Monday, October 1, 2007
Detectives arrested James C. Nackos, 35, on suspicion of burglary, theft and illegal possession of prescription drugs. On Thursday he remained in the Utah County jail without bail.
Nackos is a physical therapist at a Provo clinic. One of Nackos' clients had noticed when she finished her appointments and returned to her car it appeared someone rummaged her purse, said Lt. Rich Ferguson of the Utah County major crimes task force.
The woman's family, armed with a video camera, decided to watch her car while she attended her next appointment, he said. The family members recorded a man who appeared to be Nackos using her keys to enter the car and going through her purse, Ferguson said.
The family reported the burglary to police, and Detective Dan Forster planned a similar sting. On Tuesday, the woman arrived for an appointment again.
Ferguson said the client was inside about 20 minutes when Nackos came outside with her keys and entered the car, taking prescription medication from her purse.
"He's pretty hasty about it," Ferguson said. "He's out of the car pretty quick and we took him down at that time."
It appears Nackos
would occupy the client by having her operate a therapy machine, then he would take her car keys, he said.
"We're pretty curious if there's other victims," Ferguson said.
Nackos pleaded in abeyance in October 2005 to two felony counts of altering a prescription. The convictions were to be voided after 24 months if Nackos did not violate laws. Failing to meet that term puts Nackos at risk of going to prison for as much as five years on each count, but there was no indication Thursday of whether prosecutors or 4th District Court in Provo were planning to take action.
Nackos has had a license to practice physical therapy since 2002, according to the Utah Division of Professional Licensing. State laws list felony convictions or drug crimes as grounds for discipline against professional license holders. Professional Licensing said it has no record of any enforcement proceedings against Nackos, though it's not clear if Professional Licensing was aware of the convictions.
"It certainly is grounds for investigation," said Scott Ward, physical therapy division chairman at the University of Utah and the president of the American Physical Therapy Association. Ward said he was not familiar with the Nackos case.
Hydroxyapatite-Coated Tibial Implants Compared with Cemented Tibial Fixation in Primary Total Knee Arthroplasty
A Randomized Trial of Outcomes at Five Years
1 University of Alberta, Capital Health, 1F1.52 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada. E-mail address for L.A. Beaupré: firstname.lastname@example.org
Investigation performed at Capital Health, Edmonton, Alberta, Canada
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Stryker Canada, Inc. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Background: Although excellent long-term results have been reported with cemented tibial fixation, cementless fixation as a means to improve the longevity of total knee prostheses continues to be of interest to clinicians. The purpose of this study was to compare outcomes between cementless tibial fixation with hydroxyapatite and cemented tibial fixation in the first five years following primary total knee arthroplasty.
Methods: We performed a prospective, randomized clinical trial that included eighty-one patients with noninflammatory knee arthritis who underwent primary total knee arthroplasty when they were less than seventy years of age. The subjects were randomized at the time of surgery to be treated with either cementless tibial fixation with hydroxyapatite or cemented tibial fixation. Evaluations were performed preoperatively and at six months, one year, and five years postoperatively by a physical therapist who was blinded to group allocation. Self-reported pain and function, the primary outcomes, were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the RAND 36-Item Health Survey (RAND-36). Complications and revision rates were determined through a review of hospital records and at each patient evaluation. The Knee Society radiographic score was used to evaluate plain radiographs at each assessment.
Results: Seventy subjects (86%) completed the five-year assessment. Slightly more pain was reported in the hydroxyapatite group at six months as measured with both the WOMAC and the RAND-36, a difference that disappeared by one year postoperatively. No differences were seen in function, radiographic findings, or complications. No subject required revision of the tibial prosthesis during the study.
Conclusions: At five years postoperatively, there is no difference between cementless tibial fixation with hydroxyapatite and cemented tibial fixation in terms of self-reported pain, function, health-related quality of life, postoperative complications, or radiographic scores.Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
For Lorrie Hemerly, a short walk with her husband, Jeff, is reason to celebrate. Just a few months ago, it was impossible to keep up. Multiple sclerosis had rendered her right leg nearly useless.
