The following transcript was created using artificial intelligence and may contain typos, omissions, or other errors.

Christine Scalora: Hi, I'm Christine Scalora, part of the communications team at APTA. Happy National Physical Therapy Month 2024! Every October, we celebrate the profession and spotlight the many benefits of physical therapy.
This year we're focusing on PTs and PTAs roles in preventing falls. Falls are a big public health problem. Unfortunately, this theme touches nearly everyone, whether it's the patient population you treat or an aging loved one, falls effect more than one out of four older adults as the results of a fall can be devastating.

So to take on this issue, APTA, in collaboration with APTA academies and sections, is highlighting the work that PTs and PTAs do for falls prevention for people of all ages and abilities.

But we're doing more than just telling people about the importance of physical therapy in this space. Our government affairs team is working to get legislation related to fall screening and prevention passed in Congress, which means more access to and funding for PT-led falls prevention efforts.

I'm chatting today with a couple of experts on falls prevention. Kele Murdin is founder of Murdin Therapy and Group Otago, and Justin Elliott is vice president of government affairs for APTA.

So Kele, let's start with you. Can you tell us a bit about yourself and your practice?

Kele Murdin: Sure. My name is Kele Murdin. I live in the Seattle, WA area. I have a private practice that I focus mostly for on older adults. I also founded and created the Group Otago Method, which is taking the 17 exercise of Otago, putting it in a group format to really expand the reach of that valuable tool. So I'm a frontline clinician, in addition to working in my community for falls prevention as well.

Scalora: Also board certified in geriatric physical therapy, right?

Murdin: Yes, that's true.

Scalora: Just so many different qualifications and credentials. Just want to make sure we get some of them out there. So you know, given all of your experience and expertise as a clinician, why is falls prevention so important and how does it relate to optimal aging?

Murdin: Yes. Well, I think, Christine, you kind of led us when you first introduced this, that the fall statistics are just staggering; that most of us can think about our own family and our own lives. And we have someone in our life that's been touched by the fall in a negative way. And these statistics unfortunately are getting worse.

So the problem is huge and it's, falls are multifactorial. So. If you know somebody who had a fall, that's one person with a multi-level of why they fell, it's probably different than the next person you meet who had a fall. So it's complicated.

The statistics are staggering and that's why prevention is so important to start with.

How does it relate to optimal aging? Again, if you think about people that you're familiar with, how the consequences of a fall can just be devastating, from lack of mobility to fear of falling, and how that's limiting for you, to the inability to stay in your home. So the small factors that stack on top of each other that can really change the course of your life and what we know is that we can intervene earlier and stop that downward spiral.

Scalora: Yeah, and your point, there's so many different factors that can come into play when we're talking about falls. So you know why is it important to have physical therapists lead interventions in the falls prevention space?

Murdin: Yeah, great question. I think first, as health care providers, the first thing that comes to mind is the amount of time we spend with our patients; that face time is so valuable. And we in the health care community get a huge amount of time with our, with our patients.

Secondly, our education. We are educated to educate our patients on what they can do to manage their own fall risk. We also are educated in how what medical risk factors may be present for this individual and what non-medical risk factors may be present they can mitigate themselves.

We also are the movement specialist. We have specific training in body mechanics, in exercise prescription and balance assessment, and neurologic reeducation. We have the broad spectrum of training that really makes us the perfect provider in this space to identify and remediate the impairments that are so closely correlated with falls.

Another reason PTs are uniquely qualified to make a difference here in this space is research continues and for decades has shown that one of the most effective, if not the most effective, intervention for fall prevention is balance and strength exercises.

There is a long list of risk factors that predispose someone to a fall, but if you only could do one if you had to just pick one, what are the most effective interventions or things to mitigate in that risk factor list?

And it is strength and balance; that has the best bang for the buck and research continues to support that. Most recently there was a network meta-analysis on fall prevention that really looked at interventions for older adults and what it did is highlighted that exercise-based approaches are particularly effective, something that continues to come up. And in this, these studies show that balance and strength training, especially when combined with postural control exercises, significantly reduce fall rates. Is there anyone else in the health care community who's going to do postural control exercises while they're doing strength and balance?

Who else is qualified to do that? This is our wheelhouse. So again, we are just so poised to make a difference because balance and strength is what really to move the dial on fall prevention, and that is what we do.

