#AcutePT helps ICU save $818,000 per year!

In a recent post So, you think you can walk? I outlined some of the evidence, rationale, logic, and decision making involved in acute care physical therapist practice. I discussed the important of conceptualizing and studying physical therapists impact “beyond function.”

An article from UPI.com entitled Providing Physical Therapy in ICU Helpful highlights exactly this concept. The study discussed will be published around March in Critical Care Medicine. An e-published ahead of print version is already available: ICU Physical Rehabilitation Programs: Financial Modeling of Cost Savings. The benefits of technology allow us to begin preliminary discussion and analysis!

The authors modeled cost savings utilizing best-case and most conservative estimates of length of stay reductions, upfront costs, and other factors based on  existing published data and their specific quality improvement project. The quality improvement project undertaken at Johns Hopkins University within the medical ICU included full time, dedicated physical therapists and occupational therapists in the medical ICU. The vision:

A multidisciplinary team focused on reducing heavy sedation and increasing MICU staffing to include full-time physical and occupational therapists with new consultation guidelines.

In total, the early rehabilitation program cost the hospital approximately $358,00 more per year than the previous standard of care. So, what did the results say? Within 1 year, ICU length of stay decreased by an average of 23% while medical ICU admissions increased by over 20%. An $818,000 per year net savings after accounting for start up costs (approximately $358,000) was observed. Conclusions:

A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

The “actual experience” investigation is actually published in Archives of Physical Medicine and Rehabilitation: Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. The study lead, Dr. Dale Needham, MD, PhD, passionately advocates for the importance and necessity of physical therapists and early mobility within ICU’s for individuals with critical illness. Independently, the results of that quality improvement study are also profound:

Results: Compared with before the quality improvement project, benzodiazepine use decreased markedly (proportion of MICU days that patients received benzodiazepines [50% vs 25%, P=.002]), with lower median daily sedative doses (47 vs 15 mg midazolam equivalents [P=.09] and 71 vs 24 mg morphine equivalents [P=.01]). Patients had improved sedation and delirium status (MICU days alert [30% vs 67%, P<.001] and not delirious [21% vs 53%, P=.003]). There were a greater median number of rehabilitation treatments per patient (1 vs 7, P<.001) with a higher level of functional mobility (treatments involving sitting or greater mobility, 56% vs 78%, P=.03). Hospital administrative data demonstrated that across all MICU patients, there was a decrease in intensive care unit and hospital length of stay by 2.1 (95% confidence interval: 0.4-3.8) and 3.1 (0.3-5.9) days, respectively, and a 20% increase in MICU admissions compared with the same period in the prior year.

Conclusions: Using a quality improvement process, intensive care unit delirium, physical rehabilitation, and functional mobility were markedly improved and associated with decreased length of stay.

  • Early mobility in acute care. It’s important.
  • The physical therapist in acute care. A vital part of the care team.
  • Looking beyond function to conceptualize and understand the impact of the physical therapist? Necessary.

So, you think you can walk? #AcutePT

All you do is walk people! Are you going to walk Mrs. Smith? Are you getting Mr. Johnson up? You don’t have to think in acute care!

In my opinion, the role of the physical therapist in acute care hospitals has some of the most profound & robust reasoning and logic. In addition, clinical research evidence continues to illustrate the positive benefit of physical therapists within acute hospitals for individuals who have had total joint replacements to the most critically ill individuals in intensive care units. The Physical Therapy Journal special issue on Rehabilitation for People with Critical Illness inspired me to discuss acute care practice in more depth. Despite the complex, fast paced environment and short lengths of stay, physical therapists continue demonstrate value in regards to patient outcomes, hospital throughput and flow, and risk reduction. The acute care environment is bursting with opportunity for physical therapists to enact meaningful change through innovative practice models and health care changing research.

Yet, the above are common statements and questions the acute care physical therapist must routinely face. Unfortunately, the skills, knowledge, role, and contribution of the acute physical therapist is misunderstood not just by other healthcare professionals within and outside the hospital environment. Equally as important, is the misunderstanding of physical therapist colleagues who practice in other settings.

