SEPTEMBER 2021
IT’S A LONG AND WINDING ROAD… I’ve tried to limit the “COVID conversation” in many of my communications over the last several months. I, like many of you, am tired of the grind that has been required to get us this far in the pandemic. As I’ve mentioned in earlier messages, there is no playbook going into a global pandemic. I’ve come to accept that we don’t have a playbook to get us out of one either. In many ways, PTSMC and our people are in a much better place than we were a year ago, and that’s where I need to focus. Fortunately, our clinics are busy, with most back to capacity and some continuing to grow. The challenge of finding good people to join our team is daunting, however, I find it far preferable to lying awake at night worrying about furloughed employees and the future of the company. We are progressing in the direction of more “normal” fall activities this year. The CIAC announced that school sports will be played, which means our Athletic Trainers will be able to do what they love, and student athletes will once again take to the fields. …we hope. In addition, after a forced-hiatus last year, the Annual PTSMC Golf Tournament is returning to The Golf Club of Avon on Tuesday, September 28. For years, this event has been a fun way to say “thank you” to physicians and others who have been instrumental in supporting and participating in our success. Finally, the first ever “Happy Hour Tour” is happening! We are looking forward to some fun and socializing – a chance to reconnect with our colleagues from across the state. Our people want to reestablish the community that is so important to our
PTSMC & PT FOr LIFE HAPPY HOURs! It has been a long time since we have been able to get together, and what better way to reconnect than enjoying an outdoor gathering while the sun and warm weather are still around. PTSMC & PT For Life will be hosting regional Happy Hours in September & October! Staff 21 and older are invited to attend at their regional location.
culture, and this is a perfect opportunity to do so before the cold weather settles in. To be as safe as possible, all events will be outdoors and weather dependent. I balance these and many other steps forward against the news of the “Delta Variant,” the prospect of necessary booster shots and the conversations about healthcare organizations possibly being required to mandate vaccines for employees. The return of indoor mask mandates in several towns give me pause as I prepare to send my unvaccinated 11 year-old son back to in-person learning. …I hope. In truth, I find these to be very challenging and “fluid” times. I know a family that has just returned from a “dream vacation” in Greece, while I have other friends who have not strayed very far from their own yards this summer.
Clinician’s Corner by Lauren Randall, Wallingford Physical Therapist Fibular vs. Talocrural Mobilization HR Buzz HR is Here for You ADP Employee Registration is Here! Wellness Program #GetMoving Team Challenge Financial Wellness- Date, Time, RSVP The Extra Mile by Kristen Forster “How Much?” Employee Spotlight: Erin Walsh, Waterbury Partner & Director Residents’ Pico Project: Spine by Sam McMullen, Southington Physical Therapist, and Tom Mango, New London Physical Therapist
We are all in this together, yet the paths we walk will be different. In the end, I am optimistic we will get past COVID and whatever variant comes our way I am slowly accepting the fact that there is no direct and predictable path ahead, and we may be taking one step “The staff is phenomenal in its care, treatment, backward for every two steps forward. I wish we could move and regiment. Both Sydney (Houseworth) and through it all faster. Josh (McAdams) are that rare class of medical professions that actually explains the specific As a person, father, husband, friend and leader I am doing the best I reasons behind the chosen regiment to get you can. back into shape. I always look forward to the entire staff pushing me to the limits.” - Danbury I hope you are too! “I have been working with both Alex Thanks, (Rosenberg) and Kailey (Hanks) over the past six weeks or so and think both are truly excellent. I look forward to my appointments (though of course I am often sore afterward) because I feel supported, listened to and learn a Alan great deal each time.” - Lock Street
StriveHub Fab 5
Patient Trends New Patients per Month
Visits per Month
“I have many years of experience with PT and the treatment I have gotten at PTSMC, especially from Melissa (Boutagy) and Becky (Passante) is top notch. Their focus is usually on therapy and mobility for me and has been highly effective. I greatly appreciate their experience and intuitive approach.” - Guilford “I have been treated at PTSMC on more than one occasion and have ALWAYS found them to be highly professional. I achieved relief from my issues and the attention I required to do so. Can't say enough about how great they are! The atmosphere is fun to be in as well. I tell everyone to go there!” - Essex ”Kenny (Kregling) is a conscientious PT whose gentle manner and careful attention have made a huge difference for my recovery from back surgery and long-term back pain.” - Wallingford
See the invitation insert on Page 10-11 for location details & the RSVP contact for your clinic. RSVP to your clinic’s contact by September 7th.
