Dutch Study Finds Positive Long-Term Outcomes for Multidisciplinary Treatment of Chronic Pain

Authors of a new observational study from the Netherlands say that taking a multidisciplinary approach to chronic musculoskeletal pain (CMP) can not only result in short-term improvements, but seems to be beneficial even 2 years after a rehabilitation program has ended—particularly in terms of reducing health care provider usage and increasing patient working hours.

For the study, published online in Musculoskeletal Care, researchers followed a group of 165 patients with CMP who participated in a 15-week multidisciplinary rehabilitation program that involved cognitive behavioral therapy (CBT), education, individual and group exercise, relaxation, and hydrotherapy. The program was provided by a team that included a rehab physician, an occupational therapist, a physical therapist, a social worker, and a psychologist.

According to authors, an earlier study of the program had already established positive outcomes for pain and function at discharge; their study was focused on assessments of pain, function, fatigue, and other factors 12 and 24 months postdischarge. Participants were 87% female, with an average age of 44.1. The most-cited location of CMP was the back (71%), followed by shoulders (60%), neck (52%), and upper legs/knees (48%).

Full story of multidisciplinary treatment for chronic pain at APTA

In the News: Tech-Driven Approaches Improve TKA, THA Surgery and Recovery

Rehabilitation from total knee arthroplasty (TKA) or total hip arthroplasty (THA) may be a constant, but the time needed for rehab could be shortened, thanks to new ways of performing TKA, THA, and joint restoration surgeries.

In an April 21 article in the Miami Herald, reporter Caitlin Granfield writes about approaches to surgery that rely on technologies such as robotics and 3-D modeling to help create procedures that, among other recovery-enhancing qualities, minimize impact on surrounding muscles. Techniques include what Granfield describes as “quadriceps-sparing knee replacement, where surgeons lift the muscle and the knee-replacement surgery is performed from the side, with the incision much shorter than traditional knee replacement surgeries.”

“Over time, we’ve realized that certain muscles and tissues can simply be moved out of the way and don’t need to be detached,” one orthopedic surgeon says in the article.

Full story of tech-driven approaches to TKA and THA surgery/recovery at APTA

New Wisconsin Law Allows PTs to Order X-Rays

Physical therapists (PTs) in Wisconsin now have a big addition to their licensing law: the ability to order x-rays. The change, signed into law by Gov Scott Walker on April 25, marks the first time any state has specifically authorized PTs to make the decision.

Under the new law, to be able to order x-ray imaging, the PT must hold a clinical doctorate degree or a specialist certification, or have completed a board-approved residency or fellowship, or a formal X-ray ordering training “with demonstrated physician involvement.”

The law also requires the PT to communicate the x-ray order to the patient’s primary care physician “or an appropriate health care practitioner” to ensure coordination of care. That communication is not required if the patient doesn’t have a primary care physician or was not referred to the PT by another practitioner, or if the radiologist doesn’t identify a significant finding.

Full story of new Wisconsin law allowing PTs to order X-Rays at APTA

SNF and IRF Proposed Rules Continue CMS Push Toward Quality Reporting, Value-Based Payment

Continued emphases on quality reporting and new payment models are at the center of the Centers for Medicare and Medicaid Services’ (CMS) proposed 2017 rules for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs), along with an $800 million increase in payments to SNFs, and a $125 million increase for IRFs.

CMS is proposing an overall payment increase of 2.1%, or an estimated $800 million, but the rule also includes notice that CMS is continuing its push for quality-reporting measures required by the Improving Post Acute Care Transformation (IMPACT) Act. The 2017 proposed rule adds to the list of quality measures that will be required of SNFs beginning in 2018 to include data on discharge to community, Medicare spending per beneficiary, and potentially preventable 30-day readmissions. The proposal also stipulates that by 2020, SNFs will be required to supply reports on drug regimen reviews with follow-up.

Full story of SNF and IRF proposed rules towards quality reporting at APTA

PTJ Podcast Roundup: Debility, Children’s Mobility Needs, PTs in the ICU, and More

The lead author of a recent study on debility and inpatient rehabilitation says that while physical therapists (PTs) are crucial to identifying deficits and making important protective changes in function, the improvements they help to establish may have a time-limited effect when it comes to reducing hospital readmissions.

The comments were made during a recently posted podcast from Physical Therapy (PTJ), APTA’s science journal. In the podcast, lead author Rebecca Galloway, PT, PhD, GCS, CEEAA, joins PTJ Editor-in-Chief Alan Jette, PT, PhD, FAPTA, to discuss findings of a study on debility and readmissions published in the February issue of the journal. That study found that while higher scores on the Functional Independence Measure (FIM) at discharge correlated to a decreased risk of readmission, the decreased risk essentially disappeared after 60 days.

