ADVANCE Perspective: Physical Therapy : General Interest

Magazine Content – We Need your Input

Elizabeth Puliti — Mon, 23 Nov 2009 17:33:00 GMT

As most of our readers know by now, our monthly magazine ADVANCE for Directors in Rehabilitation has ceased publication, and has been merged with the newly rebranded ADVANCE for Physical Therapy & Rehab Medicine. The new magazine, still distributed...(read more)

New and Improved

Lisa Lombardo — Mon, 02 Nov 2009 16:48:00 GMT

Arguably, the best changes are ones that are subtle but make a big impact. To that end I would like to welcome our readers to ADVANCE for Physical Therapy and Rehab Medicine , a new and improved version of the national physical therapy newsmagazine that...(read more)

Now for Something Completely Different

Lisa Lombardo — Mon, 24 Aug 2009 17:30:00 GMT

ADVANCE is already receiving some nice feedback about our Aug. 10, 2009, cover story on therapists who entered the profession later in life, many after following established careers in other fields for years. The story, "Late Bloomers," tracked several...(read more)

Off to Baltimore!

Lisa Lombardo — Tue, 09 Jun 2009 19:41:00 GMT

The last time I was in Baltimore I was struck by how open and inviting the city was, especially the Inner Harbor area. There was a lot to explore but since I was on a business trip at the time I didn't have a lot of free opportunity to see the town outside...(read more)

Compensated for Cancer?

Elizabeth Puliti — Tue, 17 Mar 2009 00:16:00 GMT

The International Agency for Research on Cancer (IARC), part of the World Health Organization, concluded in 2007 that night work is "probably carcinogenic to humans." Furthermore, the IARC classifies the cancer risk of night work as "Group 2A," the same group as tanning beds-and only one group below asbestos and mustard gas.

According to CNN, employers in Denmark are paying compensation to women who developed breast cancer after working night shifts:

Thirty-eight eight women have so far received payments via their employers' insurance companies, the Danish National Board of Industrial Injuries told CNN.

To qualify for compensation, women must have developed breast cancer after having worked at least one night shift a week for 20 to 30 years.

The amount of compensation depends on the severity of claimants' illness and their ability to work.

This article got me thinking. Would this ever happen in the United States? Do you think health care providers--or anyone who works night shifts--would get compensated for cancer linked to night shift work?

You can read the whole article here.

Strategies on Combating POPTS

Lisa Lombardo — Wed, 18 Feb 2009 15:09:00 GMT

CSM 2009 Wrap-up: The APTA keeps a watchful eye on the legislative strategies states can use to fight encroachment of physician-owned physical therapy practices (POPTS). But there are other ways to stop what many therapists see as a major cause thwarting the autonomy of the PT profession.

Peter J. McMenamin, PT, MS, OCS, and Brian J. Tovin, PT, DPT, presented "Combating POPTS: Legislative and Non-Legislative Strategies for Every PT" on Wednesday, Feb. 11 at CSM 2009 in Las Vegas.

While the session was well-attended, both speakers expressed concern that it wasn't packed. The profession's ability to combat POPTS through legislative and legal means is directly related to its survival as an autonomous profession, McMenamin said.

"Can PTs have a viable and independent business model as part of Vision 2020?" he asked. "The interest is there-within 8 years we have seen a complete reversal of educational programs in this direction, from 20 percent of programs offering the DPT to 93 percent today. So it is market-driven. Direct access is also making progress, with full direct access in 14 states and provisional DA in 31," he said.

Strategies states are attempting to use to ban POPTS include laws against referral-for-profit (RFP); fee-splitting provisions for owners of practices, and professional corporation law, which is still a theory to deal with POPTS, McMenamin said.

POPTS are banned in South Carolina, Delaware and Missouri. All three states have language in their state practice acts that effectively bans POPTS; in SC, it is illegal for PTs to work for a POPTS. On the other hand, POPTS are deemed legal in Alabama, Tennessee and Rhode Island. McMenamin said in some of these cases, POPTS earned the right to exist in a state's practice act by essentially bartering direct access-physicians in the state backed direct access language in the PT practice act in exchange for the right to own PT practices if they chose.

"Many physicians assume that in states where they are allowed to own a POPTS, it will at some point become illegal, but they are willing to continue owning until that risk becomes reality," he said.

State chapters should never attempt to "go it alone" when developing a plan to eliminate RFPs.