IN THIS ISSUE
Blue = Actual | Orange = Budgeted
CLINICIAN’S CORNER
FIBULAR VS TALOCRURAL MOBILIZATIONS IN LATERAL ANKLE SPRAINS By Lauren Randall, PT, DPT Wallingford Physical Therapist Lateral ankle sprains are a common injury seen in an outpatient orthopedic setting, especially among athletes. Research estimates that approximately 20% – 40% of all athletic injuries involved ankle sprains.1 Ankle mobilizations are commonly used as part of the treatment plan for this population. Multiple studies have found anteroposterior talocrural mobilizations to be effective in improving ROM, pain levels, and ankle function.2 Preliminary research has also been conducted investigating the effectiveness of fibular mobilizations to treat lateral ankle sprains, which have also been found to have positive results. During the acute phase of rehabilitation following lateral ankle sprain, we want to be sure we are using the most effective techniques to treat our athletes to help them improve functional ability quickly while also providing lasting results. Is there a difference in effectiveness between talocrural mobilizations and fibular mobilizations? Izaola-Azkona et al. conducted a double-blind randomized control trial to investigate the short-term and long-term effects of anteroposterior mobilization of the talus compared to distal fibular mobilization with movement and distal fibular mobilization with movement with tape.2 Participants were amateur soccer players with acute ankle sprains (<72 hours post-injury) allocated to one of the three treatment groups.2 All participants received eight treatment sessions, with mobilizations performed three times per week for the first two weeks.2 The first six sessions consisted of the mobilizations in addition to education, manual therapy, and electrophysical modalities to ensure that patients were receiving comprehensive treatment plans.2 The last two sessions were used to educate patients on proprioceptive exercises. Outcomes examined included Foot and Ankle Ability Measure (FAAM), Patient Global Impression of Improvement Scale (PGI-I), visual analogue scale (VAS), pressure pain threshold (PPT), volume, strength, and ankle ROM.2 Outcomes were assessed at baseline and at two, five, twelve, and fifty-two weeks post intervention.
The results showed that at two weeks, the talocrural mobilization group demonstrated greater FAAM sport subscale scores compared to the fibular mobilization groups.2 When looking at medium and long-term effects, both of the fibular mobilization with movement groups were found to result in greater ADL function at five weeks and greater sports function at twelve and fifty-two weeks compared to the talocrural mobilization group.2 No significant differences were noted between the fibular mobilization with movement group and the fibular mobilization with movement group with tape.2 When looking at all time points, there were also no significant differences found between groups for PGI-I, pain, PPT, ROM, strength, or volume.2 Based on these findings, fibular mobilization with movement should be strongly considered as a part of treatment for lateral ankle sprains in athletes. These mobilizations resulted in greater long-term effects, which can help our athletes have lasting benefits even after discharge from physical therapy. Although the talocrural mobilizations did not have as significant long-term effects, they resulted in greater short-term athletic function. When preparing an athlete for return to sport following an acute lateral ankle sprain, it may be beneficial to consider both talocrural and fibular mobilizations as part of our treatment plans to improve functional ability.
References: 1. Cavazos GJ, Harkless LB. The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes. Journal of Sports Medicine and Therapy. 2021;6:008–017. 2. Izaola-Azkona L, Vicenzino B, Olabarrieta-Eguia I, Saez M, Lascurain-Aguirrebeña I. Effectiveness of mobilization of the talus and distal fibula in the management of acute lateral ankle sprain. Physical Therapy. 2021;101:1–10.
CLINICAL EXCELLENCE Upcoming Courses INTERNAL COURSES
EXTERNAL COURSE
Vestibular
Myopain TDN-2
December 4 Time & Location: TBD Taught by Rick Purdy DOCS Requirement
Concussion: A Framework To Guide Evaluation & Treatment October 23-24 PTSMC Orange Taught by Rick Purdy Not a DOCS course
Email Mallory Mason at coned@ptsmc.com for all sign ups or questions.
November 5-7 QU North Haven Campus *Myopain TDN-1 prerequisite reqiured Concussion: A Framework Guide to Evaluation & Treatment will focus on how to better assess, treat and manage concussion patients, from New Haven Physical Therapist Rick Purdy, PT, CMTPT. Rick specializes in the knowledge and skills to treat concussion and vestibular patients. Participants of this course will create models of assessment and treatment for concussion patients and utilize case studies and different patient presentations in order to more effectively manage our concussion patients. This course is intended for clinicians that have taken previous continuing education for concussions, experience working with patients with concussions and/or taken a previous Internal DOCS Vestibular course.