Full story of PTJ podcast roundup at APTA

Revised Physical Activity Plan Presents Opportunities for PTs, PTAs

APTA members familiar with the association’s vision to transform society may feel like the vision for the newly revised National Physical Activity Plan (NPAP) has a familiar ring to it. “One day, all Americans will be physically active,” it says, “and they will live, work, and play in environments that encourage and support regular physical activity.”

Sounds downright … transformative, doesn’t it?

The NPAP Alliance has released a long-awaited revision of its namesake document, a comprehensive and high-profile roadmap for supporting and encouraging physical activity among all Americans. The new version is informed by recent evidence-based findings, shaped by comments from stakeholders—including many physical therapists (PTs), physical therapist assistants (PTAs), and students in physical therapy education programs—and developed and finalized by a coalition of organizations including APTA.

Full story of revised National Physical Activity Plan at APTA

Inpatient Payment Proposed Rule Eliminates ’2 Midnight’ Reductions, Delivers 1-Time Increase to Hospitals

The Centers for Medicare and Medicaid (CMS) will not only back away from payment cuts associated with the “2 midnight” rule in 2017, but will actually award hospitals a .6% increase, according to a proposed inpatient prospective payment system (IPPS) and long- term care hospital rule released recently. In addition to the shift away from the penalties, the proposed rule continues the agency’s push for more quality reporting and value-based purchasing.

The biggest news from the proposed rule is that CMS will not implement a .2% reduction for inpatient services—a cut designed to offset what it had anticipated would be increased spending associated with the 2-midnight rule. The 2-midnight rule was intended to reduce costly admissions in cases better suited to outpatient treatment by stipulating that auditors can presume that an admission is reasonable and necessary if the patient spent at least 2 days as an inpatient, defined as 2 midnights in a hospital bed.

Full story of payment cuts associated with 2 midnight rule at APTA

PT Sue Falsone, MLB’s First Female Head Trainer, Featured in Huffington Post Interview

The Huffington Post continues its conversations on the future of physical therapy with notable physical therapists (PTs). This time, the focus is on Sue Falsone, PT, MS, ATC, CSCS, SCS, former head athletic trainer for the Los Angeles Dodgers, and the first female head athletic trainer in any of the 4 biggest professional sports leagues (Major League Baseball, the National Football League, the National Hockey League, and the National Basketball Association). Falsone is also head of athletic training and sports performance with the US Soccer Men’s National Team.

You can find a transcript of the entire interview on the Huffington Post website. In the meantime, here are a few quick takeaways from Falsone:

On the ways divisiveness among professions can slow innovation:
“It is hard to be innovative and elevate your field when the major playmakers are in court fighting turf wars. There are plenty of patients to go around, and there are bigger health care issues in this country.”

Full story of MLB’s first female head trainer at APTA

Can Care Meet the Need? Studies Show Arthritis Prevalence Is Growing, but Care System has ‘Substantial Room for Improvement’

By 2040, 1 in 4 Americans will have arthritis, 1 in 10 will experience a disability because of the condition, and—if things don’t improve—many will receive treatment from community-based programs that, more often than not, fail to recommend exercise and education as a first-line approach. That’s the picture created by 2 separate studies—one on predicted prevalence of arthritis, and another on the state of community-based osteoarthritis (OA) care.

The prevalence study, which was e-published ahead of print in Arthritis & Rheumatology, uses National Health Interview Survey responses gathered over 3 years (2010-2012) to update earlier prevalence statistics based on 2003 data. Researchers then combined results with data from the US Census Bureau to make prevalence predictions, given demographic variables including the aging of the baby boomer population.

Among their findings:

Full story of the state of community-based osteoarthritis care at APTA

Man With Paralysis Continues to Make Gains Via Technology That Allows Thought-Controlled Movement

A man who is quadriplegic continues to make advances in his ability to control his hand through an electronic neural bypass system that allows him to grasp, pour, and even play a “Guitar Hero”-type video game by way of a brain implant. Researchers behind the project claim it’s the first time an individual has been able to move and control a previously paralyzed area of the body through thought alone.

Burkhart and the researchers first made news when the system, called Neurobridge, was demonstrated in the summer of 2014. Burkhart, who lost feeling and control in his hands and legs after he broke his neck in a swimming accident, agreed to allow the researchers to implant a device in his brain that captures brain signals. When Burkhart thinks about moving his hand in specific ways, the captured impulses are translated to electronic impulses and sent to a special sleeve on his arm that stimulates the appropriate muscles, bypassing the spinal cord injury.

In 2014, the technology only allowed Burkhart to open and close his hand. Since that time, the research team has continued to work with Burkhart to refine the algorithms that translate his brain signals into specific hand and finger movements. A recent video featured in The New York Times shows Burkhart pouring dice from a bottle into a wide jar, and then using his fingers and thumb to pick up a plastic stirrer and stir the objects in the jar. Later in the video Burkhart is shown manipulating the buttons on a video game guitar.

Full story of paralysis and controlled movement through technology at APTA