"It has to be a chapter-wide effort, and you have to have your full board committed to it," McMenamin stressed. "Everyone involved must fully understand their practice act implications, and have a war chest to fight with." Other important steps include:

Establishing a POPTS task force;
Developing an educational mission for the chapter to inform about POPTS;
Developing a legal team with a lawyer to work for the chapter;
Creating a lobbying team for the chapter;
Conducting a SWOT analysis on PT autonomy to determine where support against POPTS lies;
Scrutinizing the language in the state practice act on fee-splitting prohibitions, direct access and licensure rules;
Building a base of state private practice PTs who can campaign on fighting POPTS.

The important thing to remember is that the profession still controls its own success, said Dr. Tovin. "Eliminating POPTS would have more of an effect on the profession's control than direct access does," he said.

What Do You Resolve to do in 2009?

Elizabeth Puliti — Tue, 06 Jan 2009 18:13:00 GMT

ADVANCE wishes you a happy new year! Several editors and bloggers here have resolved to change for the better in 2009. Her are our resolutions for the new year:

Jason Marketti, PTA:

1. Spend more quality time talking to my children and holding hands with my wife.
2. Stay in contact with friends.
3. Be more flexible with people's faults because I have a ton of my own.

Veronica Haywood, SPT, ATS:

1. Lose 15 pounds.

Lisa Catenacci, SPT:

1. Get to know myself better.
2. Figure out what it means to have a peaceful heart.
3. Gain closure from all of 2008.
4. Stop feeling the need to defend myself, my beliefs, and my actions. I am who I am.
5. Take a vacation. From everything.
6. Enjoy the transition from student to practitioner.
7. Make evidence-based practice a habit.
8. Form good relationships with my co-workers.
9. Start the journey of paying off student loans.
10. Be thankful every day.

Toni Patt, PT:

My goals are to work hard at school and find more time for myself.

Lisa Lombardo, editor:

1. Save more money.
2. Make some home improvements. This might not fit with resolution 1, but I'll work on a budget.
3. Get back on Weight Watchers; it worked last year.
4. Be more outgoing!
5. Try something I never did before.

Beth Puliti, senior associate editor:

1. Take better care of my body by starting a regular exercise routine and eating fresh, natural foods.
2. Stop judging people based on my first impression of them.
3. Figure out what truly matters in life and work to achieve happiness.

Lauren Fritsky, associate editor:

1. To travel more.
2. To work on my writing.
3. To do more things outside my comfort zone.
4. To make more quality time for family and friends.

Did you make a New Year's resolution? If so, tell us!

The Floundering Economy: Will You Be Affected?

Lauren Fritsky — Fri, 21 Nov 2008 14:55:00 GMT

In our Nov. 17 issue, Brett Frankenberg, PT, CAE, discussed whether the weakening economy will be good or bad for the health care business.

He points to the area of workers’ compensation as a possible place of growth. With more and more employees getting laid off, the remaining ones will be putting in overtime and possibly experiencing more on-the-job injuries requiring rehab. PTs may also start seeing more older clients as well, since many are being forced to put off retirement and continue working to make ends meet.

But there’s no denying that the thousands of other workers who are losing their jobs and possibly their access to health insurance could be a drain on business. And while President-Elect Barack Obama has a health care reform plan the works, it will take time to implement. What will happen during the transition period?

What are your thoughts, fears and comments about how the bleak financial picture might affect your career or business? What can PTs do to make sure they stay afloat?

October is National Physical Therapy Month!

Elizabeth Puliti — Tue, 21 Oct 2008 13:18:00 GMT

Is your facility or clinic doing something special to acknowledge October as PT Month? If so, ADVANCE wants to know about it! Send us a photo of your staff or of an event with a brief caption and we will include it in an online photo gallery of how PTs and PTAs celebrated the profession this month.

Email information and the photo (720 dpi; .jpeg formats please) directly to Beth Puliti at epuliti@merion.com

See last year's gallery here!

Would You Join an Online Book Club?

Lauren Fritsky — Thu, 21 Aug 2008 14:35:00 GMT

Do you like to unwind at the end of the day with a good book? Would you be interested in sharing your thoughts about a novel’s plot and themes with other avid readers?

ADVANCE for PTs is considering starting an online book club on our site. A new book would be chosen every couple of months to give ample time to read and discuss. We’d post some questions to get the discussion going. We’d even have author Q&As or video interviews when applicable.

