Patient-Driven Groupings Model: An Opportunity for Physical Therapists

When it comes to Centers for Medicare and Medicaid Services (CMS) changes, I have come to believe that there are 3 sides of the story: the CMS version, the providers’ version, and the truth, which is usually somewhere in the middle. The Patient-Driven Groupings Model (PDGM) that will govern home health payment beginning January 2020 is a good example of what I’m talking about.

PDGM shook the therapy world when it was announced that the number of therapy visits will not be considered or weighed into each 30-day period pricing for home care within a 60-day episode. As usual, providers, fearful of losing money, started to lay off therapy staff without really understanding what CMS intended.

Most of us understand that therapy visit thresholds were used to determine the additional pricing to the base rate for a home care 60-day episode. Home health providers have paid particular attention to this fact, realizing that the number of therapy visits at certain thresholds adds value to the base amount of the home care episodic rate. Back when the therapy threshold was 10 visits, home care agencies tried to have a minimum of 10 visits to capture that dollar amount. When the threshold increased to 13 visits, that number soon became the norm of therapy visits for every patient. Later, the therapy threshold moved to 19 visits. Home care agencies started to add multiple therapy services to attain that number and discharged every patient after 19 visits.

Full story at APTA

Does Everyone Have a Unique Muscle Activation ‘Fingerprint?’ Researchers Say Yes

The message
It’s no secret that people move differently, but researchers who carefully tracked muscle movements of study participants during exercise think the differences may go even deeper than variation in movement styles. Their conclusion: humans possess muscle activation “signatures” that are as unique to each individual as fingerprints or iris structure. Not only could these patterns be used to identify an individual, they write, but finding a person’s activation strategies could help to identify the potential for future musculoskeletal problems, and better tailor treatments to individual patient needs.

The study
Researchers analyzed movement patterns of 53 individuals using surface electromyography (EMG) on their legs as they pedaled on a stationary bicycle and walked on a treadmill. Using a machine learning protocol, authors of the study tracked activation patterns from 8 muscles of the right leg: the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), gastrocnemius lateralis (GL), gastrocnemius medialis (GM), soleus (SOL), tibialis anterior (TA), and biceps femoris-long head (BF). They used the data to establish unique muscle activation signatures recorded during an initial session. Participants then returned for a second round of the same activities between 1 and 41 days after the first (average, 13 days), allowing researchers to evaluate the similarities between activation patterns observed at each session.

Full story at APTA

Osteoarthritis May Play a Role in Social Isolation

When older adults become socially isolated, their health and well-being can suffer. Now a new study suggests a link between being socially isolated and osteoarthritis (arthritis), a condition that causes joint pain and can limit a person’s ability to get around.

The findings are published in the Journal of the American Geriatrics Society.

Arthritis patients often have other health issues which may increase their risk of becoming socially isolated. These include anxiety and depression, being afraid to move around (because arthritis makes moving painful), physical inactivity and being unable to take care of themselves.

Full story at Psych Central

Woman with severe spinal cord injury recovers after treatment at Danbury Hospital

A freak accident left Katherine (Kathy) Wenning unable to move her upper body. She knew she needed medical attention, but she was at her country getaway in Washington, Connecticut -; two hours by car from her home in Manhattan and the New York medical system she trusted. Kathy put her faith in a neurosurgeon and care team at Danbury Hospital to treat her severe spinal cord injury.

Fateful fall leads to unexpected injury

Kathy, 75, was getting ready for bed when she tripped on her clothes and struck her neck on a shelf inside her closet. She lost consciousness and woke up to pain radiating from her neck down to her arms. Kathy’s husband, Michael, found her lying on the floor of the closet unable to move. She just wanted to go to sleep, hoping she would feel better in the morning.

Full story at News Medical

Study Finds Racial Variation in Post-Operative Care Following Knee Replacement Surgery

A large study analyzing 107,000 knee replacement surgeries found that African Americans were significantly more likely than white patients to be discharged to an inpatient rehabilitation or skilled nursing facility rather than home care after the procedure. Researchers also found that African American patients under 65 were more likely to be readmitted to the hospital within 90 days of a knee replacement.

The regional database analysis study was published in JAMA Network Open, an open access journal of the American Medical Association, on October 30. It was a collaborative effort among researchers from Hospital for Special Surgery (HSS) in New York City (Michael L. Parks, MD), the University of Alabama at Birmingham (Jasvinder Singh, MBBS, MPH), the University of Pennsylvania (Yong Chen, PhD) and Weill Cornell Medicine/New York Presbyterian Hospital (Said A. Ibrahim, MD, MPH). The study included patients who had elective knee replacement surgery in the state of Pennsylvania between 2012 and 2015.