In the editorial Acute Care Physical Therapist Practice: It’s Come a Long Way physical therapy journal editor Dr. Rebecca Craik, PT, PhD, FAPTA comments:

“Should Physical Therapists Practice in Acute Care Settings?” That was the 2007 topic for the Rothstein Debate, an annual event held at APTA’s conference and exhibition and established to honor PTJ’s esteemed Emeritus Editor in Chief Jules M. Rothstein (1945–2005).

 Dianne Jewell, PT, PhD, FAPTA, was moderator. Anthony Delitto, PT, PhD, FAPTA, and Charles Magistro, PT, FAPTA, argued for and against the need for physical therapists in the acute care setting. On one side, the physical therapist was characterized as a sophisticated decision maker with a breadth of knowledge that spanned medicine and physiology; on the other side, the physical therapist was characterized as just another clinical staffer who “dragged” patients down the hall.

The session was filled to capacity with approximately 300 people; the tension was palpable, the debaters articulate—but tempers were kept in check. The debate was declared a draw. I still recall my surprise that day at learning about the paucity of research on acute care practice:

1. The clinical decision-making process touted as complex by the “pro” team had not been described in the literature.

2. Responsive outcome measures had not been agreed upon.

3. Clinical trials had not been conducted to compare different interventions in that setting.

4. Cost-effectiveness had not been examined.

Today, in my opinion, I feel asking whether physical therapists belong in acute care shows a gross misunderstanding for the history and future of the physical therapy profession generally and the role of the acute care practioner specifically. Where is the recognition and assessment of the logic, rationale, and research behind acute care practice? My hope is that this debate topic was purposefully chosen to expose physical therapists to the acute care practice environment. Dr. Craik contends it inspired action. Acute care research and investigations since that debate have grown tremendously in both number and quality.

What are the physical therapist’s roles in acute care?

The obvious role of the physical therapist is to examine and evaluate a patient within the International Classification of Functioning, Disability, and Health (ICF Framework) to determine current and future need for rehabilitation, appropriate discharge location, equipment needs, and current functional level. Specific impairments of body structures and function, activity limitations, and participation limitations can be identified. Physical therapists can then also prescribe mobility and movement recommendations which I like to term “movement medicine.” This conceptualization of acute care practice, while accurate, is overly simplistic. For many, this is where their understanding and conceptualization of #acutePT ends.  In fact, it only represents a minute fraction of the effect and role of PT.

Beyond Function…

The profound effect that physical therapists can have in the acute care environment extends far beyond function and mobility. When analyzing the acute care practice environment from the outside many often ask if specific physical therapy interventions are effective from a functional, patient outcomes standpoint. While valid, this narrow scope does not fully encompass acute care practice.

The role and effect of the physical therapist’s presence, input, and treatment (generally and intervention content specifically) needs to be analyzed from multiple perspectives. Various metrics need to be assessed. Outcomes from multiple levels of the care and delivery process from the individual patient to the specific unit to the hospital to the entirety of the healthcare system need to be analyzed. This includes not only function and functional improvement, but current and future costs of an episode of care. No doubt, patient performance and function including future functional status and time to accomplishment of functional milestones are vitally important. But, length of stay, readmission rate, proper/safe discharge location, and reduction of medical complications are all important outcomes to patients, hospitals, and the healthcare system.

Physical therapist’s presence, guidance, and treatment can actually reduce the risk of adverse medical events including pneumonia, blood clots, readmissions, and longer lengths of stay. They may have an impact on hospital costs, future medical costs, overall healthcare costs and morbidity. These are important outcomes metrics. Taking a function only approach to acute care physical therapist practice and research may be detrimental. For example, a study may show that the functional outcome of a patient population treated by a physical therapist resulted in minimal improvements in function at hospital discharge. But, what if the same study illustrated that the treatment drastically lowered the incidence of pneumonia. Is that an outcome of interest to patients, physicians, hospitals, and health care administrators? A retrospective study illustrated physical therapists make accurate and appropriate discharge recommendations. More interestingly, when actual discharge location did not match the therapist recommendation the odds of readmission were 2.9 times higher than when the actual discharge matched therapist recommendation.