To check out the format, visit the site of one of our sister publications, ADVANCE for Nurses, and let us know if you’re interested.

Caring, Cooperation Ease Flood Effects

Lauren Fritsky — Thu, 10 Jul 2008 19:04:00 GMT

Officials this week have released the financial toll of the floods that ravaged Iowa a month ago.

The University of Iowa in Iowa City incurred more than $230 million in damages. In Cedar Rapids, the price tag is likely to exceed $1 billion.

Despite the destruction, the residents of the state continue to band together in their recovery. Health care workers are pitching in as well.

University of Iowa Hospital was not forced to evacuate, but did struggle with getting staff to the facility amidst road closures on June 12 and 13. But people from varying departments worked as a team to make sure the patients were cared for.

"A lot of our outpatient staff, because there weren't any clinics and all of our appointments were canceled, were able to do inpatient care, and we were able to meet the needs of the patients for those two days," said Ken Leo, PT, director of rehab therapies at University of Iowa Hospitals and Clinics. "But we had to be kind of creative in how we did that."

Before flood waters forced Mercy Medical Center in Cedar Rapids to evacuate, staff members stood side by side sandbagging to keep them out. When the natural disaster left only a single awkward entrance available, workers cooperated with ambulance drivers to usher out patients. And when staff members themselves lost their homes, coworkers ventured out to help demolish the structures, pump out water and pull off dry wall.

"It was kind of a bonding experience," said Lou Ann Weber, OTR-L, director of inpatient rehab at Mercy. "I met people. I was in the water helping sandbag next to physicians and housekeepers and there was lots of camaraderie to save our hospital."

Anyone who is interested in donating to the affected communities and individuals should visit SaveIowa.org

Physical Agents: In or Out?

Lisa Lombardo — Wed, 25 Jun 2008 19:29:00 GMT

Since becoming the editor of ADVANCE in 2000, the thought has often occurred to me that PTs and PTAs are a surprisingly well-informed and opinionated bunch.

But they are also a lot of fun as well.

This was proved to me on June 13 at the annual APTA conference in San Antonio, as APTA premiered its first Oxford Debate. PT experts on both sides considered whether physical modalities that might not be based on evidence should be used and billed by PTs. Despite the seriousness of the topic, the therapists on hand made being confined to a conference room on a gorgeous sunny day in Texas more entertaining than can be expected!

The debate addressed the question: Should physical therapists remove the use and billing of selected (infrared, laser, diathermy, thermal agents) physical agents from their practice?

The idea behind the debate was to question the appropriateness of the removal or maintenance of use of these interventions, the impact of them on current practice, and how removal of them would affect PT's image and independence as a professional body.

An Oxford debate is similar to British Parliamentary debate, pitting two teams of three making the arguments both for and against the question. Each team selects an opening speaker, a second "rebuttal" speaker and a third "summator" speaker for their respective arguments, and the audience comprises the "floor," allowed to ask questions of each panel before the summator speakers wrap up. Competitors are encouraged to maintain civility but also to debate with "animation, passion and creativity," according to traditional Oxford rules. And the PT panelists certainly rose to the challenge.

The debate was lively, fun and inciteful (thanks to the participants!). In a unique twist, whenever one side gave an argument, the audience could move from one side of the room to the other to show their support for the stated argument. There was a lot of up and down as many therapists switched sides.

This struck me as particularly interesting, because it showed how complex the issue really was. More than one debate attendee mentioned that professional credibility for PT could be at stake if PTs turn too often to unproven agents for treatment.

Should PTs use modalities in the clinic-and bill for them-when patients can find hot packs and other agents in drug stores and use them at home? How much should therapists rely on physical agents when there is little to no solid evidence that they work in the long-term? Are therapists just billing, in effect, for placebos? Or are therapists wrong to reject agents that might work well for their patients' rehab?

What do you think about using physical agents? Do you use them, and how? Do you feel other therapists might rely on them too often?

The 39th Annual McMillan Lecture: "We Are What We Do"

Lisa Lombardo — Mon, 16 Jun 2008 13:44:00 GMT

SAN ANTONIO—Anthony Delitto, PhD, PT, FAPTA, became the 39^TH Mary McMillan lecturer today at the APTA conference, opening his talk to a packed ballroom with a gracious nod to those who went before him. Dr. Delitto serves as professor and chairman of the department of physical therapy at the University of Pittsburgh School of Health and Sciences. He is also the vice president for education and research at the Centers for Rehab Services.