Scalora: Yeah, that's all very helpful to think about. And Justin, at APTA, we very much know that it's important to have PTs involved in this area. So why is falls prevention legislation a priority for APTA?

Justin Elliott: There's a couple reasons. You know, first, you know as mentioned, this is an epidemic in the United States and it it's mostly unavoidable epidemic. The one out of every four Americans are falling and each year, and of course, you know, if you fall once that doubles the chances of falling again.

And you know the fall can result obviously to the patient or client with the injury, the loss of independence, the use of opioids. But it also has a huge cost on the health care system. You know all told, accidental falls among older adults result in 3 million emergency room visits and 1 million hospital stays and that adds up. The average falls related hospitalization costs $30,000 and it ranks fifth highest in terms of personal health care spending.

So all told, we're talking about 50 billion. That's billion with a B in medical costs annually, with 75% of that being paid by Medicare and Medicaid. And as we, as we all know, Medicare and Medicaid, they're having some big problems right now, particularly the Medicare Fee Schedule.

And you look at this $50 billion, a lot of that is avoidable cost. That could be money that is reinvested into things like supporting better payment for providers and expanding coverage for other conditions.

And so that is one reason that, you know, we are looking at a falls prevention and why it is part of APTA's Public Policy Priorities. The public policy priorities is a document that we publish every two years and start to coincide with the start of session of the U.S. Congress and while, of course these policy priorities were looking at increasing payment, reforming Medicare, reducing admin burden, addressing the workforce stresses. But there's also priority that APTA is focused on, which is to expand coverage for and payment for prevention and wellness services specifically falls prevention.

And one of the reasons you know, we're focused on that. I mean, aside from the fact that it just makes sense and it's the right thing to do, we also know the value that physical therapists and physical therapists bring to the system, and folks may hopefully are aware last year at this time, APTA released its landmark report, "The Economic Value of Physical Therapy in the United States." And one of the conditions that this independent economic report looked at was the role and the value that physical therapy has when it comes to falls prevention. And the independent economic analysis, you know, looked at the cost of cost effectiveness of PT services to prevent falls compared when not having any risk assessment for older Americans. And so what that study showed is that, yeah, there's a real value cost savings that PT brings to the system.

And so that's one of the reasons it's a policy priority for APTA and that we are, you know, looking at legislation to try to bring more coverage and payment for falls prevention services.

Scalora: Yeah, I know "The Economic Value of Physical Therapy" report is, you know, a really helpful tool for you and your efforts with Congress. So can you help us understand, you know, the different pieces of legislation related to falls prevention and what is, you know, APTA doing to help get these bills passed?

Elliott: Well we have two bills currently before the U.S. Congress. The first one is called the Stopping Addiction and Falls for the Elderly Act or Safe Act. This is bipartisan legislation that's been introduced in the U.S. House of Representatives. The bill number is H.R. 7618. It's been introduced by Congresswoman Carol Miller. She's a Republican from West Virginia and co-sponsored by Congresswoman Melanie Sansbury, a Democrat from New Mexico.

So what, this bill would do, it's really focused on two current programs under Medicare that we think could be improved to ensure better fall screening and prevention for Medicare beneficiaries.

Now the first program under Medicare is what's known as the Initial Preventive Physical Examination, or the IPPE. Most folks know this as the Welcome to Medicare visit. So what is the, if you're not familiar, this is a preventive visit offered to newly enrolled Medicare beneficiaries and focus on health promotion and disease prevention and detection. And every Medicare beneficiary, when once you go on Medicare within the first 12 months of joining Medicare Part B coverage, you get this Welcome to Medicare Visit. Now what this would do is that as part of this, Welcome to Medicare it would ensure that during this visit, if the physician would ask, you know, have you had a fall within the past year and if the beneficiary says, yeah, 'I had.

I had a fall six months ago.' It would trigger an automatic referral to physical therapist for screening, fall screening and services.

Now, is it possible that sometimes this question is being asked? Maybe. Right now, is it automatically triggering a referral to physical therapist? Probably not.

And that's why we're seeing, you know, these falls epidemic and so this is one way to hopefully address you know right from start getting that falls prevention screening service.