Physical therapists act not only as treating clinicians, but valued consultants (or a consulting service) in the acute care hospital. In a qualitative study of acute care practice the authors discuss acute care physical therapist practice in the evolving healthcare and hospital environment

According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, the number of hospital days of care for patients of all ages was 226 million in 1970 compared with only 166 million in 2006. Similarly, the average length of stay was 7.8 days in 1970 and 4.8 days in 2006. Today’s hospital environment is one where patients are admitted for procedures, invasive medical management, and surgical interventions while longer-term healing, recovery, and rehabilitation occur elsewhere.

As a result, questions have been raised regarding the relevance of physical therapist intervention and management, commonly associated with the more lengthy rehabilitation phase of care, being delivered in such a fast-paced setting. The responses of the physical therapists interviewed in the study by Masley and colleagues suggest something else is occurring. The themes of this article and previous studies regarding the role of the physical therapist seem to demonstrate that physical therapists have evolved to becoming valued professional consultants who provide a unique, essential perspective, rendering them integral contributors to the acute care team. Today’s physical therapists specialize in evaluating and managing the patient’s functional mobility needs and, within that scope, serve as both consultants and effective transitional care providers.

Communication and Advocacy

Inter-professional communication is an ongoing necessity within the acute care hospital. Physical therapists are routinely interfacing with nurses, physicians, case managers, social workers, and other hospital staff. Acute care physical therapists are positioned to find and fight for allies outside the physical therapy profession. Emergency medicine and critical care physicians are recognizing the skills, expertise, and contribution of physical therapists. From coast to coast, they are advocating for physical therapists within and outside hospital walls resulting in development of innovative clinical programs and lines of research. Physical therapists are routinely a part of trans-disciplinary programs to improve patient care and outcomes. Through their physical location within a hospital setting, acute care physical therapists can leverage knowledge, skills, and expertise to promote and advocate for the entire profession of physical therapy.

Where’s the evidence?!?!

Recently, on twitter, a #DPTstudent tweeted that acute care had the least amount of supporting research. One of the reasons for this perception, I believe, is that much of the evidence supporting physical therapist practice in acute care is published in non-physical therapy specific journals such as Critical Care Medicine, Chest, and the Archives of Physical Medicine & Rehab. For example, Critical Care Medicine published an entire supplemental issue on Intensive Care Unit-Acquired Weakness (ICU-AW). But, the Journal of Acute Care Physical Therapy and Cardiopulmonary Physical Therapy Journal are still fantastic resources (by jennifer). As I outline in the Leveraging Technology Series post Selection of Content, we must read outside of the physical therapy specific literature. So far, I have discussed some of the rationale, which is vital, but what has research illustrated?

Total Joint Replacement
A study investigated the effect of immediate postoperative physical therapy on length of stay for total joint arthroplasty patients illustrating that “Isolated PT intervention on POD 0 shortened hospital LOS, regardless of the intervention performed.” A study published way back in 1993 illustrated that receiving weekend treatment by a physical therapist correlated with decreased length of stay following joint arthroplasty.

Emergency Department
I have written before about the emergence of physical therapists in the emergency department. Preliminary data illustrates potentially improved patient satisfaction with care and shorter wait times when physical therapists are present in the ED. In addition, physicians practicing in emergency medicine have recognized the expertise and contribution of physical therapists in a variety of conditions including painful problems, musculoskeletal conditions, dizziness, and overall mobility/safety/discharge determination. An article in PTJ discussed the development of this novice practice venue.

Intensive Care Units
Intensive Care Units cater to patients with the most serious injuries and illnesses, most of which are life-threatening and need constant, close monitoring and support from specialist equipment and medication in order to maintain normal bodily functions.”

Early mobility and physical therapy has been shown to be not only safe, but feasible in the individuals who require mechanical ventilation. A randomized control trial investigating early physical therapy and occupational therapy in critically ill mechanically ventilated patients concluded that not only was early physical therapy treatment safe and well tolerated early on in a critical illness course, but resulted in better short term functional outcomes and less delirium. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project  demonstrated with “hospital administrative data…that across all MICU patients, there was a decrease in intensive care unit and hospital length of stay by 2.1 (95% confidence interval: 0.4-3.8) and 3.1 (0.3-5.9) days, respectively, and a 20% increase in MICU admissions compared with the same period in the prior year” And earlier this year, a systematic review on early mobility in the intensive care unit was published.

