10 Tips for Maximizing Your Experience at NEXT 2018
APTA's NEXT Conference & Exposition is coming up quick! If you didn't make it in time for advance registration, you can still register online or onsite in Orlando. Plus, we have daily rates if you can't make the whole conference.
Whether it's your first conference or your twentieth, here are some helpful tips for connecting with fellow conference-goers and making the most of your time in Orlando.
Make plans ahead of time to meet up with people you know will be attending. Your former classmates, professors, and coworkers can introduce you to their networks. Rather than feeling overwhelmed by so many attendees you've never met, you'll be exchanging ideas and building your professional networks.
Maybe you see a speaker on the NEXT app with whom you'd really like to get in touch. Contact them and see if they might have a few minutes during conference to answer some questions in person.
Learn your way around the NEXT app. Seriously, the app is a time-saver. It contains all session descriptions, locations, and times, as well as a scheduling feature to keep track of the sessions you are most interested in. You can search for sessions by day or by speaker. It also has exhibitor info and maps.
Outline your goals and plan your schedule. Write down your top 3 goals for NEXT, and then use the app to find ways to achieve them. Want to learn about a topic outside your current focus? There's likely a session on that. Want to find a mentor? Plan to attend the Oxford Debate, daily networking coffees, or receptions. APTA staff also has put together some handy highlights for early-career PTs, mid-career PTs, and PTAs.
Pack comfortable shoes to wear—and some to give. As PTs and PTAs, comfortable shoes should be a no-brainer. But if you've never been to a conference, trust us. Your back will thank you for some arch support and cushioned soles.
Shoes4Kids will thank you, too, for a donation of children's athletic shoes and socks. In the spirit of service, APTA is once again collaborating with the nonprofit to collect and distribute shoes to area children in need. Attendees can bring brand-new children's athletic shoes and socks to conference or make a monetary donation. Check out requested shoe and sock sizes.
Get inspired. NEXT signature events such as the McMillan Lecture, the Opening Ceremony (this year with Gabby Reece!), the Rothstein Roundtable, and the Maley Lecture can open your mind to new possibilities for the profession and your career trajectory, while the Oxford Debate is a good way to have fun while tackling a two-sided topic.
Connect with attendees who practice in specialties other than yours. Just because you mainly practice in orthopedics doesn't mean you can't learn from peers in pediatrics or women's health. The same is true for clinicians and academics. You never know—you might end up switching career paths, or think of new ways to collaborate in the clinic.
Get social! You have colleagues or friends who won't be attending, so don't forget to share video clips, photos, and hot tips from speakers on your topic of interest. Make sure to get a photo with friends at the selfie station in the exhibit hall. Use hashtag #APTANEXT, and follow @APTANEXT on Twitter and Facebook.
Have some after-hours fun. Once sessions are over for the day, take some time to get outside and decompress. NEXT attendees have access to specially priced, after-2 pm tickets to Universal Studio's Florida™ or Universal's Islands of Adventure™. The ticket also includes select live entertainment venues of Universal CityWalk™. There are general discounts on Orlando attractions available through the Convention and Visitors Bureau site.
Follow up with new connections. After you return home, send an email note to a speaker, and establish LinkedIn and social media connections with new acquaintances. Sharing information and advice can continue long after the conference is over.
After NEXT ends, be proud. You made it through a tsunami of information, expanded your network, and hopefully made some lifelong friends. As a profession, we're #BetterTogether.
Enjoy the conference!
Yes, We Should: 5 Ways to Transform Your Mindset to Improve the Health of Society
By Todd E. Davenport, PT, DPT, MPH
Valerie Rucker, PT, DPT, is right: "Yes, we can" be leaders in improving the health of our communities. As she pointed out in her recent #PTTransforms blog post, our Millennial colleagues are our profession's future. But I don't think we should just leave it to a new generation of physical therapists to transform how we think about health and health care. This Gen X-er is here to tell you that all physical therapists and physical therapist assistants have an important role to play.
The United States is home to some of the most advanced and abundant medical care. Our medical technology, research and development, and per-capita number of specialist physicians are among the best in the world. We spend 17.2% of our gross domestic product on medical care, which is the highest in the world by almost 5%, and amounts to over $3 trillion per year.
