Category: Nutrition

Study: High School Football Players Experience More Concussion Symptoms, Longer Return-to-Play Times Than Youth League or College Counterparts

Researchers have found that high school and college football players report more concussion symptoms than youth league players, and that youth league players tend to return to play within 24 hours of injury at a higher rate than their older counterparts. What they haven’t figured out is what accounts for the differences, although they have a few ideas.

Authors of a study e-published ahead of print in JAMA Pediatrics tracked athletic trainer-reported diagnoses, symptoms, and return-to-play rates of 1,429 sports-related concussions among the 3 levels of football during the 2012-2014 seasons. The concussion data were drawn from 310 youth football team seasons, 184 high school team seasons, and 71 college team seasons.

Researchers used a symptom cluster system to organize 17 concussion-related symptoms into 4 groups—cognitive, migraine, neuropsychiatric, and sleep—and tallied up all symptoms reported from initial injury to return to play, not just those reported at the time of the concussion.

Full story of higher concussion rates in High School football at ATPA

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

Study: To Help Reduce Sedentary Behavior in Schools, Students Need to Think on Their Feet

What’s good for the office may be good for the classroom, according to some researchers who think the standing desk trend should be extended to schools as a way to help reduce obesity and improve overall health among children.

A team of researchers published a systematic review in Pediatrics [log-in may be required] examining the effects of standing desks on students’ sedentary behavior, physical activity level, health outcomes, and academic outcomes. After analyzing the results of 8 studies conducted in elementary school settings, they found that the decreased sitting time, besides doing the obvious good, may also have a null effect on learning. “In essence, it can be hypothesized that students could effectively learn while simultaneously reducing the high volumes of sedentary time accumulated through passive and static sitting in the classroom,” authors write.

The effects on actual physical activity were mixed, with some studies finding no change and others reporting an increase in activity. The evidence on caloric expenditure and BMI was inconclusive.

Full story of physical activity in schools at APTA

Jimmo Message Hasn’t Sunk In; CMS Needs to Do More

When the Jimmo v Sebelius settlement was announced in 2013, patient advocates applauded what they saw as a landmark change for individuals who need care to maintain their medical conditions or slow their declining health. However, 3 years later, many providers and payment adjudicators are still making coverage decisions as if they’re living in a pre-Jimmo world—mostly because the US Centers for Medicare and Medicaid Services (CMS) hasn’t done enough to bring them up to speed, according to an advocacy group supported by APTA.

Recently, APTA provided a supporting declaration to the Center for Medicare Advocacy’s (CMA) efforts to get CMS to do a better job of making it clear that the “Improvement Standard”—the idea that Medicare coverage can only be extended if that care will actually improve the patient’s condition—is a fallacy, and that skilled maintenance care can qualify for payment.

“There are still many providers and contractors who do not know about, understand, or trust the change in the improvement policy,” CMA wrote in a December 2015 letter to APTA and other stakeholders. “We believe this is largely due to the fact that CMS’ Education Campaign was insufficient to make up for the rigor with which Medicare enforced the Improvement Standard—for decades.” According to CMA, CMS conducted only 1 briefing for providers and adjudicators, in early December of 2013. Since that time, CMS “has refused to do more,” CMA writes.

Full story of the Jimmo message at APTA

Study: Entry-Point Physical Therapy for LBP Saves Money for Medicaid

Editor’s note: the following is a sneak peek at research that will be featured as part ofPhysical Therapy‘s (PTJ‘s) special series on health services research, beginning with the December issue.

In an exploration of a payment area that could take on increasing prominence in physical therapy, researchers have found that Medicaid patients with low back pain (LBP) whose front-line treatment is provided by a physical therapist (PT) tend to generate lower costs over 1 year than patients who went to the emergency department (ED) or physician.

Though the study’s authors describe the number as “few” by proportion—75 Medicaid enrollees used a PT as their entry point—analysis showed that patients who began with physical therapy generated an average per-patient 1-year cost of $335, compared with $533 for primary care and $900 for patients who used the ED as an entry to care. Results were e-published ahead of print in Physical Therapy (PTJ), the journal of APTA. The study’s authors include Julie Fritz, PT, PhD, FAPTA, and Anne Thackeray, PT, PhD.

Full story of PT for LBP saving money for Medicaid at APTA

Soccer Mom: Move Forward Radio Interviews US Women’s Team Member About Postpartum RTP

When the US Women’s National Soccer Team clinched the World Cup this summer, forward Amy Rodriguez celebrated an additional victory—her successful (and physical therapy-aided) return to the team after having a baby not quite 2 years earlier.