Response Dependent Progression

Back to some of the original questions. Well, so what? All you are doing is helping people get up and walk around. Can’t a nurse assistant do that? In a study of mobilization level in a surgical intensive care unit it was found that physical therapists mobilize their patients to a higher level than nurses.  And, sometimes sitting ain’t easy. What appears simple procedurally often involves complex knowledge and decision making. A gentle manual technique may require a complex reasoning process and constant assessment of patient response. Similarly, in acute care the decision to sit up, stand, transfer, or ambulate requires the integration of physical therapy specific principles with knowledge of medical conditions, medical management, pharmacology, and pathophysiology. Mobility and therapy progression (within and between session) is based upon the principle of response dependent progression which necessitates integrating the previous knowledge with the patient’s current presentation/functional status while constantly monitoring physiologic status (vital signs), patient performance, and patient feedback (fatigue, shortness of breath, and other symptoms). The acute care physical therapist must assess and integrate complex information from various sources. Much of this information is dynamic in nature requiring constant integration and re-assessment…

So, you think you can walk?

Do you MOOC?

In a recent article in the NY Times entitle, “The Year of the MOOC,” writer Laura Pappano describes an exciting, ongoing disruption in education. MOOCs, or Massive Open Online Courses, are quickly becoming the next big thing. I’ve taken or am taking several of these and I very much enjoy the learning process. The ability to engorge your mind with such high-quality content is unmatched. However, don’t think this is simply sitting back and getting fed information. These courses, usually mirrors of the on-campus versions of the courses, can be a lot of work!

There are obvious implications for healthcare within this framework. In fact, the University of Texas System recently joined up as a main partner with EdX, a collaborative including Harvard, University of California Berkley, and MIT. In their press release on the matter, the UT office spoke directly to the idea of including health-based offerings on the EdX platform.

The UT System brings a large and diverse student body to the edX family. Its six health institutions offer a unique opportunity to provide groundbreaking health and medical courses via edX in the near future. The UT System also brings special expertise in analytics – assessing student learning, online course design and creating interactive learning environments.

Within the next year, expect to see MOOCs being offered with options to pay for credits. Within the next few years, expect to see a wholly different educational environment that what we have today. University education is set to undergo a rapid evolution. Here’s to hoping this evolution occurs consistent with the traditionally high standards that have always existed, and here’s to hoping physical therapists can find a way to educate more than just future PT’s using such tools. It’s a clear opportunity for worldwide advocacy.

#IFOMPT12 – Day 1 Summary


Just sitting lying here in the hotel room reflecting on an excellent day of programming. I was able to attend and live blog from these seven sessions, take home messages summarized here:

“Management of cervical spine disorders: Where to now?” by Gwen Jull

  • Creating classification schemes for treating patients with neck pain is a slippery slope
  • Using one patient example we can easily construct over a million subgroups
  • Teaching entry-level DPTs may require black and white concepts, but clinical reasoning resides in the gray

“Knowledge Transfer in the Age of Information Technology” by Stuart Gowland

  • Telemedicine is revolutionizing renal surgeries in remote locations in the south pacific
  • Operating rooms can be mobilized in buses that can reach remote areas of NZ
  • The quality of video is very important when it comes to broadcasting

“Motor Control of the Knee”

  • Manual therapy did not modulate spinal excitability in patients with knee pain
  • Resting knee pain was reduced in patients with knee OA following manipulation
  • To maintain the gains in knee ROM following 6 weeks of stretching, the patient must continue stretching 3 X per week

“Understanding Cervical Muscle”

  • Patients with whiplash assoc disorder (WAD) have impairments in lengthening and shortening of deep neck flexor muscles as quantified using ultrasonography
  • Detailed dissection of cadaver neck flexors revealed strong adherence of the muscles to the bones, not like drawings in Gray’s Anatomy

“Physiotherapists/ Physical therapists’ role in exercise prescription & “Exercise is medicine”” by Karim Khan

  • More people die in the USA as a result of low exercise than smoking, diabetes, and obesity – COMBINED
  • You must appeal first to the emotions of your patient, then use simple statements to effect changes in their behavior