If US medical care is so advanced and we spend so much money on it, then our health outcomes must be at or near the top in the world, right? Not necessarily. Just look at the stats related to medical process and outcomes. We have higher rates of overall mortality, premature death, and preventable deaths than comparable countries, on average.
It's now clear we have a health problem in the United States.
It's also now clear that health care and medical care aren't the same thing, and that we aren't going to treat our way out of poor health using our old ways of thinking and doing.
I believe these 2 ideas should inform how we operationalize our new American Physical Therapy Association mission statement: "Building a community that advances the profession of physical therapy to improve the health of society." In turn, our efforts at community building will propel us toward realizing our professional vision: "Transforming society by optimizing movement to improve the human experience."
So, how do we start thinking about society so we can transform it?
And how do we start talking about communities so we can build them?
The answers to these questions are simple, but they're not necessarily easy to do.
Our mission and vision statements invite a fundamental change in how we see ourselves as PTs and PTAs, from expert and caring practitioners who provide care within the confines of a clinic to population health change agents.
Does that sound like a lot? It is! And that's what makes the challenge interesting and exciting.
Here are 5 places to start:
Find your tribe. Find a group of people with whom to share, collaborate, learn, and act. There are PTs and PTAs who are actively involved in population health activities. Check out APTA's Council on Prevention, Health Promotion, and Wellness. The council already has assembled some great resources on the APTA (members-only) Hub, and they have organized some great conference programming to help you get started. Also, the Academy of Prevention and Health Promotion Therapies is an organization that cooperates with APTA and has some fantastic materials and collaborative tools to help clinicians of all backgrounds.
Get to know what your community needs. You might know the needs of your own patients very well. However, your caseload might not reflect the broader community and might be skewed by case mix, insurance, referral sources, and geography. A good place to find more information about your community's needs would be your state or local public health department or nonprofit hospital system. These organizations often produce community health needs assessments that can help you get to know your community in a new way. Public data also can help you understand your community's health needs.
Do a little asking around. Find agencies that align with critical community health needs, and ask how you can help. For example, local opioid safety coalitions have been organized in California to address the unique social, cultural, and political underpinnings of the opioid crisis. These organizations can coordinate with other stakeholders in providing services that can mitigate the incidence and prevalence of opioid use disorder in our communities, including addiction treatment programs, prescribers and pharmacists, school representatives, city and county officials, and public health officers. This model could be extended to other coalitions organized around active transportation, healthy aging in place, and other community health needs.
Find new income sources. Funding for population health initiatives will require us to "add by subtracting." That is to say, every dollar of savings on lost productivity and medical care that we provide to an organization can become our dollar of income. This way of thinking will require us to get outside our predominant habit of fee-for-service medical billing. Direct-to-employer contracts and community benefit funding are just a couple of examples of income sources to cover your costs while improving the health of your community.
Direct-to-consumer wellness arrangements also might be designed to address community health needs. Be aware that these types of cash-based services will be directed to people who can afford your services out of pocket, which might lead you to unintentionally widen existing wealth-based health disparities in your community.
Advocate for a healthier society.
Sixty percent of the variance in premature deaths is attributable to an individual's behaviors and social factors. Social and environmental contexts often influence whether an individual practices healthy behaviors. These social determinants of health are group characteristics that, in turn, predict an individual's health and access to health care. They include race, gender and sexual identity, occupation, education, wealth, built environment, and geography. In other words, your health depends in large part on who you are, where you live, what you do, and who you're attracted to and partner with.
Physical therapists and physical therapist assistants should be active in advocating for a society in which people can be healthy where they live, work, play, learn, and worship. Part of advocating for a healthier society will necessitate that our profession addresses health and health care inequities that exist based on our communities' relative social vulnerability.
So, I add a hearty "Yes, we should" to Valeria Rucker's "Yes, we can." By building healthier communities, we can ensure that the physical therapy profession remains vibrant, engaging, and dynamic in responding to our public's changing health needs now and in the future.
Todd E. Davenport is professor and director of the physical therapy program at University of the Pacific.