"When I received this honor," he said, "I first looked at the cast who preceded me and I was awestruck. We have all debated hotly on the issues of our time, but there is one thing we do agree on--we are all honored as I am honored to deliver this message and to have my name included with yours."

But it didn't take long for Dr. Delitto's lecture to turn to frank discussion of the challenges the profession faces and how its leaders need to step up to take the reins and turn things around.

Following the theme of his lecture, Dr. Delitto maintained that physical therapists should continually demonstrate their value to the health care field and to patients. "How do we do this? Through public relations, but our overall strategy should be to tell patients that our knowledge and skills match that of those in other fields," he said. "Our message can be so much more convincing that with continuing access to patients, we are not only effective, but also cost-effective."

The PT profession has "a lot to brag about" with regard to presenting compelling benchmarks for National Institutes of health funding, he said. He said 25 percent of NIH funding for rehabilitation research goes to PTs. But does that research get lost in translation once practitioners hit the clinic?

"We place the blame, as in ‘well, the research is never applicable to the clinic,' or [the reverse] ‘well, the practitioners just don't follow the research,'" Dr. Delitto said. "In reality there is room for improved performances in the clinic to start to match evidence-based practice. If the PT profession can make the claim that it is entirely evidence-based, "then adhering to evidence-based practice is not just a nice thing to do, it is also necessary," he said.

The profession needs a new strategy to stop "digging trenches between our clinical and research communities," he said. He quoted Albert Einstein: ‘You don't need to build a bridge unless you've dug a ditch.' We can continue to blame each other but we should instead look to the health care environment in general to see the disparities."

PTs and other practitioners are all affected by the decreases in reimbursement, he said. "Salaries for PT have stagnated while costs of care and education have both gone up. Other professions, physician assistants for example, pay higher salaries for less education and that does not bode well for our applicant pool." PT services are always profitable, Dr. Delitto asserted, but dwindling reimbursement rates across the health care spectrum have resulted in lower salaries.

"Should PT reconsider its strategy?" he asked. "We've been reactionary for too long to impositions on our own practice. We listen too often to those who want to give us too little for our services." But the profession can take steps toward more fair payments, he said.

"First, we can identify areas where we have substantive proof of the effects on PT on overall cost savings. We can also take our arguments to the right level of the food chain. And we can stress that the impact of physical therapy equals cost-effectiveness for health care. Improvement of PT services through better reimbursement will have a positive effect on our recruitment by allowing salaries to rise," he said.

Dr. Delitto also called for more scrutiny of clinical instruction. By chance, the 2008 Jules Rothstein Debate that followed this afternoon centered on this very subject, and Dr. Delitto served as a moderator.

"It is past time for us to look at the clinical instruction component of our educational system, it is at its most vulnerable and frankly is becoming an eyesore," he declared. "How long will we bury our heads and ignore this elephant in the room? Recognizing that we have a problem is actually good news because we're not ignoring it.

Are there barriers to achieving the transition to a doctoring profession for PT? Yes, Dr. Delitto said, but they are not insurmountable. Dr. Delitto used a quote Dr. Rothstein had given him, again from Einstein: "In difficult times lie opportunities."

"We are the stewards of our own profession, and we must solve our clinical education problems," he said. "Remember, the need for a bridge is a sign of a failure in planning."

Dr. Delitto thanked his colleagues in his field, and cited his "phenomenal" faculty at the University of Pittsburgh.

The Alamo!

Elizabeth Puliti — Fri, 13 Jun 2008 23:46:00 GMT

SAN ANTONIO—With the scorching sun beating down on us (is everything bigger in Texas?), we walked the two blocks from our hotel to the hallowed ground of the Alamo. And we weren't the only ones. It seems the Alamo is the perfect destination for tourists and Texans alike on a hot June afternoon. But that didn't stop us from devouring the history and beauty—inside and out—of the Alamo.

In 1724, construction began on the current site, offering visitors almost 300 years of history to contemplate. The Alamo was originally a missionary—Mision San Antonio de Valero—and served missionaries and converted Indians for just about 70 years.

The Alamo as well as the city of San Antonio played a significant role in the Texas Revolution. Both Jim Bowie, a well-known knife fighter, and David Crockett, a frontiersman and former Tennessee congressman, fought in defense of the Alamo.