“Tendinopathy task force – guideline development” by Alex Scott

  • It takes 17 years to get 14% of research findings adopted into clinical practice
  • CPG are viewed as too restrictive by clinicians

“Biological mechanisms of dizziness” by J Treleaven, E MajMalmstrom, R Landel

  • The neck is very unique, not just a muscular joint but a major sensory organ
  • Multimodal therapy is a great approach for treating these patients
  • Postural stability is impaired in patients with neck pain
  • Put frickin’ lasers on the heads of your patients! (Dr. Evil Voice)
  • Treat the neck like you would a sprained ankle

Off to bed, catch you all at 8AM with live blogging of Joy MacMacDermid!

#IFOMPT12, here we come!

Quebec City Aerial | flickr user Andos_pics


The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT <- say it, it’s fun!) will be happening very soon (Oct 1-5) in Quebec City, Canada. Specific details on the Conference Website.

The conference will showcase some of the most up-to-date information by the leaders in manual therapy. It is an opportunity not to be missed. You may not be able to attend, but fortunately the 21st century offers many ways for you to learn and to engage with those attending:

Live Blogging

Live-blogging is live coverage of an event as it happens. The correspondent sitting in the lecture hall can share quotes from the speaker, links to relevant websites, photos, and more. The service we will use is called CoverItLive. You can check out their current event listings and view a live event right now to get a flavor of what this is like. You can also scroll through a transcript of the coverage of an event after it has concluded, here is an example from CSM2012. The best part of watching a live blogged session is your ability to contribute to the discussion remotely!

Replay Transcript
Replay Transcript


PTTT contributor Mike Pascoe had a successful pilot experience live-blogging five sessions from CSM2012 and is ready to step up his game for IFOMPT2012! We have dedicated a special page of PT Think Tank to IFOMPT Live Coverage. Mike Pascoe will be live-blogging all day, every day! Head over to the page and look at the sessions Mike Pascoe is planning on live-blogging. You can even sign up to receive email reminders a specified amount of time ahead of the event:

Setup an event reminder
Setup an event reminder



Official conference handle: @IFOMPT2012

Conference hashtag: #IFOMPT12

Are you using twitter to network before arriving at IFOMPT?



Official conference blog

PT Think Tank, of course!


Au revoir!

Looking forward to meeting you in Canada and interacting with you on the web…

Term & Title Protection for the #PhysicalTherapist & #PhysicalTherapy

APTA Term Protection Ad

The American Physical Therapy Association recently constructed a Term and Title Resource Center regarding the use of the terms physical therapy and physiotherapy as well as the titles physical therapist, physiotherapist, PT, DPT, and MPT.

They have even constructed a 1 page advertisement, that I think is actually rather clever. The APTA announces

The full-page color advertisement will run in future editions of State Legislatures magazine, the monthly publication of the National Conference of State Legislatures which is provided to state legislators, legislative staff, and other state policy makers in all US jurisdictions.

I commend the APTA for their efforts and resources, which are no doubt, an important step. And, there have been some victories. Virginia successfully enacted term protection for physical therapy and title protection for physical therapists.

Unfortunately, physical therapists are currently losing this battle on both the legislative (lack of term protection laws), but just as importantly, the judicial level. In 2010, the Washington State Supreme Court issued an impactful ruling that dealt specifically with physician owned physical therapy services (POPTS). But, the ruling also has significant ramifications for the use of the term physical therapy.  Details about the ruling can be found in an APTA released statement. The Kentucky Supreme Court issued a similar opinion.

The Washington State Supreme Court Opinion states:

Physical therapy is one aspect of the practice of medicine. The practice of medicine is defined by RCW 18.71.011(1) as ‘[o]ffer[ing] or undertak[ing] to diagnose, cure, advise, or prescribe for any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary, by any means or instrumentality.’ This broad definition readily encompasses all the acts constituting the statutory definition of the practice of physical therapy.

Ouch. But, it gets worse. The Washington State Medical Association exclaimed “Big Win in Supreme Court!!!” following the ruling. They continue:

The decision represents a victory for physicians and medical practices, not only because it is now clear they can employ physical therapists, but because an adverse ruling could have outlawed their employment of other licensed health care professionals (such as nurses).