Keeping It Real: Finding the Missing Link Between Our Patients and Research
By Christine McDonough, PT, PhD
If consumers are going to "#ChoosePT" to address their movement disorders and functional limitations, they need to perceive physical therapists (PTs) as the preeminent experts in conditions that affect movement, pain, and quality of life. Potential patients and clients look for a strong recommendation from their family, friends, or peers, and perhaps a referral from their treating physician. Physicians and payers—both public and private—want to know that science informs our practice and that our interventions will result in tangible improvements in patient outcomes.
Patient clinical data registries such as the Physical Therapy Outcomes Registry have the power to use large amounts of outcomes data to evaluate outcomes of a given intervention for a specific condition in a specific population—for example, the effects of resistance training on falls in older, community-dwelling women.
This real-world evidence is important, because to provide the best possible patient care and transform the health of our communities, you need to know:
- How to classify patients for accurate clinical decision making
- What interventions work for a particular patient under specific circumstances
- What the prognosis is for patients who undergo treatment
- What kind of home exercise program or behavior changes are necessary to optimize outcomes
Randomized controlled trials (RCTs) are the "gold standard" for establishing the effectiveness of treatments, but their role is changing, as clinical registries enable researchers to understand real-world impacts from patient outcomes data. Evidence developed from clinical data registries such as APTA’s Physical Therapy Outcomes Registry—with their power to use large amounts of data to evaluate outcomes of specific interventions for specific conditions and populations—will fill important gaps in knowledge that will serve PTs and meet the needs of our consumers.
RCTs Are Important but Have Limitations
While RCTs aren’t going away any time soon—and shouldn’t—they are very expensive, and they often take a long time to plan and to complete. It simply is not feasible to conduct RCTs on every intervention available.
Because of the way they are designed, both efficacy and effectiveness RCTs have built-in limitations in determining whether a given intervention will work for the patients you see every day.
Efficacy trials answer the question: "Does the treatment work better than placebo?" If the results of an efficacy trial are positive, researchers can investigate additional questions in subsequent trials. But if the results are negative, the intervention may be abandoned altogether.
These high stakes have an impact on the design of efficacy studies. Because a negative result may mean abandoning a potential intervention after significant financial resources have been devoted to a trial, they are often designed to optimize the possibility of detecting a treatment effect. This is done by designing the trial to answer a focused question, such as "Is this treatment better than no treatment under ideal circumstances?" The studies often include patients with similar characteristics that make them the most likely to benefit, and they exclude more complex patients that might muddy the waters of interpretation.
Effectiveness trials answer the questions: "Is the treatment better than existing treatment?" or "Does the treatment work better when combined with existing treatment?" As with efficacy trials, in order to avoid abandoning effective treatments trial design must balance broad inclusion with detection of treatment effect. Clinical trials are now being designed to more closely represent the real-world environment. These "pragmatic trials" include a broader range of providers and patients, and provide support more aligned with what would occur in real-world implementation.
The Real World Is Not the Ideal World
The effects found in early efficacy and effectiveness studies are not always the same as the effects found in real-world circumstances. There are several important reasons for the differences, including:
- The providers delivering interventions in clinical studies often are different from those providing treatment in the community.
- The patients receiving interventions are more complex than those in clinical studies.
- The range of activities and support provided in clinical trials are not available in actual practice.
So clinical trials are now being designed to more closely represent the real-world environment. These "pragmatic trials" include a broader range of providers and patients, and provide support more aligned with what would occur in real-world implementation.
In a recent blog post on medical registries, Dr Caroline Fife highlighted 10 goals that many registries share. Among them, 6 will be of critical importance to the future of physical therapist practice.
Provide evidence to support value of interventions and services to stakeholders. The Physical Therapy Outcomes Registry will provide direct evidence of the results of real-world PT services that can be used to communicate our value to clients, patients, payers, and policy makers.
Submit quality reporting data to CMS (eg, MIPS). For future quality data required of PTs, the Registry can streamline the process.
Provide benchmarking data to users. Including your data in the Registry will allow you to get real-time feedback to inform and improve clinical decision making and outcomes. High performers can share their success, and everyone will benefit.