The other thing it would do, there's a second program under Medicare called the Annual Wellness Visit. And again, this is not something to be confused with your, you know, annual physical exam. It's really an annual visit to look at wellness and personalized prevention plan. And it looks at, you know, not only physical but also emotional and psychological well-being. But same thing, this would happen if this legislation is passed. During that Annual Wellness Visit, you're gonna be asked, 'did you have a fall within the past year?' and if beneficiary says yes, again, automatic triggering of a referral to a PT for fall screening, falls prevention service. That would be a huge win to expanding access to service, making sure that Medicare beneficiaries are getting access to falls prevention screening and services.

And more importantly, it would ensure that PTs have a role in both of these very critical programs.

So it'd be a huge first step forward on addressing this epidemic in falls. You know, the second bill we have is really focused on our veterans, and the bill is called the SAFE STEPS for Veterans Act. It was introduced in the Senate by Senators Angus King. He's an independent from Maine and Senator Mike Rounds, Republican from South Dakota. And in the House. It was a Congresswoman Nikki Budzinski, Democrat from Illinois, and Jack Bergman, a Republican from Michigan. And those bill numbers are Senate, it's 4556. In the House, it's H.R. 9179.

And really this is focused on the VA and two big things that this bill would do. First, this sounds really like common sense. It would create an office of falls prevention within the VA. And there would be a falls prevention coordinator within the VA to really coordinate the work that the VA is doing, but also to coordinate with other federal agencies, primarily with things like the NIH to look at and develop veteran-specific research for falls prevention programs and really work with HHS and other groups, again to make sure that that we're streamlining work, really looking at initiatives related to research, so that our veterans receive evidence-based falls prevention care.

But the other big thing that this would do, and it's very similar to the SAFE Act, it was make sure that a new benefit for veterans would be that they would get an annual fall screening from a PT, and so again that would be a huge issue. Again, makes sense to take to provide the service to our veterans. It would decrease costs, prevent the injury and often loss of independence that veterans have and also again make sure that PTs are on the front line with this health epidemic.

So these are two big bills that we've been pushing and are currently working on up on Capitol Hill.

Scalora: Yeah. Thank you for that breakdown. It's really interesting to see sort of where APTA is working to get some of this put in place with various institutions and getting people to physical therapists. And you know, Kele, once people are going to see their PT, what evidence-based programs do PTs and PTAs need to know about so that they can make sure that they are providing the best false prevention, screening and treatment possible?

Murdin: Yes, I think that's a big part of it is where do we, where do we send these people? And so there is a hub of information on the National Council on Aging website of what are evidence based programs. So if you need to first know what they are, things like enhanced fitness, the SAIL program, Otago is on that list as well. What is, what has been supported to be effective in this space with by the evidence to reduce falls? So I would familiarize with yourself with what those programs are. And then you need to be a consumer in your own area and to know what is available to your community.

So I think knowing what the evidence-based programs are and what's available in your area so that you can really be a guide for your patients to help them find a program that's local to them, that would really address the impairments that you have identified in your care.

Scalora: I think that's really great point to not just think you know about resources available, but to think about the leadership role PTs can be playing here within their communities. And so you know, adding on to that, how can all PTs and PTAs not just those who maybe work primarily with older adults confidently incorporate falls prevention efforts into their work with patients

Murdin: Yeah, I think this really kind of falls back to why we went to school in the first place to be a physical therapist. You know what are the things that kind of make up our education? Again, we have specialized knowledge in this area.

All, all therapists have that. We have the clinical skills to evaluate balance, strength, coordination and all of those are key components to fall risk. We know how to do exercise prescription. We can develop exercise programs that are tailored for someone's specific strength, balance, and coordination. We know how to do functional assessments. We have the ability to do a home safety evaluation.

We can educate. We can counsel. We can coach our patients through these programs.

So I think owning that, remembering that I have all this training and this is what I offer my community, although I may not see myself as a older adult specialist. When you recognize and identify the any of these risk factors that are going to impair their balance when they have impaired strength, those kinds of factors are going to increase our risk of falling.