Rodriguez shares her story on the most recent episode of Move Forward Radio—how she approached her pregnancy and return to sport, and the role that physical therapy played in that journey. Although told through the eyes of a world-class athlete, Rodriguez’s story will resonate with moms of any athletic ability who want to regain a physically active lifestyle after childbirth.

Other recent Move Forward Radio episodes include:

Total Knee Replacement: A Storybook Approach
Louise Chegwidden, PT, FT, has watched patients and families struggle to cope with the information overload that accompanies total knee replacement surgery, and decided there had to be a better way to prepare families and improve expectations. To fill that void, she wrote a guidebook for families called “Granny Gets a New Knee: and a Whole Lot More.” Chegwidden discusses some of the things patients and family caregivers should know about total replacement surgery, including the benefits of seeing a physical therapist before the procedure. (You can read more about Chegwidden and other physical therapist book authors in PT in Motion’s July feature story “Physical Therapist Authors.”)

Full story of postpartum RTP at APTA

‘Things PTs Wished You Knew’ Featured in Redbook

If you could give a stranger only 1 health tip based on your experience as a physical therapist (PT), what would it be?

A recent blog post from Redbook magazine asked 8 PTs to “spill the secrets they share with their closest friends” as part of an article on the “Things Physical Therapists Wish You Knew.” APTA members Marianne Ryan, PT, BSOCSJill Boissonnault, PT, PhDSuzanne Badillo, PTCandy Tefertiller, PT, DPTJulie O’Connell, PT, DPT, and Robert Gillanders, PT, DPT, OCS, were interviewed for the story.

Check out the Redbook article for the actual tips, which touched on areas that ranged from children in sports to the advisability of flip flops as everyday footwear, and from strengthening pelvic floor muscles to the connection between stress and pain.

For more information on the recent article in Redbook, visit APTA

From the Foundation: CoHSTAR Looking to Fund Studies; Fellowships and Scholarships Announced

The physical therapy profession’s first center of excellence for health services and health policy research is now accepting letters of intent for pilot study funding, but the July 15 deadline is fast approaching.

The Center on Health Services Training and Research (CoHSTAR) pilot study program is designed to provide funding for pilot research into areas related to health services research, and will be funding up to $25,000 in direct costs for each study approved.

According to CoHSTAR, pilot studies “may be designed to provide preliminary data that will support larger subsequent funding efforts, or develop new infrastructure … needed to pursue physical therapy health services research questions.” Application details, funding priorities, and other resources are available at the CoHSTAR pilot study webpage.

For more information on CoHSTAR looking for fund studies at APTA

From PT in Motion Magazine: Predictive Analytics, Coming to a Practice Near You?

“Big data” isn’t just a marketing buzzword: it’s a tool with real-world applications that are already reshaping the way some physical therapists (PTs) treat their patients through the use of predictive analytics.

The June issue of PT in Motion magazine takes a close look at the growth of programs and initiatives that match treatment and outcomes data to patient demographic and other variables to help PTs get a sense of the patient’s chances for success using various treatment approaches. Some programs literally provide PTs with a percentage-based estimates; others chart progress against aggregated data on patients with similar conditions, comorbidities, and demographic variables.

The article explores several predictive analytics programs already in use, including one developed and used by Intermountain Physical Therapy in Salt Lake City, Utah, and another subscription-based service known as Focus on Therapeutic Outcomes (FOTO). Though slightly different in function, both programs aim to provide PTs with data that is closely matched to a particular patient’s situation.

Full story of PT predictive analytics at APTA

Resistance Training Effective in Countering Bone Density Loss, but Only When Combined With High-Impact, Weight-Bearing Exercise

Nondrug approaches to preserving bone mineral density (BMD) in women postmenopause can be effective—but only if the training includes high-impact or weight-bearing exercise in addition to progressive resistance training, according to a new meta-analysis of 24 studies.

Researchers analyzed results from the studies—5 controlled trials and 19 randomized controlled trials involving 1,769 women who were postmenopausal—to determine the effects of physical training on bone density, particularly in the spine and hip. Participants were limited to women who did not engage in regular exercise prior to study enrollment, and who were not receiving hormone replacement therapy or antiresorptive treatment. BMD outcomes were measured by way of X-ray or photon absorptiometry.

Full story of resistance training at APTA