Support quality improvement. Registry data can be used to identify improvement opportunities and to measure the success of quality improvement initiatives.
Support development of classification and risk stratification tools to improve clinical decision making. As we identify the characteristics that predict response to treatment, we can improve our outcomes and the value of our services
Provide real-world data for research to fill gaps not covered by traditional research.
There is wide recognition of the value of using data to improve patient care—as it is actually delivered—and help bridge the gap between what is learned in clinical trials and what we need to know. Registries provide this missing link by collecting standardized outcomes data from real-world patients, with all their complexities.
PTs across the country are participating in APTA’s Physical Therapy Outcomes Registry to help bridge the gap. They are pioneering the way for the future of our profession and the future of health care. Visit www.ptoutcomes.com/ to learn more.
Christine McDonough, PT, PhD, is assistant professor in the departments of physical therapy and orthopaedic surgery at the University of Pittsburgh. She also is a member of the Physical Therapy Outcomes Registry Scientific Advisory Panel.
Yes, We Can: How a Millennial Mindset Can Help PTs Improve the Health of Society
By Valerie M. Rucker, PT, DPT
As a Millennial, sometimes I joke that I was born in the wrong decade because of my affinity for Marvin Gaye and Frankie Beverly band, Maze. As with generations before mine, the younger generations tend to get a bad rap: Critics contend that Millennials are entitled, too fast-paced, transient, and lazy, and they scoff at our participation trophies.
But Millennials are undoubtedly key contributors in the workforce, across all disciplines and fields. Studies have shown that we are helpers, doers, activists, tech-literate, collaborative, and left-brain dominant. We give back to the community just as older generations have done, but rather than donating to institutions we are more likely to support causes we are passionate about. According to the Millennial Impact Project, health care is among the top 5 issues we care about, along with civil rights, climate change, education, employment, and immigration.
With all of this collective energy and interest igniting our generation, Millennials have a unique opportunity to impact health care, specifically the physical therapy profession, in a meaningful way. And the beautiful part is that you don't have to be a Millennial to adopt this mindset!
I began noticing the ways in which the Millennial mindset could change the game in health care as I sat in the first lecture of my first conference as a new graduate, at CSM 2018 in New Orleans. The conversation was about the term population health. Mike Eisenhart and his copresenters, Todd Davenport and Dawn Magnusson, explained that population health is broadly about identifying the problem, creating a service appraisal to address the needs of the community, and then using that program or project within the population being addressed.
Sounds simple, right? But the driving component of why this works is applying a patient narrative to a larger population. With its goal of keeping people healthy and out of formal care, population health introduces the concept of social determinants of health—linked to many of the issues my Millennial peers care about deeply. Population health is a way we as PTs can manage the needs of underserved communities.
I considered a then-current patient on my caseload. "Mrs Jones" is a middle-aged, cisgender, African American woman who had experienced chronic low back pain since 2008. That diagnosis in itself does not scream "unique," as this is a common diagnosis in America, but her narrative does.
Mrs Jones lost children to neighborhood violence within the past 8 years, lost her job because of her back pain, and missed appointments after shootings in her apartment building led to an abrupt move. Along with a host of cardiovascular and pulmonary diagnoses, other musculoskeletal issues limited Mrs Jones in most activities of daily living and decreased her quality of life.
Jumping back and forth between listening and contemplating, I gathered from Eisenhart's lecture that Mrs Jones' social determinants of health included (1) being part of a vulnerable and underserved population, (2) living a sedentary lifestyle, (3) living in an unstable, variable environment, and (4) lacking access to quality health care.
The wheels in my Millennial mind turned, as I questioned how I could take this narrative and apply it to the bigger picture. What population shares this story? What are the barriers to addressing the disparities within that population? As PTs, we see our patients more often than do many other health care providers and, as such, can capture our patient's stories.
Snapchat, a social media app-based company developed by Millennials, is marketed as a way for people to share their stories via photos and short videos. One picture conveys one moment, but a story emerges in viewing a user's "snaps" over time. That concept can be used to develop sustainable solutions to population health problems, by capturing patients' stories and looking at them as a whole to get a more complete picture of entire populations and the challenges they face.