Double ouch. The ruling as well as the medical community’s reaction clearly illustrate that legislators, the judicial system, and physicians do not view physical therapy as a unique profession nor physical therapists as skilled, collaborative, unique members of the healthcare team. It appears physical therapy continues to be viewed as a prescribed or provided modality with physical therapists as mere technicians or employees under the physician umbrella.

We either need to more aggressive with our formal national, state, and local legislative lobbying and education (including legislators,  patients, colleagues, etc), or we we need to seek and secure allies within the medical and healthcare community, including but not limited to physicians. I vote for both.

What are you doing to #SolvePT? What should we do at the grassroots level?


Term and Title Resources via the American Physical Therapy Association
Term Protection Advertisement/Handout
Physician Owned Physical Therapy Services (POPTS) and Referral for Profit via AAOMPT Student Special Interest Group Blog
APTA Statement on WA Supreme Court Decision
WA Supreme Court Decision and Statement
Virginia Term Protection
Kentucky Court Ruling Information[/list]

Osteopractor™ Invokes Ire of AOA

Earlier this week, I stumbled across this filing with the U.S. Patent and Trademark Office. It is a notice of Trademark infringement alleged by the American Osteopathic Association (AOA) and its component boards against James Dunning, concerning the use of the term, Osteopractor™, which has been commented on before at this blog.

In the filing, the AOA states:

Applicant’s mark so resembles Opposer’s previously used and
registered marks as set forth above as to be likely, when applied
to the services set forth in Applicant’s application, to cause
confusion, mistake, or deception or to comply that Applicant was
certified or approved by Opposer within the meaning of Section
2(d) of the Trademark Act.

There is, of course, a retort from the accused stating that they disagree. This will be interesting to watch as this debate unfolds.

On a somewhat related note, I find the architecture of the U.S. Patent and Trademark Office to be quite nice.


If You’re Going, You Might As Well Get There

[list][/list]Sometimes, it’s pure and simple logic that prevails as the best solution to something. This was the case in an important new study published ahead of print in Spine. You may have seen the presser released by APTA, AAOMPT on the matter. They’re exuberant, and they should be. Well, mostly.

The study, published by Drs. Julie Fritz, John Childs, Rob Wainner, and Tim Flynn, examined a payor database and looked at over 32,000 data sets of patients with low back pain with the purpose of describing physical therapy utilization in primary care settings. Further, they looked at both associated healthcare costs and the question of whether the physical therapy care being provided was either adherent with practice guidelines for an active treatment or non-adherent. Treatments were classified as non-adherent when they included things like ultrasound that are not proven interventions for patients with low back pain. While not a perfect practice, the researchers used billing codes as their determination factor for treatment adherence.

The findings of this study are fascinating to me. Albeit, many public health studies that look at low back pain and care patterns and/or costs are fascinating to me, so I’ll let you be the judge.

The key findings of the study were:

[list style=”circle”]

    • For patients receiving physical therapy, early referral (within 14 days) was associated with less overall healthcare utilization, which included lower use of surgery, fewer doctor visits, less injections, and less advanced imaging that those with delayed referral (14-90 days).
    • For patients receiving adherent care, overall health utilization was also lower, but to a lesser degree that that seen with the early referral group.



Graph demonstrating health utilization costs related to low back pain. Series 1 is costs for patients in early referral (gray) vs. delayed (orange). Series 2 shows costs for adherent care (gray) vs. non-adherent care (orange).


As you can see by the graph above, significant savings were realized by early referral to physical therapy and by adherent physical therapy care. Logic sure does shine forth here. If you’re going to go somewhere, well you might as well just get there. Significantly, the finding in this study is important because it runs counter to the suggestions by many LBP practice guidelines that suggest primary care physicians delay referral to other services as many patients are likely to improve anyway. Overall trends to reduce the medicalization of LBP are important, but this study reflects a trend whereby physicians are referring about half of patients to physical therapy within 14 days anyway. It turns out, this may end up being an evidence-supported practice.