Full story at Hospital for Special Surgery

APTA Cosponsored Study: Direct Access to Physical Therapy for LBP Saves Money, Lowers Utilization Better When It’s Unrestricted

Unrestricted Direct Access to Physical Therapist Services Is Associated With Lower Health Care Utilization and Costs in Patients With New-Onset Low Back Pain

The message
Does unrestricted direct access to a physical therapist (PT) make a difference compared with “provisional” direct access systems that include restrictions such as visit limits and referral requirements for specific interventions? A new analysis of insurance claims records from nearly 60,000 adults across the US says yes.

The study, cosponsored by APTA, reveals that for patients with new-onset low back pain (LBP), seeing a PT first in states with unrestricted direct access resulted in lower health care costs and use compared with patients seeking care in provisional access states. And the differences don’t end there: researchers found that patients in provisional access states who saw a PT first tended to incur higher costs than those who saw a primary care provider (PCP) first, while data from unrestricted direct access states showed relatively equal, if not slightly lower, costs for seeing a PT first compared with PCPs.

Full story at APTA

The Armless Archer

One of the top-ranked archers in the country is 36-year-old Matt Stutzman of Fairfield, Iowa. “The last time we looked into it, 1% of archers in the world make a living shooting a bow,” he said.

He’s not bragging – he is really just that good, and has the accolades to prove it. “January of 2010 is when I decided to be the best archer in the world. And by 2011, I had already made the U.S. Team, and by 2012, I went to my first Games, and won a Silver!”

And he did it all with his feet.

Yes – one of the most celebrated archers in the world was born without arms.

“When it first started, it was, ‘Look at this guy without arms!’ And now it’s like, ‘Uggh, Matt’s here,'” he laughed.

Full story at CBS News

Effective non-surgical treatment options for urinary incontinence

A common myth about urinary incontinence (the loss of bladder control or urinary leakage) in women is that surgery is your only option.

Urinary incontinence can happen to women at any age, but is most common in older women. The course of treatment, be it surgical or nonsurgical, is based on the type of incontinence you have and the severity of your symptoms.

The most common types of urinary incontinence are stress incontinence (a condition in which you lose urine during general physical movement or activities like coughing, laughing, sneezing or exercising) and urgency urinary incontinence (an urge to urinate so intense you lose urine before you’re able to get to the toilet, also referred to as overactive bladder incontinence). Many women have a combination of stress incontinence and urgency urinary incontinence, a condition called mixed urinary incontinence.

Full story at News-Medical.net

Technology’s Brave New World of Ethical Challenges Explored in PT in Motion Magazine

That latest piece of technology you’re thinking about weaving into your practice? Maybe it should come with a warning label.

This month, PT in Motion magazine takes a look at the ethical issues that new technologies can introduce in physical therapist practice. From seemingly offhand social media posts to the use of voice assistant devices (VADs) such as Alexa to mounting cameras in clinics, experts interviewed for the story explain the ethical considerations that need to be weighed before powering up.

“New Technology: Keeping It Ethical, Keeping It Legal” focuses on 7 general areas of technology: providing online advice, posting photos, VADs, wearable technology, use of cameras, electronic health records, and telehealth. PTs interviewed for the article include APTA Ethics and Judicial Committee Chair Bruce Greenfield, PT PhD, FAPTA; APTA Section of Health Policy and Administration member Robert Latz, PT, DPT, who’s also the section’s representative on the association’s Frontiers in Rehabilitation, Science, and Technology Council; and Nancy Kirsch, PT, DPT, PhD, FAPTA, president of the Federation of State Boards of Physical Therapy and author of PT in Motion‘s “Ethics in Practice” column.

Full story at APTA

UK military researcher studies ways to prevent chronic pain

Josh Van Wyngaarden grew up in a military family, traveling all over the world during his father’s 22 years in the Air Force.

“It’s really all I ever knew,” he said. “And I knew I wanted to serve in that way, too.”

The University of Kentucky College of Health Sciences doctoral student was in high school when 9/11 occurred. It moved him to follow in his father’s footsteps by applying for the Air Force Academy, where he studied for four years. Knowing he wanted to pursue a medical career, he ultimately chose the path of physical therapy, earning his doctorate of physical therapy at San Antonio’s Army-Baylor DPT Program.

Full story at News Medical