At the end of the lecture, instead of feeling helpless I felt energized; not only did I have the desire to help, but I now knew of a concrete way to do so, through research and implementation of the population health model. Even small amounts of collaboration and creativity across health care disciplines can effect a ripple of change throughout a community, thereby impacting the triple aim of health care: lowering health care costs, improving the patient experience, and improving the health of populations.
Why can't PTs be leaders in population health? We are an integral part of the interdisciplinary team, thereby fostering vital relationships with other health care providers. We attend conferences such as CSM, which spark interests and start conversations about topics that can impact whole communities and patient populations. We have a powerful platform via APTA, upon which we can make our—and, more important, our patients'—voices heard. We already provide patient education regarding lifestyle modifications and techniques for a better future. We also can impact the health of society by adopting the Millennial mindset: one that sees the need, addresses it with creativity, and attacks challenges without fear of failure.
After reading this post, you might ask, "Millennial, what makes you think you can fix everybody?" And to that I might reply, "What makes you think we can't?"
Valerie Rucker is a licensed physical therapist. She currently works within an outpatient department in Washington, DC, and is a member of the DC Physical Therapy Assocation.
Why Member Advocacy Is Crucial: Reflections From the Federal Advocacy Forum
By Jennica Sims
Policymakers make decisions every day that impact the physical therapy profession—everything from state scope of practice and licensure issues, to payment under Medicare, to the regulations practitioners must adhere to. They need to understand and appreciate what physical therapists do so that they don't make misinformed decisions that could negatively impact patients.
But legislators at both the state and federal levels know little about health care and even less about physical therapy, so it is incumbent upon APTA members to educate them about the profession and the needs of the patients they serve. Last week, more than 270 APTA members did just that as they assembled on Capitol Hill for the annual APTA Federal Advocacy Forum, visiting their legislators' offices, and others.
As a PT, PTA, or student, you are a natural advocate, because you have a story to tell and information to share about the physical therapy profession. You know about the depth and breadth of our education, the scope of what we do, and the challenges that we face on everything from payment to administrative burden. More important, you know the challenges, struggles, and accomplishments of our patients (and legislators' constituents). Talking to a lawmaker can be as easy as telling your story and describing your practice setting, the patient population you treat, and the challenges you face in transforming society.
"If you care about what you do and think we really make a difference in the world, it's important to be the voice to that fact and let legislators know!"
—Theresa Marko, PT, DPT
How Can I Make an Impact?
The best way is to engage in activities that help you build a personal relationship with your member of Congress or state legislators. Here are a few ideas:
- Host a practice visit at your clinic or facility for a legislator—it's a great way for the legislator to see the physical therapy profession up close.
- Get involved and volunteer for a local political campaign.
- Attend town halls hosted by legislators.
- Send a simple email or note thanking them for their work.
- Volunteer for your chapter or section as an APTA key contact or federal affairs liaison, get involved with your chapter's legislative committee, or attend your chapter's lobby day at the state capitol.
- Attend the APTA Federal Advocacy Forum in Washington, DC!
"I was fortunate enough to go to Federal Advocacy Forum last year and was hooked! Coming back this year is my way of continuing the advocacy mission that will be ongoing for the duration of my career. Once I entered the PT family, I understood advocacy was something the professional organization placed incredible value in. I had to be a part of the team fighting on the front lines for our profession and our patients."
—Domenic Fraboni, SPT
Federal Advocacy Forum
The Federal Advocacy Forum is an annual educational and advocacy event that is hosted each spring by APTA in the District of Columbia. This year we had more than 270 attendees representing 48 states and DC. The forum is great opportunity to learn about the current issues that federal policymakers are considering that impact the profession, and to get training on how to be an effective advocate. We cap off the forum with a day on Capitol Hill, where attendees meet with their members of Congress to talk about specific designated issues impacting the profession. The forum is also a great way to engage with fellow colleagues from across the country, meet new friends, network with peers, and have a great time while making a difference for the profession.