Not all was rosy, however. Here are some other findings that were important:

Overall patient data sets and 7% utilization for patients with low back pain.


[list style=”circle”]

    • Overall utilization for physical therapy for patients with low back pain in this data set was only 7%.
    • Overall healthcare costs were higher for patients receiving physical therapy. This might reflect increased severity, co-morbidities, etc, we just don’t know.
    • Only 21% of the physical therapy care provided was able to be classified as adherent. This could reflect an imperfect measuring tool, but I suspect there’s a problem here.
    • Wide geographic variability persists in the management of LBP, including physical therapy utilization and adherence to guidelines.


This study is full of many other gems. It’s gated at Spine, so apologies for not including a full text link. The good new: Spine is a huge journal and this will be seen. As with many studies, this leaves more questions to ask. Such as, what factors make the patients who are referred early have lower subsequent utilization. The authors hypothesize it may have to do with the concept of self-efficacy. I like it.

I like it so much, in fact, that I’m involed in a related study with some of the authors to examine a similar question in a Department of Defense database. I’m eager to see what we find.

This study was jointly funded by grants from the Orthopaedic and Private Practice sections of the APTA, AAOMPT, and a faculty research grant from Texas State University.

APTA Vision 2020: What’s your grade?

Alan Besselink, blogger and Austinite extraordinaire has written a thoughtful post entitled, “APTA’s Vision 2020: My 12 Year Report Card.” In the post, Alan breaks down the components of Vision 2020 and provides his summary of the progress toward each.

To review, here’s the Vision 2020 statement from the APTA:

“By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.”

I’m sure certain parts of this resonate more with different folks. For Alan, the issue of Direct Access takes center stage. I agree with his critique of the APTA PR machine, which labels 40 something states as having some form of direct access to physical therapists…while in actuality, many of those states are not very gate-keeper free at all. Alan points out that the state we both practice in, Texas, is listed as a Direct Access state by APTA. I consider that false.

Here are Alan’s grades for each section:

  • Autonomous Practice: F
  • Direct Access: F
  • Doctor of Physical Therapy and Lifelong Education: F
  • Evidence-based Practice: F
  • Practitioner of Choice: F
  • Professionalism: A
  • Overall: F


Now, I’m not sure I agree with Alan on all of these grades (specifically the EBP and DPT grades), but he makes a good argument for each of his choices in his post. My question to you is, what do you think about the progress we’ve made on Vision 2020. As Alan points out, “As they say, if you do what you’ve done, you will get what you’ve got. Sadly, what we’ve got isn’t much different than what we had 12 years ago.” This may be a good opportunity to take stock and make some changes in strategy before we get too close to 2020 to change!

[icon style=”notice”]I’ll summarize the results of this poll in another post prior to the APTA Annual Conference.[/icon]

How do you Grade APTA Vision 2020 Progress

Physical therapist Blogger, Alan Besselink has already submitted his grade. What's yours?

Alphabet Soup Redux

Credential Soup word cloud

In 2009 at the Annual Meeting and Exposition of the American Physical Therapy Association in Baltimore, MD, the Oxford Debate took up the issue of alphabet soup. The issue debated was, “Are the use of multiple credentials a distraction or an attraction to our profession?” The team in favor of eliminating the excessive use of credentials included, Robert Landel, PT, DPT, OCS, CSCS; Stephen C. F. McDavitt, PT, DPT, FAAOMPT, and Robert H. Rowe, PT, DPT, DMT, MHS, FAAOMPT. A well-credentialed bunch, indeed.

I recall siding with that team, as I have always had an eye toward PR and branding and consider too many credentials as being bad for a brand. Successful branding includes paying attention to your brand’s identity, as Philip Davis points out in this well-crafted blog post. This can be anything from making sure your fonts and colors are the same to making sure you dress according to how you want your brand to be perceived. If fonts and colors are important, a myriad of obscure credentials are most certainly critical as well.

This weekend’s visceral debate on Kyle’s post brought this larger issue to the forefront once again. What do you think about this issue of alphabet soup? Join the #SolvePT discussion tomorrow, hosted by @SnippetPhysTher.

[icon style=”notice”]Update: Check out the summary of the tweet chat on 5/22/12 here. [/icon]