So I would say for all PTs, knowing what risk factors are for falls and filtering in what you already do or what you already screen your patients for and have a lens of fall prevention in part of your repertoire. And again just asking those two questions that Justin talked about, that the doctors are asking, have you had a fall in the last year? Are you concerned about falling? It could be as simple as that to do a screen. Other you know, do you have a repertoire of falls assessments? Do you know what they are? You know how to perform them? I would say that would be other basic skills for you, for any therapist that works with any population. I think there's been studies showing that of all the patients that come to see us for therapy, 44% are at increased risk of falling. So even if they coming to me for a shoulder injury that change in their movement pattern could really predispose them to an increased risk of falling, because how they're having to accommodate for this lack of movement.

Seeing that bigger picture of how we can intervene with patients along that spectrum of prevention is I think really critical to really use all the skills that we have available.

I would also say in addition to knowing your risk factors, know some of your resources: know how to do a screen. There's a STEADI protocol that the National Council on Aging has, they have beautiful tools, beautiful handouts. There's a lot already waiting for you. You just need to know how to access it to give it to your patients.

The APTA Geriatrics has many resources and you don't have to be a geriatric specialist to be a member or to have access to those materials. There is a balance and falls special interest group and they developed a balance and fall toolkit that is open access to all PTs and PTAs as well. They have outcome measures. They have information on evidence based programs and there's also a very dynamic course that's offered in person for a balance and fall certification.

Scalora: And we'll make sure we include links to those resources in our episode notes so that members can find them and incorporate them into their practice. And then you know, on the other side of the issue, Justin, what can PTs, PTAs, students, and supporters of physical therapy in general be doing to help get this legislation across the finish line?

Elliott: The first is to make sure you're keeping informed as to what's going on with this legislation. And there's a couple things that you can do. First is you go to apta.org and click on advocacy. We have position papers on both of these bills that you can download or print out, and that's going to be a tool that will a) give you information about the bill, but also something you can share with your members of Congress.

And of course, October, the Congress is currently in recess, they're all back in district. So it's a great time to see if you can meet with your member of Congress to talk about this legislation.

The second thing that I always encourage every APTA member to do, and that is to subscribe to the APTA Advocacy Network. And you can again do that by going to apta.org, clicking on advocacy, and what that does is two things. One you will then get the APTA Advocacy Newsletter. This is a newsletter we publish every other month that provides updates as to what's going on Capitol Hill with all of our priority bills, also what's going on with federal agencies, payment issues and state legislature.

So it's a great way just to continue to get those updates and information about what's going on. And also you will then receive action alerts on bills. So when we have a situation where we need folks to contact their member of Congress to co-sponsor a bill or to urge their support of it, you would get action alerts.

And it's it really takes less than 30 seconds. You click on a link, it fills out a form for you, looks up your member of Congress. You hit send and within 30 seconds you've sent a letter to your member of Congress and support of a legislation. And we actually have a template letter in support of the SAFE Act on APTA's Legislative Action Center and you can go to that's site again apta.org, click on advocacy. And you can look at the various bills that we have these letters on, you know, not only the SAFE Act, but you know, we have things on Medicare payment reform and PT workforce issues.

And so it's a great way to, you know, engage with your members of Congress, you know, and then finally, every APTA component, whether it's a chapter, a chapter or section or academy, has what's known as a Federal Affairs Liaison. FAL and the FALs work with APTA to coordinate efforts to get more PTSs and PTAs involved with their members of Congress in their state. And so I would say reach out to your component FAL. And really what we're trying to do is you know match PTs and PTAs with House members or Senate members so that they can begin building a relationship and, you know, work with them to advance this these bills and all of our priority issues that we're currently working on up on Capitol Hill.

Scalora: Yeah, we'll make sure we include those links as well. And we know how important it is to have our members reaching out to their members of Congress to get things done.

So I want to thank you both for chatting with me today and sharing your expertise on falls and APTA's advocacy efforts. APTA members, you can find a lot of resources on apta.org. In addition to the ones we talked about, you can also find a guide to hosting a fall screening and assessment in your community, as well as handouts and social media graphics you can download and share.

Don't forget the APTA Learning Center and PTJ: Physical Therapy & Rehabilitation Journal are always good places to learn more.

And as Justin said, APTA's Legislative Action Center makes it easy to tell your representatives in Congress to support falls prevention legislation and all the other issues APTA is fighting for.

If you aren't already, please subscribe to APTA Podcasts to hear more from our members and staff experts, plus the latest in research from PTJ author interviews.  

Happy National Physical Therapy Month!