"It was one of my first questions when they told me I had MS. Was I going to wind up in a wheelchair?" Hemerly says.
But now, physical therapists are using a new wireless, computer-controlled device to help people with central nervous system disorders. Hemerly suffers from what is known as "Foot Drop." She's not able to raise her toes while she's walking.
That's where the "NESS" L-300 comes in. "NESS" stands for neuromuscular-electrical-stimulation-system. The NESS has three parts -- a sensor inside the user's shoe with a transmitter that is clipped onto the heel, the brace at the knee, and a small, hand-held control unit.
When Hemerly steps down on her heel, the transmitter sends a wireless signal to her brace. Then, two electrodes send a timed, electrical pulse to the nerves that control the paralyzed foot.
"That is the one that you're stimulating during what's called the 'swing phase,' when you want the leg to be able to go up and through without issue," says Kathy Slezak, physical therapist at Good Shepherd Rehabilitation Network in Allentown, Penn.
Hemerly can control the "NESS." When she's tired, her foot starts to drag, so she can increase the electrical stimulation.
But the biggest benefit? Hemerly says the device has greatly increased her stability. This first-time grandma said she couldn't hold little McKenzie and walk at the same time. Now, that's changed.
"It gives you a little bit more confidence now. You can do a bit more," Hemerly says.
Patients say they can feel the electrical charge going into their leg, but it's not painful, and they get used to it quickly. Physical therapists say they've had the most success with patients who have paralysis on only one side of the body. Good Shepherd Rehabilitation Network is the only in-patient Beta testing site for the technology in the United States.
Tuesday, August 7, 2007
It was a very nice lady who, when she overheard me talking one day, came up and excitedly told me that her granddaughter, who had recently graduated from high school, was now doing physical therapy.
“Is that so? Where?” I asked trying hard not to knit my brow too tightly at her. Her granddaughter, it turns out, had gone to work in a chiropractor’s office. The “physical therapy” she was doing was applying various hot packs and electrical modalities to patients before or after the chiropractor performed his adjustments.
There is often confusion between chiropractic and physical therapy. Chiropractic treatment is a philosophy of health that asserts pain and dysfunction, regardless of where it presents itself, stems from misalignment of the spine; therefore, chiropractic treatment must include manipulation. You may receive other modalities during your treatment with the chiropractor, but the massage, heat and electrotherapy are only adjuncts to the chiropractic manipulation.
Physical therapists, by way of contrast, believe that a vast majority of pain and dysfunction results from problems in the soft tissues (muscles, ligaments, tendons, nerves, etc.). Apart from the philosophical differences, from my experience, the biggest difference between chiropractic and physical therapy is in the effort to guide you to a point when you will become independent of the physical therapist. Especially early in your treatment, I may do treatments to you, but by the time we are nearly done, you will be independent in various movements and practices which will allow you to manage your condition on your own.
Just as I, a physical therapist, cannot advertise chiropractic services, a chiropractor may not say or advertise that he offers physical therapy unless he either is dually licensed or employs a physical therapist who would then perform physical therapy for his clients. A chiropractor may use any of the modalities to help relieve your symptoms. The modalities — which include ultrasound, heat, ice and electrotherapy — can be used by a variety of health professionals and others. They are not tightly regulated and are not, in and of themselves, considered physical therapy. Your dentist may have ultrasound and electrotherapy available. When you go to a spa, they may have the same machines available to use as an adjunct to your massage.
While hot packs and electrotherapy can be a soothing adjunct to any treatment, they should never constitute the treatment in entirety. If that is the only service you are receiving, you need to have a lengthy discussion with your healthcare professional.
Massage, in and of itself, is not physical therapy. If the professional care you are receiving — whether chiropractic or physical therapy — only includes the modalities and massage by an unlicensed aide, you are being shortchanged. Massage is a wonderful way to maintain your health, reduce your stress, care for and nurture your self. It is not, however, an effective treatment for most of the conditions you would seek professional help with.