"The APTA Federal Advocacy Forum is an excellent opportunity to network with fellow PTs about issues that concern all of our areas of practice. I've been coming for 5 years in a row and I can't get enough! It's my favorite APTA [event]. Being in the House and Senate buildings as more than a tourist, with relevant issues to discuss and education to provide to our policymakers, is so invigorating! It's critical that PTs, PTAs, and students engage in advocacy throughout their careers in our field. With the way that health care is changing, no one else will ensure that our patients continue to get the care [they] need. It's our JOB!"
—Ami Faria, PT, DPT
Advocacy: What Are the Results?
At the federal level, the physical therapy profession has had a couple of good wins just in the past 2 years, thanks to APTA members making their voices heard and through momentum gained by events such as the APTA Federal Advocacy Forum. A few examples:
Locum tenens. In 2016, through the work of member advocates, APTA was able to get a bill through Congress that will provide for locum tenens for physical therapists in private practices. This allows a PT in a rural or underserved area to bring in another licensed PT to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education.
21st Century Cures Act. Signed into law in 2016, the Cures Act will improve coordination of rehabilitation research throughout the National Institutes of Health and require the development of a comprehensive rehabilitation research plan, updated every 5 years.
PTAs under TRICARE. In December 2017, APTA was able to get language inserted into the annual defense spending bill that added PTAs as authorized providers under TRICARE. We're now working to get that new law implemented via regulations, and in the near future PTAs will be allowed to treat TRICARE patients.
Elimination of the hard cap! The big win was the permanent fix to the Medicare therapy cap that was enacted in February. The legislation permanently removes the hard cap on outpatient therapy services, thus we'll no longer be required to go to Congress every year asking for renewal of the temporary exceptions process. We should take a moment to celebrate closing the door on a 20-year advocacy effort that has challenged our ability to ensure timely and appropriate services to patients. Reaching this milestone affords APTA the opportunity to expand our advocacy agenda to implement more fully our vision to transform society by optimizing movement to improve the human experience.
While the profession has made strides and has much to celebrate, there is still much work to be done. The US health care system is undergoing tremendous change, which presents many challenges as well as new opportunities. Working together we can continue to move the profession forward and meet APTA's vision of transforming society.
Learn more about how to get involved in advocacy at: www.apta.org/Advocacy/.
Jennica Sims is congressional affairs and grassroots specialist for APTA.
Blunt Conversations: Setting Realistic Patient Expectations for Pain
At APTA's recent "Beyond Opioids" panel, Sarah Wenger, PT, DPT, observed that clinicians need to give patients realistic expectations for pain and pain relief. But how do we have these difficult—yet important—conversations? In this Q & A, Wenger dives deeper into the topic.
Wenger is a board-certified orthopaedic clinical specialist and associate clinical professor at Drexel University's College of Nursing and Health Professions. She co-authored "Reducing Opioid Use for Patients With Chronic Pain: An Evidence-Based Perspective" in the May PTJ special issue on nonpharmacological management of pain.
During the panel discussion, you stated that a "goal of zero pain is not realistic for anyone." Managing patient expectations also was a theme in your Perspective article. How do you convince a patient who is experiencing debilitating pain that some pain is okay?
SW: People in pain often cling to the idea of a cure but are usually realistic about their current scenario. Being truly blunt here is helpful. I tell patients that I can’t get rid of all their pain and that most adults have some pain, but I can help limit how much that pain interferes with life. I say things like: "You told me your pain stops you from walking more than 2 blocks. What if I could get you walking 4 blocks before the same pain stopped you? Most people with chronic pain notice that once they are doing more their pain doesn’t bother them as much. Whether or not your pain changes, at least you will be able to do more of the things that are important to you, and I think that is worth working on—how do you feel about that?"
Build-up patient buy-in and establish caring and respectful rapport. Be honest and realistic about prognosis.
How can physical therapists and physical therapist assistants build trust and credibility with patients with chronic pain?
SW: Be transparent. Demystify your clinical reasoning and decision making, so your patients can understand your assessments and how you used the information you collected from them. Tell them exactly what you want them to do and why. Research has found that empathy, respect, genuineness, acceptance, encouragement, communication, and warmth are associated with positive provider¬-patient relationships.
