AUGUST 2018
- COMING UP THIS MONTH -
Saturday, August 4 at 9:00 am New London clinic at the Ocean Beach Kelley Half Marathon
THE CUTTING EDGE Orthopaedic residency advances clinical excellence.
A commitment to clinical excellence has been part of PTSMC’s culture since our inception. The words became one of the three tenets of our mission statement ten years ago. PTSMC’s Orthopaedic Residency will officially “kick-off” in August 2018! This accomplishment represents a significant investment in people, time, effort and financial Our first cohort will be comprised of three PTSMC resources. clinicians. Channing Harwood, John Galer and Erik Schmitt will undergo an intensive growth and learning The application to be accepted by ABPRTFE (APTA’s experience comprised of 150 hours of clinical mentorresidency accreditation body) as an accredited residency ship as well as 175+ hours of “classroom” learning. has been led by Mike Gans, who will also assume Our goal is to provide residents with the knowledge, leadership of the new program. Mike is looking forward to skills and clinical reasoning capabilities to function at joining a small, forward-thinking group of similar the “top of their license,” as well as at the top of the programs, saying, “I am excited about the residency physical therapy profession! program because it provides PTSMC with the opportunity to be on the cutting edge of clinical education. There are It is my hope that PTSMC’s Orthopaedic Residency only nine residency programs in all of New England, and Program will ultimately improve ALL of our clinicians only two are in orthopaedics, so we are truly leading the and the care we provide, because Clinical Excellence is field here at PTSMC.” at the core of who we are and what we do. Mike will be joined by an exceptional team of PTSMC’s Thanks, clinical leaders who have stepped up to teach and mentor. Alan A special thanks to mentors Joe Allen, Nick Almonte, Danielle Dunn, Ken Kosior and Russ Woodman.
PTSMC IS STARTING A JOURNAL CLUB! Calling all clinicians! PTSMC officially has a Journal Club! We will be meeting monthly via Gotomeeting. The first club meeting will be Wednesday August 27th 11am-12pm. If you’re interested in attending, please email mike.gans@ptsmc.com
Welcome back to our Athletic Trainers! Welcome back to Jenna Bouffard, Caitlin Chaput, Sam Donahue, Bethany Grady, Caty Halpin, Erik Lanese, Hailey Lugo, Liz Saunders, Chelsea Searless, and Katie Urycki!
Saturday, August 4 at 2:00 pm Naugatuck clinic at the Naugatuck Summer Street Festival Saturday, August 18 at 9:00 am Westbrook clinic at the Clinton Bluefish 5K Thursday, August 23 at 10:00 am “Oh My Aching Joints!” with Joe Allen at the West Hartford Elmwood Community Center Fri-Sun, August 24-26 All Day Event Plainville Balloon Festival
Oct. 13, 2018 7 pm - 12 am
Night
Hartford Yard Goats Club
StriveHub Fab 5
“My therapist regularly is evaluating how much I can do and consults with me on how I did in between sessions. When I had difficulty with an exercise, she changed the routine to help me better reach goals.” - Wallingford “The staff is very friendly and knowledgeable about the whole process of getting your body back into working shape :)” - New Milford “The staff is amazing at making people feel comfortable. You can really see how educated they are in their field and how much they want to see their patients get better. I’ve seen great results and unlike previous visits to other facilities, I look forward to physical therapy.” - Plainville “Outstanding customer service and extremely knowledgeable staff. You will not find a better PT group anywhere. Everyone is a professional and incredibly friendly as well as totally committed to your long term recovery. Don’t go anywhere else!” - Windsor “Friendly and professional group that take an active role in patient recovery and are focused on and capable of helping me reach my goals as a patient.” - Guilford
CLINICIAN’S CORNER BY TOM KASSAN, PT, DPT
CURRENT EVIDENCE ON IMAGING IN PATIENTS WITHOUT BACK PAIN It is estimated that low back pain will affect almost 66% of adults at some point throughout their lives.1 Unfortunately, this often leads to costly imaging, injections, and surgeries. However, new research is emerging that puts into question the results of CT and MRI imaging as a diagnosis for low back pain, and should have a great impact on improving future care. In 2014, Brinjikji et. al systematically reviewed the literature to determine the age-specific prevalence of MRI and CT imaging findings in asymptomatic individuals. The study focused on 6 findings often associated with degenerative disc disease: disk degeneration, disk signal loss, disk height loss, disk bulge, disk protrusion, annular fissures, facet degeneration, and spondylolisthesis.1 The systematic review included 33 studies reporting imaging findings on 3,110 individuals. As shown in Table 2 below, disc degeneration was identified in 52% of 30 year olds. This increased to 80% in 50 year olds and 93% in 70 year olds. Additionally, disc bulges were identified in 40% of 30 year olds, increasing to 60% by