Guest guest Posted October 1, 2011 Report Share Posted October 1, 2011 Your Daily Posterous Spaces Update October 1st, 2011 Tailored Care Of Back Pain More Cost-Effective<http://ptmanagerblog.com/tailored-care-of-back-pain-more-cost-eff\ ectiv> Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73235540> Tailored Care Of Back Pain More Cost-Effective Embedded media -- click here to see it.<http://ptmanagerblog.com/tailored-care-of-back-pain-more-cost-effectiv> Featured Article Academic Journal Main Category: Back Pain<http://www.medicalnewstoday.com/sections/back-pain/> Also Included In: Primary Care / General Practice<http://www.medicalnewstoday.com/sections/primary_care/> Article Date: 30 Sep 2011 - 2:00 PDT New research that compares a more tailored or stratified management of back pain <http://www.medicalnewstoday.com/articles/172943.php> by general practitioners (GPs) in primary care with the current " one size fits all " standard approach finds it could be more effective for patients and also cost less. You can read how the UK-based trial came to this conclusion in the 29 September online issue of *The Lancet*. In the UK, about 9% of adults goes to see their GP every year because of back pain. Under the current primary care strategy, which promotes a standard approach regardless of the level of severity of the condition, as many as 80% of these patients are still reporting pain or disability 12 months later. Lots of studies have reported the benefits of various treatments, including cognitive behavioural therapy and exercise-based approaches, but none has looked at them in terms of which therapies benefit which patients, suggesting there may be room for efficiency improvements in the primary care management of back pain. In this study, Dr C Hill from the Arthritis Research UK Primary Care Centre at Keele University in Stoke-on-Trent, UK, and colleagues report how they carried out the STarT Back trial designed to compare the clinical and cost effectiveness of stratified management to current best practice. In the stratified approach, patients fill in a simple screening questionnaire that allows their low back pain to be assessed according to estimated risk of persistent disability: low, medium or high risk. Treatment is then tailored to each of these groups. In this study, a low risk patient was given a minimum of one consultation session where they received advice on activity, exercise and returning to work. The medium risk patient received the standardized physiotherapy<http://www.medicalnewstoday.com/articles/160645.php>that is included in the one size fits all approach, while the high risk patient received physiotherapy enhanced with psychological advice. The participants were 851 adults with back pain whom the researchers recruited between June 2007 and November 2008. They had been to see their GPs at ten different surgeries in England. They were randomly assigned to receive either stratified care (568 patients), or to be in a control group (283) that received the current best practice comprising advice, exercise and manual therapy given by qualified physiotherapists. To measure outcomes, the researchers asked the participants to fill in the Roland and Disability Questionnaire. This assesses the extent to which treatment relieves pain and improves ability to function. The researchers also calculated the costs of the two approaches, both in terms of estimated healthcare moneys spent, and quality adjusted life years (QALYS). The results showed that at 4 months and also at 12 months, the patients who received stratified care showed a significant improvement on the disability scores compared to the controls. Also, at 12 months, the stratified care group reported lower levels of fear, depression <http://www.medicalnewstoday.com/articles/8933.php> and higher levels of general health. They were also significanlty more likely to be satisfied with the treatment they received at the 4 month point, and they had lower absence rates from work due to back pain over the 12 month period than the controls. For the costs, the researchers found stratified management was more beneficial and cost less than the average health care cost, with an average saving of £34.39 per patient compared to the best practice received by the controls. " At 12 months, stratified care was associated with a mean increase in generic health benefit (0·039 additional QALYs) and cost savings (£240·01 vs £274·40) compared with the control group, " they write. They conclude: The results of this trial provide the first evidence that a stratified management approach to target the provision of primary care significantly improves patient outcomes and is associated with substantial economic benefits compared with current best practice. " " The findings of this study represent an important advance in primary care management of back pain, and have important implications for commissioners and providers of services for back pain, " they add. In an accompanying comment, Bart Koes from Erasmus University Medical Centre, Rotterdam, The Netherlands, describes the results as " very promising " . He says they show the stratified approach is cost-effective and sees no financial reason why it should not be adopted: " Clinicians and researchers now face the challenge of implementing and further optimising the new approach, " he adds. Arthritis <http://www.medicalnewstoday.com/articles/7621.php> Research UK funded the trial, which was was carried out from the Primary Care Centre at Keele. via medicalnewstoday.com<http://www.medicalnewstoday.com/articles/235270.php> #Physicaltherapist Pet Peeve #1 | MyPhysicalTherapySpace.com<http://ptmanagerblog.com/physicaltherapist-pet-peeve-\ 1-myphysicalthera> Posted about 19 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=73258135> September 30, 2011 #Physicaltherapist Pet Peeve #1 From MyPhysicalTherapySpace.com<https://www.google.com/reader/view/feed/http%3A%2F%2F\ feeds.feedburner.com%2FEvidenceInMotion> by Larry Benz > > In the next several posts, I am going to outline my biggest professional > pet peeves. #1 is easy, I hate the term skilled physical therapy and even > the term " physical therapy " is starting to be an irritant. > > The origin of this debacle stems from medicare's language and the > requirement in the certification portion of the plan of care (which in and > of itself is also a major pet peeve) that requires that the medical needs of > the