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On May 25, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a decision memo establishing coverage for supervised exercise therapy (SET) for Medicare beneficiaries experiencing intermittent claudication due to peripheral artery disease (PAD). A meaningful impact on population health is possible with greater freedom to participate in regular physical activity. The authors of this editorial explain the potential roles of physical therapists in the SET program and argue for further integration of physical therapists through collaborative practice. J Orthop Sports Phys Ther 2017;47(12):892-894. doi:10.2519/jospt.2017.0111.

Members of the physical therapy profession have had a long-standing reputation as the “white hats” in health care. Our message has intuitive appeal--we deliver recovery, restoration, and re-engagement when disease and injury threaten to steal people's health and well-being. The socioeconomic

BackgroundThe Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited.ObjectiveThe primary purpose of this study was to determine the use of quality indicators in physical therapist practice.DesignThis was an observational study.MethodsAll members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use.ResultsParticipants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%–51.3%) and use of standardized measures (5.5%–35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques.LimitationsThe survey was not assessed for test-retest reliability. A low response rate was a source of potential bias.ConclusionThe study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

Background Several factors have been shown to influence first-time pass rates on the National Physical Therapy Examination (NPTE). It is unclear to what extent academic difficulty experienced by students in a physical therapist education program may affect NPTE pass rates. The effects of institutional status (public or private) and Carnegie Classification on NPTE pass rates also are unknown. Objective The aim of this study was to quantify the odds of failure on the NPTE for students experiencing academic difficulty and for institutional status and Carnegie Classification. Design This investigation was a retrospective population-based cohort study. Methods Quota sampling was used to recruit a random sample of 20 professional physical therapist education programs across the United States. Individual student demographic, preadmission, and academic performance data were collected, as were data on program-level variables and data indicating pass/fail performance on the NPTE. A generalized linear mixed-effects logistic regression model was used to adjust for confounding factors and to describe relationships among the key predictor variables—academic difficulty, institutional status, and Carnegie Classification—and the dependent variable, NPTE performance. Results Academic difficulty during a student's professional training was an independent predictor for NPTE failure. The odds of students who had academic difficulty (relative to students who did not experience academic difficulty) failing the NPTE were 5.89 (95% confidence interval=4.06–8.93). The odds of NPTE failure also varied depending on institutional status and Carnegie Classification. Limitations The findings related to Carnegie Classification and institutional status should be considered preliminary. Conclusions Student performance on the NPTE was influenced by multiple factors, but the most important, potentially modifiable risk factor for poor NPTE performance likely is academic difficulty during professional training.

Background and PurposeThe purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health, pain, and function for patients diagnosed with adhesive capsulitis.ParticipantsData were examined from 2,370 patients (mean age=55.3 years, SD=12.4; 65% female, 35% male) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy.MethodsPrincipal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care. A nested logistic regression model was used to identify intervention categories that predicted a 50% or greater change in Physical Component Summary-12 (PCS-12), physical function (PF), bodily pain (BP), and hybrid function (HF) scores.ResultsNone of the patients achieved a 50% or greater improvement in PCS-12 scores. Improvement in BP scores was more likely in patients who received joint mobility interventions (odds ratio=1.35, 95% confidence interval=1.10–1.65). Improvement in HF scores was more likely in patients who received exercise interventions (odds ratio=1.50, 95% confidence interval=1.03–2.17). Use of iontophoresis, phonophoresis, ultrasound, or massage reduced the likelihood of improvement in these 3 outcome measures by 19% to 32%.LimitationsThe authors relied on clinician-identified ICD-9 coding for the diagnosis. Impairment measures were not available to support the diagnosis, and some interventions were excluded because of infrequent use by participating therapists.Discussion and ConclusionsThese results are consistent with findings from randomized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis. Ultrasound, massage, iontophoresis, and phonophoresis reduced the likelihood of a favorable outcome, which suggests that use of these modalities should be discouraged.

Background and Purpose. The purpose of our study was to determine whether physical therapy interventions predicted meaningful short-term improvement in physical health for patients diagnosed with sciatica. Subjects. We examined data from 1,804 patients (age: X̄=52.1 years, SD=15.6 years; 65.7% female, 34.3% male) who had been diagnosed with sciatica and who had completed an episode of outpatient physical therapy. Methods. Principal components factor analysis was used to define intervention categories from specific treatments applied during the plan of care. A nested-model logistic regression analysis identified intervention categories that predicted meaningful improvement in physical health. Meaningful improvement was defined as a change of 14 or more points on the Physical Component Scale-12 (PCS-12) summary score. Results. Twenty-six percent (n=473) of patients had a meaningful improvement in physical health. Improvement was more likely in patients receiving joint mobility interventions (odds ratio [OR]=2.5, 95% confidence interval [CI]=1.5–4.4) or general exercise (OR=1.5, 95% CI=1.2–2.0). Patients who received spasm reduction interventions were less likely to improve (OR=0.77, 95% CI=0.60–0.98). Discussion and Conclusion. Physical therapists should emphasize the use of joint mobility interventions and exercise when treating patients with sciatica, whereas interventions for spasm reduction should be avoided.

Background This study was conducted to identify which pre- and perioperative clinical parameters were predictive of predischarge submaximal exercise capacity and early postdischarge maximal exercise capacity in cardiac transplant recipients. Methods We studied 24 patients (mean age = 46; 25% African American) who underwent cardiac transplantation followed by an early (immediately posttransplant) postoperative exercise training program. The patients' submaximal exercise capacity was measured at hospital discharge (25 days posttransplant) using the 6-minute distance walk test. Maximal cardiopulmonary exercise testing was done within 4 months of hospital discharge (68 days) to measure peak exercise oxygen consumption (VO2) and to estimate peak exercise capacity as measured by metabolic equivalents (METs). Six clinical variables were assessed for their relationship with predischarge submaximal exercise capacity and 10 clinical variables were evaluated for their relationship with early posttransplant maximal exercise capacity. Results Predischarge submaximal exercise capacity was correlated with postdischarge estimated METs (r = 0.43; P = 0.04). No predictors of predischarge submaximal exercise capacity were identified. Predictors of estimated peak exercise METs following discharge were younger age, longer time since resolution of rejection, and shorter postoperative hospitalization. Younger age was the only predictor of peak VO2. Conclusion Postoperative physical training may improve exercise capacity early after transplantation and minimize effects of preoperative clinical factors that could negatively affect exercise capacity. Interpretation of these results, however, is limited by the small sample and absence of a nonexercising control group. Older recipients, those with a longer length of hospital stay, and shorter duration of time since resolution of rejection may be at risk of reduced early postoperative maximal exercise capacity. Identification of these predictors is important to maximize early reconditioning efforts and plan outpatient rehabilitation.

Background and Purpose: The purpose of this study was to determine whether admissions data could be used to estimate physical therapist student risk for failing the National Physical Therapy Examination (NPTE). Subjects: A nationally representative sample of 20 physical therapist education programs provided data on 3,365 students. Methods: Programs provided data regarding demographic characteristics, undergraduate grade point average (uGPA), and quantitative and verbal Graduate Record Examination scores (qGRE, vGRE). The Federation of State Boards of Physical Therapy provided NPTE data. Data were analyzed using hierarchical logistic regression. Results: A prediction rule that included uGPA, vGRE, qGRE, and race or ethnicity was developed from the entire sample. Prediction rules for individual programs showed large variation. Discussion and Conclusion: Undergraduate grade point average, GRE scores, and race or ethnicity can be useful for estimating student risk for failing the NPTE. Programs should use GPA and GRE scores along with other data to calculate their own estimates of student risk.