age 50 and 77% by age 70. Although the authors list several limitations of the study, they made sure to specifically exclude any and all studies that “did not explicitly state that patients were pain-free” to ensure the integrity of the results.1 The biggest question I have after reading this study, is that if a large majority of patients without pain have these findings on imaging, how clinically relevant are the imaging findings of patients that do have pain? And how should we explain this to our patients? There are several other studies that attempt to find the correlation between pain and imaging, but there has not been anything conclusive. For example, in 2016 Burgstaller et. al found that there was no correlation between MRI findings of lumbar stenosis and severity of pain.2 Additionally, a literature review in 2014 concluded that “a reliable diagnostic tool that could help a clinician to determine if a disc is the source of the pain in patients with chronic LBP is still not available” after looking at several variations of MRIs and provocative discography.3 In another example, a cross-sectional study in 2013 found “… MRI findings were not related to the degree of disability or the intensity of LBP.”4 Lastly, a systematic review from 2011 found that “MRI findings of disc protrusion, nerve root displacement or compression, disc degeneration, and high intensity zone are all associated
with LBP, but individually, none of these abnormalities provides a strong indication that LBP is attributable to underlying pathology.”5 I believe the overall consensus from these studies are of great value to clinicians and patients alike, and should help put the results of imaging in their place as only a (small) part of the patient examination. So while imaging can be important for ruling out more serious pathologies such as tumors, myelopathies, and fractures, it should not be used as a diagnostic tool for pain. Additionally, these conclusions strengthen the role of physical therapists in performing a thorough subjective history and physical examination, by providing the most clinically relevant findings in properly treating a patient. The results of imaging should only be considered relevant when correlated to our clinical findings, not vice versa. Please use this table in your clinic to help in educating your patients and continuing to provide excellent care.
1. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2014). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2. Burgstaller, J. M., Schüffler, P. J., Buhmann, J. M., Andreisek, G., Winklhofer, S., Del Grande, F., ... & Held, U. (2016). Is there an association between pain and magnetic resonance imaging parameters in patients with lumbar spinal stenosis?. Spine, 41(17), E1053-E1062. 3. Brayda-Bruno, M., Tibiletti, M., Ito, K., Fairbank, J., Galbusera, F., Zerbi, A., ... & Sivan, S. S. (2014). Advances in the diagnosis of degenerated lumbar discs and their possible clinical application. European Spine Journal, 23(3), 315-323. 4. Berg, L., Hellum, C., Gjertsen, Ø., Neckelmann, G., Johnsen, L. G., Storheim, K., ... & Norwegian Spine Study Group. (2013). Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis. Skeletal radiology, 42(11), 1593-1602. 5. Endean, A., Palmer, K. T., & Coggon, D. (2011). Potential of MRI findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine, 36(2), 160.
Let’s get to the point. PTSMC has invested a great deal of time, effort and money into Trigger Point Dry Needling (TDN) training over the last few years. As a newer PT procedure, the results of TDN have been exciting as patients have shown amazing improvement. Considering TDN is relatively new and that it is much more invasive than any other intervention we use we want to ensure we are doing our very best to provide this treatment in the safest way possible.
Student Program Update STUDENT PROGRAM UPDATE As PTSMC’s Compliance Officer, I was tasked with the exploration of recommending the most comprehensive TDN Kevin Howard will present on Medial Elbow training organization for our clinicians that best meets our primary goals of the highest level of training and the safest delivery. As a clinician, I took Levels 1-3 of IAMT Trigger point dry needling, which was a fantastic experience. I recently attended Myopain Level 1. So I had the opportunity to compare the two programs; Myopain and IAMT. Myopain has clearly met and exceeded both goals of high level training and safety.
of Pitchers on August 10th at 1 pm in Avon.
Brian Reis will present “Clinical Application Myopain has a detailed and precaution oriented approach. They have a well-established method for education and spend of Movement Impairment Syndromes” on a large portion of time on safety and needle handling. Their technique and approach is specific and effective as well as August 7th at 1 pm in Waterbury. providing very comprehensive reference materials. Their education level is high and their methods and procedures are on point. Myopain has a certification program that includes a written test and practical exam at the end of the third course.
