Marc S. Goldstein

Delivering the Physical Therapy Value Proposition: A Call to Action

In 2009, the United States spent more than

Workforce Projections 2010–2020: Annual Supply and Demand Forecasting Models for Physical Therapists Across the United States

2.5 trillion, or 17.6% of its gross domestic product, on health care.1 Furthermore, expenditures are projected to grow an average of 6.1% per year from 2009 to 2019.1 Long-term performance of the health care delivery system is widely viewed to be unsustainable economically.2 Concern about financial sustainability is magnified by the recognition that increased health care spending does not fully address the needs of Americans or result in higher-quality care or greater patient satisfaction with the delivery system. The Institute of Medicine (IOM) noted that rapid technological expansion and subsequent complexity resulted in safety failures and suboptimal benefits.3 This report, along with other health policy studies,4–6 indicated a high variability in health care delivery across the nation. Sociodemographic disparities and inadequate access to needed services for many individuals are compounded by the high cost and variable quality of health care.7 In 2010, the Agency for Healthcare Research and Quality (AHRQ) reported that racial and ethnic minorities and individuals with lower socioeconomic status often receive poorer quality of care and have greater difficulty accessing care compared with individuals who are white or who earn higher incomes. Furthermore, 1 in 5 Americans experience delays in or denials of needed health care.8 Inadequate access is particularly troubling given the projected need for services. By 2030, individuals aged 65 years and older will account for almost 20% of the total US population. Approximately 40% of this cohort is estimated to have a disability and is in need of health care services.9 This paradox of high costs, variable quality, and inconsistent access to services in the face of overwhelming demand was central to the health care reform deliberations that resulted in passage of the Patient Protection and …

Item Response Theory Analysis of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL)

Background Health human resources continue to emerge as a critical health policy issue across the United States. Objective The purpose of this study was to develop a strategy for modeling future workforce projections to serve as a basis for analyzing annual supply of and demand for physical therapists across the United States into 2020. Design A traditional stock-and-flow methodology or model was developed and populated with publicly available data to produce estimates of supply and demand for physical therapists by 2020. Methods Supply was determined by adding the estimated number of physical therapists and the approximation of new graduates to the number of physical therapists who immigrated, minus US graduates who never passed the licensure examination, and an estimated attrition rate in any given year. Demand was determined by using projected US population with health care insurance multiplied by a demand ratio in any given year. The difference between projected supply and demand represented a shortage or surplus of physical therapists. Results Three separate projection models were developed based on best available data in the years 2011, 2012, and 2013, respectively. Based on these projections, demand for physical therapists in the United States outstrips supply under most assumptions. Limitations Workforce projection methodology research is based on assumptions using imperfect data; therefore, the results must be interpreted in terms of overall trends rather than as precise actuarial data–generated absolute numbers from specified forecasting. Conclusions Outcomes of this projection study provide a foundation for discussion and debate regarding the most effective and efficient ways to influence supply-side variables so as to position physical therapists to meet current and future population demand. Attrition rates or permanent exits out of the profession can have important supply-side effects and appear to have an effect on predicting future shortage or surplus of physical therapists.

Vitalizing Practice Through Research and Research Through Practice: The Outcomes of a Conference to Enhance the Delivery of Care

Background The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) instrument was created to assess the perceived ability of patients receiving physical therapy in adult outpatient settings to perform actions or movements. Its properties must be studied to determine whether it accomplishes this goal. Objective The objective of this study was to investigate the item properties of OPTIMAL with item response theory. Design This investigation was a retrospective cross-sectional item calibration study. Methods Data were obtained from the American Physical Therapy Association, which collected information from outpatient physical therapy clinics through electronic charting databases that included OPTIMAL responses. Item response theory analyses were performed on the trunk, lower-extremity, and upper-extremity subscales of the Difficulty Scale of OPTIMAL. Results In total, 3,138 patients completed the Difficulty Scale of OPTIMAL at the baseline assessment. The subscale analyses met all item response theory assumptions. The items in each subscale showed fair discrimination. In all analyses, the subscales measured a narrow range of ability levels at the low end of the physical functioning spectrum. Limitations OPTIMAL was originally intended to be administered as a whole. In the present study, each subscale was analyzed separately, indicating how the subscales perform individually but not as a whole. Another limitation is that only the Difficulty Scale of OPTIMAL was analyzed, without consideration of the Confidence Scale. Conclusions OPTIMAL best measures low physical functioning at the baseline assessment in adult outpatient physical therapy settings. The addition of categories to each item and the addition of more challenging items are recommended to allow measurements for a broader range of patients.

