degree in public health, exercise physiology, sport development, sport psychology, or a related discipline received within the last 5 years. Current graduate students in these areas of study are also encouraged to apply. Proof of health insurance is required for participation in this program.

    To be considered, please send a current CV/resume to the attention of HHSrpp@orau.org. Please reference DHHS-OASH-2014-0115 in all communications.

    PCFSN’s mission is to educate, engage, and empower all Americans to lead a healthy lifestyle that includes regular physical activity and good nutrition.

    CDC Releases Ebola Recommendations for US Hospitals

    Now that the first patients with Ebola are arriving in US hospitals, the US Centers for Disease Control and Prevention (CDC) has released infection prevention and control recommendations for patients with Ebola hemorrhagic fever.

    Although the recommendations focus on the hospital setting, guidelines for personal protective equipment (PPE) and environmental infection control measures are applicable to any health care setting. The recommendations will be reevaluated and updated as additional information becomes available.

    For more CDC information on the ongoing outbreak of Ebola, visit http://www.cdc.gov/vhf/ebola/index.html.

    UnitedHealthcare Delays Requirement for Functional Limitation Reporting

    UnitedHealthcare (UHC) is delaying implementation of a plan to require functional limitation reporting (FLR) for physical therapy, and has not announced a new launch date. APTA remains opposed to UHC's intention to move to FLR.

    UHC announced its original decision to implement FLR in May. The company had planned to require G-codes and severity/complexity modifiers on contracted PT claims with dates of service on or after August 1, 2014. Those changes have been put on hold indefinitely.

    In a July letter, APTA urged UHC to stop its plan to implement the requirements, arguing that the difficulties experienced by physical therapists (PTs) during Medicare's changeover to the requirements, as well as limitations in data, made UHC's planned August 1 move ill-advised.

    APTA offers a functional limitation reporting webpage that provides resources to help members understand these requirements.

    New Telehealth Bill Includes PTs, Could Mean Big Changes for Medicare

    A newly introduced bill aimed at expanding the use of telemedicine in the Medicare system would allow reimbursable telehealth services for physical therapy and permit use of the technology in more populated areas.

    Called the Medicare Telehealth Parity Act of 2014 (.pdf), the bill introduced by Reps Mike Thompson (D-CA) and Gregg Harper (R-MI) would gradually roll out changes over 4 years. The changes would eventually remove current limits on the population areas that qualify for Medicare's telehealth reimbursements, allow for much-expanded remote patient monitoring, and include rural health clinics as approved telehealth care sites.

    Another important feature of the bill: a provision that outpatient therapy services, including physical therapy, delivered via telehealth technologies would be reimbursable under Medicare.

    Although Medicare currently allows some telehealth delivery, the system limits reimbursable use to rural areas, and requires beneficiaries to travel to "originating sites," with no provisions for remote patient monitoring. The proposed bill would use a phased-in approach to remove those population-based limits and allow the addition of remote patient monitoring for specific conditions. The bill also requires the General Accountability Office to study the use of remote patient monitoring for outpatient therapy.

    This year, APTA's House of Delegates approved a resolution that supports the adoption of telehealth technologies in physical therapy as "an appropriate model of service delivery" when provided in ways that are "consistent with association positions, standards, guidelines, policies, procedures, Standards of Practice for Physical Therapy, Code of Ethics for the Physical Therapist, Standards of Ethical Conduct for the Physical Therapist Assistant, the Guide to Physical Therapist Practice, and APTA Telehealth Definitions and Guidelines; as well as federal, state, and local regulations."

    APTA will monitor this bill and alert members on its progress.

    APTA offers resources on telehealth in physical therapy—including a link to Board of Directors definition and guidelines--on its telehealth webpage.

    PTNow: Easier, Better, Faster, Stronger

    Think PTNow.org has made it easier to use evidence in patient care? The PTNow Editorial Board has something to say about that: you ain't seen nothin' yet.