PTSMC has selected Myopain as our provider of choice for education in Trigger Point Dry Needling. This means, clinicians looking to pursue TDN education must attend Myopain to have PTSMC pay for it. Many PTSMC clinicians have taken IAMT TDN and received a great education. Clinicians who received education from IAMT will be grandfathered in to the system, meaning they can finish the IAMT track. There are plans to bring Myopain in for an inhouse PTSMC program. More information will be coming on that. Please reach out to me at Emily.hansen@ptsmc.com with any questions or concerns. - Emily Hansen, Compliance Officer
Jamie Pare and Jon Soderquist will host Paige Allen for her final affiliation beginning August 27th. Paige is currently a student at Texas Women’s University.
NOVEMBER AND DECEMBER VACATION REQUESTS
Employees have been submitting their time off requests for November and December, however please be aware that the approval is not completed until September 25, 2018.
Extra MILE
Approval Process Employees may submit a vacation time request at any time during the year, however the submission and approval Tips for EXCELLENCE in customer service deadline for November and December requests is listed with Alison Pearce, Customer Experience below. Employees may only request time off during on holiday during the November and December request period. Coordinator
HSA QUALIFIED EXPENSES
Did you know you can use your HSA money to purchase the following items? • Contacts and contact lens solution • Eye glasses and accessories • First aid kits • Hot and cold packs • Lip balm • Reading glasses and magnifiers • Sunscreen for babies, children or adults • Thermometer
PREVENTATIVE CARE
Preventative care offers the following with no copay and no deductible. Get your yearly physical with no cost to you! • Well Child Care • Yearly Routine Health Examinations • OB/GYN Visits • Mammography • Hearing Screening
Submission Deadline September 15, 2018
Director Approval Deadline September 25, 2018
The November and December Holidays for 2018 and New Year’s Holiday for 2019 will be observed as follows: Thursday, November 22nd Tuesday, December 25th Tuesday, January 1st
Monday, December 24th Christmas Eve Schedule All clinics will be open from 7:00am - 1:00 pm on Monday, December 24th. All full-time employees who are scheduled to work 8 hours a day and work from 7:00 am - 1:00 pm will be paid for 8 hours on this day. All employees who have requested time off on this day will use the total vacation hours requested. The approval considerations for prime-time vacation requests are as follows: • Time available • Seniority • Length of time requested (preference given to extended time vs. one day) • Appropriate staffing levels maintained
Patient Services Coordinator Southington Practice Liaison Admin
ALWAYS smile when answering the phone, it really makes a difference. Customers can hear that smile over the phone. Try it!
Thanksgiving Christmas New Year’s Day
CURRENT JOB OPPORTUNITIES AT PTSMC Physical Therapist New Haven Westbrook
The
Physical Therapy Aide Groton Guilford New Haven Waterbury Watertown Westbrook
Check PTSMC.com for our most up to date postings and feel free to share! We’re always interested in connecting with referrals of colleagues and friends.
DID YOU KNOW? Some United Healthcare Medicare Complete 3 plans require authorization from Optumcare as well as an electronic referral from PCP. Be sure to check the back of the insurance card. This is where you will see the Optumcare notification. You must call 888-556-7048 to start the authorization process prior to or on the first visit. Most of the Medicare 3 plans still only require an electronic referral, but I have seen an increase in these Optumcare plans. If you have healthid.optum.com website access, you can see a full copy of the insurance card online.
When greeting customers: Smile, make eye contact and greet them by name, e.g. “Hi Mary, how are you today?” Make it personal. If they told you something about themselves on their last visit remember to ask them about it – I have had patients say “Thank you for asking, that means a lot!” and “WOW you remembered!” These simple things set us apart from other PT groups. How many of us go to a doctor’s office and feel truly welcome and cared for? Many times, we are handed a piece of paper to sign and more often than not, they don’t even know your name!! Treat people how you would like to be treated. It’s pretty simple when you think about it, but in practice it can make a huge impact on a patient’s experience. Share your tips on how YOU go “The Extra Mile” – send an email to alison.pearce@ptsmc.com, we will pick 3 winners for a $5 Dunkin Gift Card.
“Optimism is a happiness magnet. If you stay positive, good things and good people will be drawn to you. - Mary Lou Retton
Life Beat Beat the heat with these fantastic fitness activities! The Adventure Park at Storrs • Storrs, CT • Only $12 per person • Climb, Connect and Communicate with loved ones.