Physiotherapy Health Services Research (PHSR): The Road ‘That Must Now Be Taken’

The American Physical Therapy Association (APTA) provided funding for a series of meetings among a small group of leaders representing the research and clinical communities whose task was to plan a conference, the outcome of which would be a “road map” for the process of generating evidence that would be implemented by clinicians so that the provision of services might be enhanced. Two of these planning sessions were held and resulted in a decision to focus a conference on the identification of strategies to lessen perceived “gaps” between physical therapist clinicians and researchers and the development of strategies to bridge the “gaps” between the 2 groups. These meetings ultimately resulted in the Vitalizing Practice Through Research and Research Through Practice Conference hosted by APTA. A perceived gap between research and practice has been cited as a problem by others within and outside the profession as well. In a recent editorial in the Journal of Orthopaedic and Sports Physical Therapy , Bechtel et al stated, “We have a problem in manual therapy, and perhaps in the whole profession of physical therapy. Our problem is the growing chasm between researchers on the one hand, and clinicians on the other.”1(p451) A recent Institute of Medicine workshop titled “Transforming Clinical Research in the United States: Challenges and Opportunities” echoed this theme and identified bridging the divide between research and practice as one of the most critical needs facing clinical research.2 Discussion of the perceived gap between research and practice extends internationally, as Demers and Poissant3 lamented that research would be meaningless if it did not affect clinical practice. Furthermore, Demers and Poissant discussed the value of creating partnerships across the research process, from conception to dissemination of results. Translational research , at its most macroscopic level, essentially refers to efficient movement …

Outpatient Physical Therapy Improvement in Movement Assessment Log

The healthcare landscape is changing rapidly, and the systems through which physiotherapy services are funded and delivered are in a state of unrest across high-income, middle-income and low-income countries. The purpose of this editorial is to generate discussion and debate regarding two salient issues in our profession: first, the necessity to recognize the extent to which global economic pressures are and will affect physiotherapists and second, the requirement to position physiotherapy health services research (PHSR) as a prominent and central research direction that must be encouraged and rapidly absorbed into our research milieus. In this editorial, we comment on these two issues and ultimately advocate that physiotherapists integrate PHSR as a necessary direction if we are to advance our position within an increasingly complex healthcare marketplace. The sorrowful and solemn lament often heard among physiotherapists is that decision makers have not appropriately prioritized physiotherapy relative to other services or that somehow they ‘just don’t get it’. The stark reality is that the global economic landscape is challenging all aspects of health care, and there is now a prevailing need to do more with less (Rosoff, 2012). Even a cursory review of the massive and sweeping cuts in workforce and public sector spending within the UK’s National Health Service or within Greece’s planned 40% reduction in hospital expenses and 45% reduction in mental health services (Zarocostas, 2011) provides an important context to this argument. Although rationing of physiotherapy services may not be a new concept, the amplitude of the current worldwide socio-economic climate is unique, and as a result, healthcare rationing and cost containment strategies are likely to continue for the foreseeable future. Given changes in global economic stability, providers of health services that cannot demonstrate empirically that access to their services results in measurable cost or system-wide efficienciesmay well find themselves under intense scrutiny. An extreme example of this scrutiny recently occurred in North Carolina, one of the southern jurisdictions in the United States,

The Development of an Instrument to Measure Satisfaction With Physical Therapy

The use of the OPTIMAL form, and other functional assessment tools, is in response to changes in the Medicare outpatient therapy cap exceptions process and documentation requirements for 2007 and further changes resulting from the 2014 Middle Class Income Tax Relief Act. As a result, physical therapists are required to do Functional Limitation Reporting for Physical Therapy Services under Medicare Part B. OPTIMALs 22 items help us to map the functional assessments and impairment limitation restriction reporting that CMS is requiring on all Medicare patients