You also mentioned focusing on "small-step goals" of participating in activities of daily living. Can you elaborate?
SW: Helping patients focus on doable goals can keep them from being overwhelmed by the enormity of processing the whole biopsychosocial pain experience all at once. Invite patients to appreciate their progress. Of course, we want to strive for full function and no pain, but we need to acknowledge that any progress in that direction is helpful. Better is better, even if it isn’t ideal. Small wins help build the foundation of confidence and hope needed to tackle larger goals.
Patients with chronic pain often feel that their health care providers don’t hear them. What are some tactics for clinicians to make sure (1) they hear their patients accurately and (2) their patients have confidence they’ve been heard?
SW: Repeat your understanding of the patient’s story and ask them to verify and fill in gaps. Explain why you want to know the information you are asking for. If patients understand how you are thinking, they can better choose the most important things to share.
Include what you perceive the important details to be and tell it like a story; in other words, don’t verify facts without verifying the narrative. Patients feel heard when they think you "get it"—not when you separate their story into a collection of facts.
Also understand your own perspective and the difference between pattern recognition and bias. We all use pattern recognition to help us diagnose and treat. We need to assess if the patterns we identify are accurate or if they have been influenced by our perspective or beliefs. An example of this a patient who is injured in a worker’s comp case and displays fear-avoidant behavior. We tend to assume that the employee is trying to get something over on the employer without ever considering how fairly the employer is treating the employee. The employee could be fearful because they are being mistreated and disrespected at work and is legitimately concerned that their injury will be ignored or worsened by the employer’s practices. I like to tell my students, "use your judgement, but don’t be judgmental."
Your PTJ article mentions the importance of monitoring patient learning and employing "high-quality teaching and mentoring skills." Is the profession "there yet" in terms of possessing these skills?
SW: I don’t think health care is "there yet" in teaching and mentoring, and we should absolutely devote more attention to this essential aspect of health. We should assess how each patient understands their health and tailor education based on that individual’s knowledge and beliefs.
A basic education process might follow these steps:
- Assess knowledge and beliefs.
- Design a curriculum tailored to each individual that addresses what you believe is important and what the patient is interested in and open to.
- Build salience; adults learn best when the material is salient to their perceived needs and circumstances.
- Use a range of individualized instructional methods.
- Mentor for knowledge translation; help the patient apply learned information to their day-to-day lives.
- Assess barriers and partner with the patient in problem solving.
- Reinforce and encourage.
For PTs who don't work in a multidisciplinary environment, do you have suggestions for growing a professional referral network to make sure the patient is receiving supportive care in all the areas they need?
SW: There are 2 important ways you can tap into the effectiveness of interdisciplinary care without formalized access to it. First, you can broaden your perspective by reading literature from a wide range of professions and learning from your colleagues in other occupations. Second, you can be a skilled and tenacious communicator. Initiate contact and make yourself available. Create front desk practices, websites, etc, that facilitate communication. Build relationships with other providers by coordinating, reinforcing, and supporting each other’s plans of care. Be verbally efficient; time is hard to come by, so make sure your point is obvious and not lost in the details. Ensuring that communication is a positive experience will lead to more efficient and effective work flow for all parties.
It's Time to Walk the Talk When It Comes to Our Vision for Society
By Chris Hinze, PT, DPT
By now, APTA's Vision Statement for the Physical Therapy Profession—transforming society by optimizing movement to improve the human experience—should be fully ingrained in the consciousness of every physical therapist (PT), physical therapist assistant (PTA), and student.
Why? Because despite the ambitious-sounding language, our vision statement is about making very real differences in the lives of people. It's what we're all about.
As PTs and PTAs, one lever that we have at our disposal to transform society by optimizing movement is increasing physical activity participation. Traditionally, PTs and PTAs may have considered opportunities to enhance physical activity on an individual, or patient-by-patient basis. Unfortunately, to address the physical inactivity epidemic and chronic disease burden facing America, increasing physical activity participation at a larger scale is imperative.
More recently, inspired by the Vision, many PTs have shifted their perspective toward a population health approach. In terms of physical activity, this means getting more people moving, more often.
