Beyond Opioids: The Future of Pain Management

March 14, 2018 — Cindi Scheib wanted to die.

A three-day weekend spent jumping and dancing on Labor Day 2014 had left her with a neck injury – specifically the cervical spine – that was possibly an exacerbation of an unrecognized mountain biking injury earlier that year. To make matters worse, her doctor performed the surgery to fix the injury on the wrong part of her spine.

Now 54, Scheib has lived with constant neck pain and other unusual sensations throughout her body ever since. These sensations, including electrical shocks down her spine, buzzing, vibrating, burning sensations, ringing in her ears and sensitivity to normal noises, had gotten so bad, she said, that “I wanted to go to bed and not wake up tomorrow. This life was so bad, so horrible, that I couldn’t imagine how I was going to live the rest of whatever life I had,” says the Harrisburg, PA, nurse.

Full story at WedMD

On the PTA Payment Battleground, We Are All APTA

I was working as a physical therapy technician when Congress instituted the Medicare cap on therapy services on January 1, 1999. I was to graduate as a physical therapist assistant (PTA) in May of that year, and, at that time, I had no idea or even much concern about what the cap would mean for our profession or my career.

I heard horror stories about layoffs of physical therapists (PTs) and PTAs due to the payment changes, but as a new graduate I was focused solely on finding a job in my chosen profession. It was not until years later, when I began working in outpatient care and seeing problems with payment, that I realized the importance of getting involved with advocacy.

Since that time, I have been as engaged as possible at the local, state, and national levels to be part of the solution to problems that arise for our profession, including payment for the services that we provide to our patients on a daily basis.

Full story at APTA

New Research: Prescriptions for Narcotics Are Surging for Knee Pain

Although physical therapy and lifestyle changes have been shown to bring significant improvements to those with knee osteoarthritis, new research suggests U.S. physicians may be leaning toward pain medications instead.

Published in Arthritis Care & Research, the study looks at 2,297 physician visits for the condition, data that’s kept in a national database. Researchers found that PT and lifestyle suggestions—like losing weight, quitting smoking, eating healthier foods, and getting more exercise—declined from 2007 to 2015, while prescriptions for nonsteroidal anti-inflammatory drugs, narcotics, and opioids increased.

In fact, during study period, lifestyle recommendations and referrals for physical therapists were reduced nearly by half, while prescriptions for narcotic pain relievers nearly tripled.

Full story at Runner’s World

CMS Rule on Hospital Price Transparency Sets the Stage for Major Shift in Public Access to Charges for Services

The big picture: Hospitals will face more stringent requirements to disclose charges for items and services—including physical therapy—in a consumer-friendly, online form. Hospitals aren’t happy about it.


A final rule from the US Centers for Medicare and Medicaid Services (CMS) makes it clear that the agency will move ahead in its efforts to make hospital cost data more accessible to consumers. Beginning January 1, 2021, hospitals will be required to share a much more detailed range of charges, including gross charges, charges negotiated with a third-party payer, charges for cash payment from individuals, and minimum and maximum negotiated charges. The publicly accessible data must cover at least 300 services that patients can schedule in advance—known as “shoppable” services—and while hospitals have some leeway as to which service charges are included, they are required to lists charges for a core set of 70 services, including physical therapy, specifically therapeutic exercise (CPT 97110).

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

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

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

UnitedHealthcare to Expand Program Waiving Copays, Deductibles for Physical Therapy for LBP

Momentum around better insurer coverage of physical therapy continues to build at UnitedHealthcare (UHC), which announced that it’s moving ahead to expand a pilot project that waives copays and deductibles for 3 physical therapy sessions for patients with new-onset low back pain (LBP). The pilot follows a multiyear collaboration between APTA, OptumLabs®, and UHC.

The program is targeted at UHC enrollees in employer-sponsored plans who experience new-onset LBP and seek care from an outpatient in-network provider. The program fully covers up to 3 visits to a physical therapist (PT) or chiropractor in addition to visits normally covered. When the program was rolled out in June, it was limited to plans sponsored by employers of more than 50 employees in Florida, George, Connecticut, North Carolina, and New York. The expanded pilot, which begins January 1, 2020, will extend to self-funded plans with 2 to 50 employees in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia.

Full story at APTA

Final Home Health Rule Cements PDGM, Allows PTAs to Perform Maintenance Therapy

When it comes to its most talked-about provisions, the US Centers for Medicare and Medicaid Services’ (CMS) final rule for home health payment under Medicare isn’t much of a change from the proposed version released earlier this year, meaning that an entirely new payment system will indeed be rolled out beginning January 1. But other parts of the rule have been tweaked—and in several areas, those tweaks represent wins for the physical therapy profession and the patients it serves in home health settings.

It’s official: PDGM is on for 2020.
There wasn’t much debate about whether this would happen, but the final rule eliminates any doubt: the Patient-Driven Groupings Model (PDGM) will be the system under which CMS pays home health agencies (HHAs). It’s a big change, and APTA offers extensive information on the details of the model, but the bottom line is that the PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. The system classifies episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. CMS says it will monitor how HHAs are operating under the PDGM, including the provision of therapy services.

Full story at APTA