patient are such that they require " skilled " services. The intent is to > differentiate that the services are not maintenance. Oddly enough, there is > legitimate debate and legal work which is defending the rational for > providing maintenance services to medicare patients because it prevents > downstream problems and costs but that's another post for another time. > Unfortunately, within our own profession " skilled physical therapy " has > taken on a life of its own. > > The rational is that if a non physical therapist (e.g. technician) is > performing a service under direct supervision of a PT that the service is > not " skilled " and therefore it is not physical therapy and therefore should > not be reimbursed. Medicare took this too an extreme and released an > explicit provider list that requires all services be performed by a physical > therapist or a physical therapist assistant. Many within our own profession > and even within our national association have tried to make this the > standard. The famous RC-3<http://blog.myphysicaltherapyspace.com/2011/04/accountability-in-physicalth\ erapy-rc-03-11.html>which passed overwhelmingly is one step to unravel that mess. We can only > hope that somebody at CMS applies a more logical stance to their > hypocritical rule. > > CMS has extensive language about PT's and PTA's<http://www.medicarenhic.com/providers/pubs/Physical%20and%20Occupational%2\ 0Therapy%20Guide.pdf>. > It aptly defines a physical therapist and even refers to their scope of > authority " in accordance with state laws " . CMS also define's clinician " to > refer to only a physician, nonphysician practitioner or a therapist (but not > to an assistant, aide or any other personnel) " . Understandably, the > definition of a clinician does not include physical therapy assistants. So > the first question you have to ask is why in their explicit provider rule do > they include a clinician and a non-clinician? Why doesn't it include other > non clinicians who while under direct supervision of a physical therapist > are allowed under most state practice acts? Perhaps more to the point, CMS > states that PTAs " may not provide evaluation services, make clinical > judgments or decisions or take responsibility for the service. They act at > the direction and under the supervision of the treating physical therapist > and in accordance with state laws. " Therefore, are we to believe that > " skilled physical therapy " is provided by a non clinician who cannot provide > clinical judgement? Which brings me back full circle to the whole pet peeve > of " skilled physical therapy " . (side note: don't kill the messenger here, I > am only reporting CMS' own language). > > If we use the term " physical therapist's care " there is clearly an > impression of skill, clinical judgement, licensure, clinician, and > authority. We have made the term " physical therapy " so generic that its > meaning is ambiguous and it has become an interchangeable part for non > clinicians like physical therapy assistants, ATC's, techs, personal > trainers, and exercise physiologists (whoever they are). Attaching the > term " skilled " in front of it has made it more marginalized since it is > literally care by a non-clinician who cannot make clinical judgements. Yet, > we even have a large faction saying that it the care even if under direct > supervision of a PT is rendered by other non-clinicians who cannot provide > clinical judgements it is not skilled therefore it cannot be reimbursed. > Sound absurd? You bet. > > There is an antidote. Let's get rid of the term physical therapy when the > context should be physical therapist or care by a physical therapist. The > implication of physical therapist's care would always paint the > responsibility of the patient to their PT who is liable. This is very > similar to physicians who clearly are responsible for the patients care > regardless of who took the blood pressure, temperature, or filled the > syringe with medication. When we use the term physical therapy it is > unfair to the educational rigor and knowledge attainment by the professional > responsible. The emotional argument about restricting delegation and > direction of care by the physical therapist is always based on a perceived > notion of abuse and a perverse incentive to use only technicians for > financial reasons. Can't we agree that there already exists lots of abuse > by over using non clinicians who cannot provide medical judgement doing > physical therapy including physical therapy assistants who practice without > on-sight direction and supervision? Can't we create a cultural shift via a > re-branding effort to always point to the physical therapist as the > lynchpin <http://www.thefreedictionary.com/linchpin>? isn't that what a 7 > year doctoring profession and vision 2020 is all about? > > I know that I am going to try my best to promote in this manner. We market > heavily and promote that patients have their own personal or family physical > therapist. Rory Mcilroy who hurt his wrist in a recent golf tournament had > his personal " physio " come out and take a look<http://www.sbnation.com/2011/8/11/2357844/rory-mcilroy-injury-update-wrist-\ pga-championship-medical-attention>. > Heck, even Cher recently sent her physical therapist<http://www.stuff.co.nz/entertainment/celebrities/5700964/Chaz-Bono-Che\ r-fears-for-my-health>to to take care of her son who injured his knee on Dancing with the Stars. > > Wouldn't a name change to American Physical Therapist Association make more > sense? Just doing a small part and changing to hash tag #physicaltherapist > is a small step in the right direction. Lastly, this post is in no way > intended to denigrate physical therapy assistants and other non clinicians > who clearly play an integral role in a physical therapist's care of a > patient. > Thoughts? > > > @physicaltherapy (trying to change to @physicaltherapist) via blog.myphysicaltherapyspace.com<http://blog.myphysicaltherapyspace.com/2011/09/p\ hysicaltherapist-pet-peeve-1.html?utm_source=feedburner & utm_medium=feed & utm_camp\ aign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29> [image: Posterous] <http://posterous.com> Want your own?<http://posterous.com> Change your email settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\ xkgmH> Quote Link to comment Share on other sites More sharing options...
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