Physical therapists perform soft tissue mobilization, which is sometimes confused with massage by those who have not had their soft tissue mobilized. Massage may include scented oils, fragrant candles and soothing music while a massage technician smoothes and soothes your muscles. It may be a gross understatement to say that soft tissue mobilization can be uncomfortable. A physical therapist performing soft tissue mobilization is actually reorganizing the tissues so that, once you recover from the treatment, you will find that your pain and dysfunction is greatly reduced. Soft tissue mobilization must be performed by a licensed therapist; either a physical therapist or physical therapist assistant.
Some of our friends and neighbors are being required by their doctor to go to the doctor’s office for physical therapy. “Surely,” you think, “the doctor can perform physical therapy.” Actually? No. physical therapy is performed solely by physical therapists. Your physician may employ a physical therapist who will treat you, but you would have to ask yourself why the doctor is requiring you to travel such long distances to receive your therapy when there are qualified therapists here in your home town. Your doctor is obligated to tell you that he profits from your treatment through the physical therapist he employs.
Personally, I have concerns about physical therapists working for other professionals. It is not that I expect all physical therapists to be self-employed like I am. That is a hard road; a path not for the timid. When a physical therapist works for a doctor or for a chiropractor, I believe — and research on the topic supports my conviction — the patient suffers. Research shows that when the physician profits from the patient’s referral to therapy, treatment is less effective and includes significantly more visits than when the patient is seen by an independent physical therapist.
If you are being treated in a physician-owned physical therapy clinic, be sure you are, in fact, being treated by a physical therapist. A physician cannot direct the activity of a physical therapist assistant. Although assistants are licensed, they must be directly supervised by a physical therapist. When your physician bills your insurance for physical medicine (what physicians sometimes call physical therapy), the doctor must perform the treatment himself. He cannot relegate your care to an unlicensed aide.
A physical therapist has a graduate degree and may even have board certification in their area of expertise. Those diplomas and licenses should be proudly displayed. When you are receiving physical therapy, you should be receiving the focused attention and skills of a licensed professional and not, with all due respect to my friend’s granddaughter, a high school graduate working her first real job. You come to us with pain and dysfunction and we help you through various means to regain as much movement and function as possible. When some restriction persists or when the condition you have is chronic, we help you learn to manage that condition and maximize your abilities in spite of it. A physical therapist helps you reclaim your life from the enemy: pain and immobility.
Monday, July 30, 2007
When combining these two job titles under the overall heading of physical therapy professionals, the most common salary range was actually the highest, "More than $75,001," which included 13.5 percent of respondents. However, the lowest salary range option, "Less than $30,000," also registered a high percentage (11.7 percent). Other common salary ranges included $55,001 to $60,000 (12.5 percent), $50,001-$55,000 (11.6 percent) and $45,001-$50,000 (11.3 percent). There were at least 219 respondents for all 11 salary range options, with the least common range being $30,001-$35,000 (4.3 percent).
When the physical therapy professional population was broken down by nine geographical regions, some interesting statistics became clear. West South Central was the most lucrative region for PT professionals (average salary: $55,729) by a slim margin over the East South Central region ($55,560).
Substantially behind these two regions were the third and fourth most lucrative, Pacific, with an average salary of $53,394 for PT professionals, and Middle Atlantic at $53,261. The fifth-most lucrative region was Mountain/Southwest ($51,090), while the final four were West North Central ($50,583), South Atlantic ($50,247), East North Central ($49,423) and New England at $47,648.
PTs by Region
Of the more than 5,000 survey respondents who selected physical therapy as their profession, approximately 4,400 indicated they were physical therapists, as opposed to PTAs. Among that population, the most common salary range was also the highest option, "More than $75,001," including 15.9 percent of respondents. Other high-ranking ranges were $55,001-$60,000, (13.7 percent of respondents), $50,0001-$55,000 (12.2 percent), $45,001-$50,000 (11.5 percent) and $60,0001-$65,000 (10.4 percent). There were at least 44 respondents for all 13 salary range options, with 6.2 percent of respondents representing the lowest category, "Less than $20,000." The category registering the fewest respondents was $20,001-$25,000, which included just one percent of PTs who filled out the survey.