    A July 29–31 meeting of the board brought together 22 board members representing acute care, cardiovascular and pulmonary, geriatrics, home health, neurology, oncology, orthopedics, pediatrics, sports, and women’s health with social media and video experts and APTA staff to assess PTNow’s progress and look to the future. PTNow cochairs Judy Deutsch, PT, PhD, FAPTA, and Tara Jo Manal, PT, DPT, OCS, SCS, led discussions and breakout sessions geared toward finding the best and quickest way to help clinicians apply evidence and improve patient and client outcomes.

    In an APTA video dispatch, Deutsch highlighted major developments over the past year, including integration of APTA’s Open Door service, now known as PTNow ArticleSearch, into the PTNow site for seamless access to full-text articles in a variety of literature databases; launch of PTNow’s blog, including features such as "All Evidence Considered," with a primary goal of talking about what to do when evidence is weak or doesn’t exist; and launch of CPG+ (see CPG+ torticollis guidelines for an example), a translation aid that provides highlights of clinical practice guidelines and guidance about what changes clinicians can make immediately based on a guideline.

    According to Deutsch, PTNow users can look forward to more enhancements over the next year, including increased resources on intervention. "That’s one of the areas where PTs probably want the most help," she said. "We’re going to synthesize information about intervention and animate it with videos. Our video repertoire is going to be much richer."

    In addition, Deutsch said, education and outreach efforts will "explode in terms of mini-sessions on the site and targeted presentations to all kinds of audiences—clinicians, educators, and even clinicians in training, [who] are our students."

    When it comes to reactions to PTNow, "people can’t believe that this resource exists," Deutsch said. "People are finding the synthesis products to be very relevant to their practice. They're excited about it, and they always give us suggestions for improving it, and that's exactly what we are doing—we're dynamically trying to change and respond."

    SNF, IRF Final Rules for 2015 Released by CMS

    Rule changes for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) will increase payments by 2% and 2.2%, respectively in 2015. In addition to the increases, the new rules issued from the Centers for Medicare and Medicaid Services (CMS) will make changes to a host of reporting, coding, and data collection models, as well as establish definitions of various therapy models in IRFs.

    The payment increases amount to an additional $750 million for SNFs, and an increase of $180 million for IRFs.

    IRF rules changes (.pdf) include the following:

    • Removal of 10 status post-amputation diagnoses codes from the list of codes that meet presumptive compliance criteria
    • Beginning October 1, 2015, addition of an item in the IRF patient instrument (PAI) to record the amount and mode of therapy delivered by each therapy discipline for the first 2 weeks of the IRF stay
    • Creation of definitions for "individual therapy," "co-treatment," "concurrent therapy," and "group therapy" in an effort to align with current SNF Part A definitions
    • Addition of a yes/no check off in IRF-PAI that would indicate whether prior treatment and severity requirements have been met for patients with arthritis
    • Addition of IRF quality reporting measures that would include outcome measures related to MRSA and clostridium difficile infection (CDI)

    The final rule changes for SNFs (.pdf) involve a provision that will allow SNFs to use a change of therapy (COT) other Medicare required assessment (OMRA) to reclassify residents formerly but not currently in a therapy resource utilization group (RUG) into a new RUG. CMS will continue to prohibit the use of the COT OMRA for initial classification of patients into a therapy RUG.

    Additionally, the SNF final rule includes a statement from CMS that acknowledges the comments it received around the development of an alternative therapy payment model. The agency states that several models are being explored, and that the changeover to a new model must be timely and incorporate stakeholder feedback that addresses problems in the current SNF payment structure. CMS has not set a date for implementation and is still accepting input on the issue.

    APTA will post a detailed summary of the rules in the coming weeks.

    Want to find out exactly how these rules changes will affect your practice setting? Attend APTA’s Postacute Care Compliance Seminar on November 15, 2014.