Cactus-lined stone paths lead to myriad buildings throughout the Alamo's grounds. We visited the Shrine, a building dedicated to the memory of the men who fell in defense of the Alamo. We also saw The Daughters of the Republic of Texas Library, a building that contains books and documents on Texas history.

Though some facts surrounding the Alamo siege are still widely debated, it is no mystery what the sacred ground has come to signify: a place where men fought and ultimately died in the name of freedom.

PT 2008 'Kicks it Up' at the Opening Ceremony

Elizabeth Puliti — Thu, 12 Jun 2008 14:40:00 GMT

SAN ANTONIO—PT 2008 kicked the conference off right last night with a stimulating opening ceremony. APTA President R. Scott Ward, PT, PhD, welcomed the overflowing audience of PTs to San Antonio. He had nothing but praise for the 7^th largest city in the country, a city that, in his words, exudes "world-class cuisine, offers opportunities for fun and adventure, and captures the spirit of Texas while keeping its old-world charm."

"When you're not in sessions--and we won't tell anyone--stroll along the Riverwalk and see all this city has to offer," he encouraged the audience.

Dr. Ward noted there are more than 350 speakers at this conference who represent seven countries. He thanked everyone involved and recognized the newly elected officers (a new treasurer, speaker of the house and directors) of the APTA.

Next to speak was the president of the Texas Physical Therapy Association, Carolyn Oddo, PT. "While you're hear, you will experience typical Texas weather. The moisture you feel while walking the Riverwalk isn't a hot spring shower--but Texas humidity," she joked. "We survive by drinking cold beverages--like margaritas."

She persuaded the audience to visit the Alamo, "which is almost a requirement for Texas citizenship," she said.

President Ward took the stage again to speak about the advantages and challenges to the profession of physical therapy and the work of the Association. He noted the common goal of PTs and PTAs alike is to make lives better for patients. "It's a goal we can--and should--be proud of." He told the audience that the public already recognizes that fact.

"When I tell people I'm a PT, they react favorably. I've never been asked, ‘What is a PT?'" Instead, he relayed, one of two things usually happens: the person expresses their desire for an on-site consult ("I'm sure you're familiar with these encounters, which I call ‘Thanksgiving Day clinics,'" he said), or they ask where he practices and are genuinely interested to find out.

"We tend to think the public doesn't know what we do," but they do, he said. "We are overly humble. Never forget what you do-and never forget to make it clear to others who you are."

He encouraged the audience to view challenges as opportunities not only for the PT profession, but for the patients you are fortunate to serve.

Perhaps the most riveting of all the speakers at the ceremony was the last to talk to the audience. This year's keynote speaker was Lee Woodruff, author, freelance writer, contributing editor of ABC's "Good Morning America"--and wife to Bob Woodruff, the ABC journalist reporting in Iraq when a roadside bomb hit his convoy on January 29, 2006.

Bob suffered a traumatic brain injury from the 155 cm bomb packed with rocks. He remained in a medically-induced coma for five weeks. After much medical attention and physical therapy, he has healed far beyond doctors' expectations.

When Lee took the stage at the Convention Center Ballroom last night, she was met with a standing ovation and thundering applause, to which she responded, "I think it is no surprise that the physical therapists would be getting up and down during all of this."

Transitioning from Dr. Ward's speech, she told the audience, "I'm not a person who forgets what you do. Your profession has healed my husband and my family and I have the utmost respect. The surgeons and doctors may get all of the attention...but you are the wind beneath all of our wings--and you probably don't always get the credit that you deserve."

If Bob had been reporting in a previous war, it is likely he would not have survived, she said. In Vietnam, there were three injured to one dead. In the current war, there are 12 injured to one dead. Fifteen to 30 percent of the 1.6 million servicemen will come back with some sort of brain injury, she recited. "This war is rewriting what we know about brain injuries."

Bob's miraculous recovery wouldn't have been possible without PTs, OTs and speech therapists, Lee acknowledged. PTs never told her "He won't be able to," or "He can't" or "He shouldn't"--common phrases among doctors, she said. "I heard from you motivation; you were giving me that little bit of hope so I could go to bed that night."

Lee and Bob created the Bob Woodruff Family Foundation which raises money to assist members of the military with cognitive rehabilitation and other health care needs following traumatic brain injury.

"We could not have done it without the love of people like you," she concluded.