Within the entire physical therapist population, the highest average salary was registered by the East South Central Region at $60,128. Right behind it were the West South Central region ($58,700) and the Middle Atlantic ($56,809). Representing the statistical middle were the Pacific ($56,438), South Atlantic ($54,989) and East North Central regions ($54,106). The lowest three regions in terms of average salary were Mountain/Southwest ($53,582), West North Central ($52,889) and New England ($52,832).
PTAs by Region
Slightly fewer than 800 of the PT professionals responding to the survey indicated they were PTAs. As a group, the most common salary range among the PTA population was actually the lowest option in the survey, "Less than $20,000," with 16.6 percent. Other common ranges included $35,001-$40,000 (16.3 percent), $30,001-$35,000 (15.3 percent) and $40,001-$45,000 (14.7 percent). There were, however, at least a handful of respondents in the highest ranges as well, with 1.1 percent indicating they fell in the $65,001-$70,000 category, 0.4 percent picking the $70,001-$75,000 option, and 0.8 percent selecting the "More than $75,001" category.
Regionally, there was much disparity among PTAs in average salary. The most lucrative region was West South Central, where the average PTA made $38,952 per year. Other high totals included East South Central ($37,500) and Pacific ($34,891). The middle regions included Mountain/Southwest ($33,350), South Atlantic ($32,179) and West North Central ($31,764). Bringing up the rear, meanwhile, were Middle Atlantic ($29,870), New England ($29,581) and East North Central ($27,316).
Taken as a whole, these statistics offer an intriguing look at the regional physical therapy salary situation in the United States. For example, the East South Central and West South Central regions proved to be the two most lucrative for physical therapy professionals as a whole, physical therapists as a specific group, and physical therapist assistants as a specific group. East South Central actually averaged about $1,400 more per year than West South Central for physical therapists, but West South Central's even greater salary advantage in the PTA category gave that region a slight edge for physical therapy professionals as a whole.
On the opposite end of the spectrum, the New England region proved to be consistently less lucrative than other regions in all three categories. Ranking at the bottom for PT professionals as a whole ($47,648), it was also the lowest-ranking region for PTs ($52,832) and second-lowest for PTAs ($29,581).
The East North Central region, on the other hand, demonstrated the greatest disparity in terms of its ranking for PTs compared to PTAs. Ranking in the middle of the pack for physical therapists with an average salary of $54,106, it was last by a margin of more than $2,000 in the PTA category with an average of $27,316. The Middle Atlantic region also offered a significant PT/PTA ranking disparity, placing third in the physical therapist category ($56,809) but just seventh in the physical therapist assistant category ($29,870).
Disparity existed from the opposite perspective as well. For example, PTAs in the Mountain/Southwest region (ranking fourth at $33,350) could expect to earn a decent buck compared to other parts of the country, whereas PTs in the Mountain/Southwest region were paid at a comparatively low rate (ranking seventh at $53,582).
The South Atlantic region, meanwhile, deserves credit for consistency. It ranked exactly in the middle, fifth out of nine regions, for both PTs ($54,989) and PTAs ($32,179). Statistics being a funny thing, however, the disparate numbers registered by other areas actually made South Atlantic rank seventh out of nine regions among PT professionals as a whole ($50,247).
Salary and Education
Based on the results of our salary survey, levels of education have a decided impact on salaries earned in physical therapy—although not in the way some might believe.
Participants in the survey were asked to identify their level of education from four main categories—non-four-year college graduates (high school or GED, some college experience, associate's degree), college graduates (bachelor's degree), master's degree (MA, MBA, MPH, MS) or doctorate degree (DPT, PhD).
Those who fell into the non-four-year college graduate category showed the lowest salaries, with the three categories reporting an average annual salary of $32,261. The surprising results came from the other three categories, where the discrepancies between salaries were minimal.
College graduates with bachelor's degrees in the physical therapy field reported an average salary of $62,084, comparing favorably to those PTs with master's degrees (average salary of $64,247 annually) and those with DPT or PhD degrees ($64,192 annually).
Six percent of respondents—about 300 people totalidentified their educational level as something other than the above categories. That group reported an average annual income of $61,337.