For many years, APTA has served as an organizational partner for the National Physical Activity Plan Alliance (NPAPA). NPAPA is the nonprofit coalition of national organizations that works to ensure the long term success of the National Physical Activity Plan (NPAP). For PTs, PTAs, and students with their sights on transforming society by optimizing movement to improve the human experience, a review of the NPAP is a great place to start.
We all can agree that, generally speaking, our society's physical activity habits need to change, and it can be difficult to wrap our heads around where to begin. But we don't need to overcomplicate the issue. How about we start by getting people walking?
In 2015, the US Surgeon General issued a call to action through the Step It Up! initiative to promote walking and walkable communities. Walking is an accessible and convenient way to incorporate daily physical activity into everyday life and can be 1 opportunity for PTs to encourage physical activity participation at both individual and population levels.
NPAPA's 2017 United States Report Card on Walking and Walkable Communities highlights where America is coming up short in terms of promoting walking and walkable communities. For example, nearly half of US adults report no walking for transportation or leisure for more than 10 minutes per week, resulting in a "C" grade. Children perform even worse, scoring an "F," with fewer than a third of US children walking to and from school. Furthermore, America is receiving failing grades in "pedestrian infrastructure," "institutional policies," and "safety," while barely making the grade in "walkable communities," with a D.
Thankfully, there is hope for a better and more physically active future. Last month, NPAPA released its Promoting Walkability & Walkable Communities—Cross Sector Recommendations from the National Physical Activity Plan Alliance report. The report highlights opportunities for all sectors to Step It Up! and collaborate to make America a more equitable and inclusive place to walk. The cross-sector report highlights 3 outcome components to enhance walking and walkable communities: places, policies, and programming. This is guided by process components that support the desired outcomes: cross-sector collaboration, data monitoring, and funding. The framework is anchored in an overarching theme of equity and inclusion recognizing that social injustice contributes to disparate access to walking and walkability.
Interested in helping to be a force for transformation in your community? Here are a few ideas to get you started:
- Be a health role model. Model the behavior you wish to see from your patients, clients, and community. Consider walking to work 1 day a week. If it's too far, consider bicycling or using public transportation. Schedule walking staff meetings. Let your community see you walking in your community.
- Get educated on the social determinants of health. The APTA Learning Center has some fantastic resources to get you started, including a recording of a very informative webinar titled "In Pursuit of the Big Picture: What Are Social Determinants of Health and Why Do They Matter in Physical Therapy?"
- Engage with groups who are doing the work. The APTA Council on Prevention, Health Promotion, and Wellness in Physical Therapy and The Academy of Prevention and Health Promotion Therapies are 2 great places to start.
- Look and listen to the needs of your community. See a person walking or using a wheelchair in the road? See a walking path worn in the dirt where a sidewalk should be? These are clues that a community is coming up short in terms of walkability.
- Educate your communities on the benefits of walking and walkable communities. Consider letters to the editor, blog posts, and community presentations.
- Get creative with programming. Consider starting a community walking group or walking "school bus" to make walking more social and fun.
- Advocate. Become engaged with your local government and advocate for policies and infrastructure that support walking.
- Collaborate! Look for opportunities to connect and collaborate with other individuals and groups in your community with a common mission of a healthier society. Public health offices, disability rights organizations, advocacy groups, and transportation agencies are just a few places where you can start.
One PT, 1 profession, or 1 industry will not enhance America's physical activity or transform society. NPAP recognizes this and identifies no fewer than 9 "societal sectors" that have a role in making a change, from business and industry to faith-based settings, and from health care to mass media.
But just because a problem is big doesn't make it impossible to solve. Yes, changing old, unhealthy habits (and the infrastructure that gets in the way of adopting healthier ones) is hard and will require serious effort. But transformation is all about applying energy, creativity, collaboration, and commitment to an issue. And our profession is all about transformation.
Chris Hinze, PT, DPT, practices in Traverse City, Michigan. He is the APTA representative to the National Physical Activity Plan Alliance, a position previously held by Dianne Jewell, PT, DPT, PhD. Hinze also is active in promoting physical activity in his local community, serving as vice president of Norte, Traverse City's Pro Walk/Bike Advocacy Organization.