NEW EMPLOYEES
Welcome to PTSMC. We’re so happy to have you!
Jake Courtman
Emily Fillion
Alexandra DeFrance
Guilford PT Aide
Middletown PT Aide
Marketing Coordinator
Anna Mayo
Kyle McCormick
Mike McGowan
Elizabeth Park: • Hartford, CT • FREE • Walk along flourishing flowers any time of day.
Newington PT Aide
Windsor PT
Guilford PT Aide
West Hartford Reservoir: • West Hartford, CT • FREE • Enjoy five radiant reservoirs along some of the most beautiful trails.
Samantha Palicz
Colleen Menard
New Milford PT Aide
New Milford PT
Talcott Mountain State Park: • Simsbury, CT • FREE • Enjoy an exquisite hike to an unexpected reward at the top.
Miriah Ventre
PT Aide Guilford
Tarrywile Park & Mansions: • Danbury, CT • FREE • Explore trails that take you through fields of savory blueberry and strawberry patches, spectacular views, or strenuous rocky terrain.
Welcome back!!
Erik Schmitt
Westbrook PT
Former PTA
Ashley Tighe
Wallingford PT
Former PTA
Harrison Picard
Southbury PT Aide
PTSMC Happenings
Branford PT student Laura shared resarch on testing techniques used for vestibular rehab to identify issues such as vertigo and dizziness.
Middletown enjoyed stretching out runners at the Citizens Bank 5k Summer Run!
Michael Gans, Director of Clinical Excellence (2nd from right), and Stephanie Weyrauch, Orange PT (4th from right), represented PTSMC on a panel discussion at the APTA NEXT conference. Guilford celebrated PT Aide Tara’s birthday.
Congraulations John!
Social Media Sensation!
Thanks to Cara McEvoy for sending this image of Branford & New Haven giving PT student Laura a warm send off as she returns back to school!
Congratulations to John, who came to PT for Life in Southbury to help rehab his hip! Now he’s feeling on top of the world thanks to our incredible staff. He credits his recovery mainly to strengthening, stretching, and dry needling.
"Drew, thanks to you and the team at PT for life. This is why Physical Therapy is so great. This picture is from the top of Piz Lunghin in Switzerland, about 2900 meters tall. The hip therapy really made this possible this year!"
-John C.
AUGUST BIRTHDAYS Livia Shehu Caitlin Chaput Colleen Menard Rowan O'Connell Kayla Thomas Michelle Kijewski Michael Lynch Sarah Alkire Cierra Hungerford Tom Kassan Erik Schmitt Elena Masiello Olivia Tarca Leslie Riviere Natalie Lytle Elton Purvis Zack Niziolek Lauren Peladeau Steve Berry Julie Jeski Stephen Dering Bella Olmstead Erik Olsen Nicholas Almonte Caitlin Greco Izzy Stowik Ashley Claud Bryan Baker Ellie Ramsey Stevie Fell Tracy Caligiuri Sylwia Danowski
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Watertown Guilford New Milford Admin Naugatuck Wallingford Naugatuck New Haven Admin Newington Westbrook East Hampton Windsor New London Admin Westbrook Avon Groton Guilford Plainville Guilford Middletown Southbury Orange Westbrook Wallingford Avon Westbrook Branford Waterbury Waterbury Newington
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BELATED BIRTHDAYS
Kristin Whitney June 29th Jessica Decoteau July 13th Stephanie Delfranco July 14th
East Hampton Groton Admin
ANNIVERSARIES Jason Smutnick Tracy Caligiuri
Windsor Waterbury
PT PSA
Bethany Grady Erik Lanese Joe Mabry
Groton Waterbury Waterbury
ATC ATC PT Asst.
Ashley Troiano Caitlin Chaput Chelsea Searles Christian Santana Christine Rasile Danielle Spinella Devon Macko Gabby Verrilli Jonathan Savona Katie Urycki Kristin Whitney Liz Saunders
New Haven Guilford Southbury New Milford Admin Guilford Plainville Naugatuck Branford Westbrook East Hampton New London
PT Aide ATC ATC PT Aide Accountant PT Aide PT Aide PT Aide PT Aide ATC PT Aide ATC
Congratulations! Julian Chacko Caleb Charles Chacko & Lillian Michelle Chacko Born July 13, 2018 6 lb 3 oz & 6 lb 2 oz
Erik Olsen Leonardo Michael Olsen Born July 18, 2018 7 lbs 7 oz