Levels of Education
Respondents were split almost 50-50 between those with master's or doctorate degrees and those without. While only 2.2 percent of respondents reported having earned a Master of Business Administration (MBA) degree, these respondents reported the highest average annual salary of any individual educational level at $75,431.
Not surprisingly, the most common level of education reported was a bachelor's degree, comprising 32 percent of respondents. Following closely thereafter was the MSPT degree at 30 percent. Associate's degree was third-most popular, at 14 percent, followed by the DPT at 10 percent. As previously stated, 6 percent of respondents cited another level of education. The other eight percent was comprised of those with master's degrees other than MSPTs, and people who were either high school graduates or had only completed some college.
Along gender lines, male respondents reported an average annual salary of $60,058, while females reported earning $51,106. The good news is that the majority of males and females in similar positions earn comparable paythe difference can likely be attributed to a larger number of males in higher-level positions.
Pay Based on Experience
First-year physical therapists responding to our survey reported an average salary of just under $43,000 per year, which compares quite favorably to salaries in similar fields. Following that first year, our results indicate that therapists can expect an annual increase of about 5 percent, before salaries tend to level off around year eight of their careers with a salary in the high-$50,000 to low-$60,000 range.
Using this information as a composite, the height of a therapist's earning potential seems to be between years 15 to 20 of his career—or right around age 40. Therapists with more than 20 years of experience can expect salaries in the low-to-mid 70s. According to the survey, salaries can again level off after a therapist reaches 35 years of experience—however, as you might imagine, the number of responses from therapists with that level of experience was limited—less than 100 such clinicians.
Eighty-two percent of respondents said they had been practicing PT for 15 years or less, with more than 50 percent of those respondents falling between one and five years experience. Another 12 percent were in years 16 to 25 of their career, with the final 6 percent having upward of 25 years of experience.
Salary and Setting
According to our results, setting also seems to impact the salaries of physical therapists and PTAs. In the case of both PTs and PTAs, outpatient and clinical settings are the most common place to work followed by long-term care facilities, hospitals and private practice.
In the outpatient setting, average salaries range from $46,655 all the way up to $103,000 while inpatient practitioners reported salaries ranging from $30,000 to $73,000.
Location of the setting may have some impact on the salaries, as outpatient practitioners reported far higher numbers working in suburban areas (48.5 percent), followed by urban areas (32.7 percent) and rural areas (18.8 percent). On the other hand, the majority of PTs in inpatient settings (50.3 percent) worked in urban areas followed by suburban practitioners (34.1 percent) and rural practitioners (15.7 percent).
Physical therapists in academic settings reported salaries ranging from an average of $42,000 for first-year educators to $114,000 for an educator with 32 years of experience. The average salary, however, among educators (full and part time) was $61,850.
School PTs, on average, are making a salary of $55,004. The majority of school-based practitioners reported working in suburban areas at 46.5 percent, however, their counterparts in rural and urban areas are almost evenly distributed at 28.2 and 25.4 percent, respectively.
Examining Home Health
Home-health therapists and PTAs, on average, have a higher salary relative to the PT population at large. The median salary among home-health physical therapists is $61,030, while among the general physical therapy population, the average salary was $59,827. While the difference is not great, it becomes more apparent when broken down by subcategories, such as location.
In most regions, home-health practitioners take home an average salary of approximately $4,000 more than the rest of the physical therapy community. However, in the Pacific region of the country, as well as the Middle Atlantic and Mountain/Southwest regions, home health practitioners average approximately $10,000 more in salary than those who are not in home health.
"Home health has a wider range in income, both on the high and low end," explained Roger Herr, PT, MPA, COS-C. "This is a function of both the flexibility in hours and range of commitment of clinicians."
Home health care practitioners also tend to have a greater level of experience, Herr added. "There is an industry bias to having at least one year of related health care experience before entering home care, so the population will be more experienced," he said.
Benefits are also a difference with home-health practitioners compared to clinical and private-practice PTs. According to the survey results, home-health PTs tend to have fewer benefits than the PT community at large does. A smaller percentage of home-health practitioners receive dental insurance, health insurance, vacation/sick time and other common benefits.
However, according to Herr, the setting lends itself to this type of discrepancy. "Wider variety in benefits leads some to choose to work in places with less benefits. Homecare people work both part-time and full-time, so they may have additional supports as in other modes for getting benefits (partner/spouse)," he said.
Brian W. Ferrie, Rob Senior and Stefanie Kurtz are on staff at ADVANCE.
Sunday, July 29, 2007
Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands
First published on July 17, 2007
KP Westlake, PT, PhD, MSc, is Post-Doctoral Fellow, Rehabilitation Research and Development Center, VA Palo Alto HCC, 3801 Miranda Ave, Palo Alto, CA 94304 (USA).
EG Culham, PT, PhD, is Professor and Director, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Background and Purpose: Age-related changes in the ability to adjust to alterations in sensory information contribute to impaired postural stability. The purpose of this randomized controlled trial was to investigate the effect of sensory-specific balance training on proprioceptive reintegration.
Subjects: The subjects of this study were 36 older participants who were healthy.
Methods: Participants were randomly assigned to a balance exercise group (n=17) or a falls prevention education group (n=19). The primary outcome measure was the center-of-pressure (COP) velocity change score. This score represented the difference between COP velocity over 45 seconds of quiet standing and each of six 5-second intervals following proprioceptive perturbation through vibration with or without a secondary cognitive task. Clinical outcome measures included the Fullerton Advanced Balance (FAB) Scale and the Activities-specific Balance Confidence (ABC) Scale. Assessments were conducted at baseline, postintervention, and at an 8-week follow-up.
Results: Following the exercise intervention, there was less destabilization within the first 5 seconds following vibration with or without a secondary task than there was at baseline or in the falls prevention education group. These training effects were not maintained at the 8-week follow-up. Postintervention improvements also were seen on the FAB Scale and were maintained at follow-up. No changes in ABC Scale scores were identified in the balance exercise group, but ABC Scale scores indicated reduced balance confidence in the falls prevention education group postintervention.
Discussion and Conclusion: The results of this study support short-term enhanced postural responses to proprioceptive reintegration following a sensory-specific balance exercise program.
By Milos Pesic
Continuing education in any field is a great boost to one’s value. To have that same continuing education offered online is a godsend. Not only does online education offer the chance to enhance one’s knowledge, but it offers to have you learn at home. Enter – physical therapy continuing education online. Physical therapists everywhere rejoice! A chance to further their knowledge, at home, with different online institutions to choose from, a godsend indeed for physical therapy.
Physical therapy continuing education online is a growing boon for the industry. What with thousands of physical therapists seeking quality education, but have been hampered by time, money, or simply being too far away, physical therapy continuing education online is proving to be a very good way to further physical therapy studies. One of these online institutions offering continuing education is OnlineCE. One of the industry’s leaders, OnlineCE offers students a variety of courses which include introduction to hand therapy, sports and hand injuries, topics in shoulder rehabilitation, upper extremity anatomy, wound management and a host of other courses for health professionals especially physical therapists. Another accredited corporation that provides physical therapy continuing education online is Care2learn.com. Care2Learn.com is a Florida based corporation and is provided by onlineHealthNow,Inc. Online courses offered include: A Physical Therapist’s Guide to Documenting for Medicare, Assessment And Documentation Of Wounds, On the Frontier With HIPAA-What HealthCare Professionals Need to Know and Do, Contract vs. In House Therapy: Making the Decision under PPS, to name a few.
Depending on your preference of courses, there are a slew of other sites that offer physical therapy continuing education online, giving you the chance to choose. Some sites offer courses not offered by others, so choose carefully which site you would enroll in. Choose the site which best suits your preference. Other sites to check out are CEUWORLD.com, Texas Physical Therapy Association and American Physical Therapy Association. Of course you are not limited to these sites, you can check out other sites to help you find the site for you.
In all, physical therapy continuing education online is a fast growing industry. Choose which site you’d want to join and know the courses offered. Know all you can about the various sites and know what courses you would like to enroll in. Physical therapy continuing education online is here to stay, which is a good thing for physical therapists. Be careful though of bogus sites; be sure the site you choose is accredited. Physical therapists rejoice indeed.