2021 Continuing education opportunities list https://ptsmc.egnyte.com/dl/mcbFLYwFkg/2021_Clinical_Excellence_List_of_Courses.xlsx_
Use the link above for a list of PTSMC Internal, PTSMC Sponsored, and External course opportunities. Please reach out to Mallory Mason via coned@ptsmc.com if you have any questions.
Lower Extremity Course on August 21st Held at PTSMC Wallingford on August 21
Welcome to our new auditors! Stephanie Weyrauch and Meagan Hoffman will be joining our Audit Team come this fall and will participate in Q4 audits! Welcoming Meagan Hoffman, Westbrook PT, who has been with PTSMC since 2015. Meagan is excited to bring her expertise as a excellent documenter to the team. Meagan looks forward to the reviewing and education process of auditing our clinicians. Stephanie Weyrauch, Orange PT, has been with PTSMC since since 2018, is happy to join her coworker Katy Sullivan on the team. Stephanie is always looking to be a leader in and out of the company. She is passionate about all things PTSMC and the profession. Stepping into the auditor role, Stephanie takes her passion for PTSMC and the PT profession and sees this as an opportunity for her to continue to learn as well as educate other clinicians on documen-tation and compliance. Welcome to Meagan and Stephanie to their new roles on the PTSMC Audit Team!
STUDENT PROGRAM UPDATE
PTSMC welcomes four students who will begin affiliations at the following clinics: Adam Heitner (QU) will be working with Ted Raczka in Branford. Jacob Ober (UCONN) will be working with Tyler Naef in East Hampton. Melissa Calcavecchio (QU) will be working with Rebecca Petrosino in Fairfield. Brendan Nork (QU) will be working with Justin Santamaria in Westbrook.
Stephanie Weyrauch, PT, DPT, MSCI
Meagan Hoffman, PT, DPT, OCS, CMTPT
Thank you to these four PTs and all of other PTSMC clinicians who “give back” by helping to educate future PTs!
HUMAN RESOURCES New Hire Referral Bonuses HR IS HERE FOR YOU
We need your help! Do you know anyone who would be a perfect fit for PTSMC or PT for Life? We’re offering a referral bonus for all positions!
HR will continue the Virtual Clinic Visit format for the month of September. Check your email for more details. The links to sign up are listed below and will be included in the email. We will be available from 7:00 am – 5:00 pm each day. Meet with Karen Havlicek Tuesday, September 21st https://calendly.com/hrroadtrip/hr-is-here-for-you-kh Meet with Sandra Boccialetti Tuesday, September 28th https://calendly.com/sandra-boccialetti/hr-is-here-for-you
$500
EMPLOYEE REGISTRATION IS HERE! ADP registration begins this week and must be completed by all employees by 9/10! By Wednesday, September 1st • You will receive an email from Sandra Boccialetti that will include with instructions and training links for how to register and use ADP Workfoce Now. By Friday September 3rd • You will receive a registration email from ADP to begin your registration process. Note, ADP recommends using Chrome. o You will create a username, password and security questions. o If you have registered with ADP with another employer you must use a DIFFERENT username and password when registering under PTSMC. Registration Deadline: Friday, September 10th • Your ADP Registration MUST be completed by end of day September 10th. o Prizes will be offered to clinics who have full registration completed by the deadline. • Once registration is completed employees will continue to receive emails and training videos from Sandra Boccialetti. Effective September 19th all employees will be completing timesheets in the ADP Workforce Now system • October 6th will be the first live payroll with ADP • October through December continued communication and training
CONGRATULATIONS! Congratulations to the following PT Aides who have completed the SIPTA (Skills Introduction for PT Aides) Program: Nicole Brissette, Lock Street Sam Grandich, Lock Street Katie Picone, Southbury
CURRENT JOB OPPORTUNITIES Patient Services Coordinator Fairfield Groton Guilford New Milford Orange Westbrook Windsor
Physical Therapist Fairfield Groton Naugatuck/Watertown New London New Milford Wallingford West Hartford Wethersfield
Physical Therapist or Physical Therapist Assistant Groton New Milford Westbrook
Physical Therapy Aide Danbury Essex Fairfield Guilford Lock Street Middletown Naugatuck New Haven New Milford Wallingford Watertown West Hartford Westbrook
Executive Assistant Admin Data Analyst Admin Employer Services Specialist Admin
Check www.PTSMC.com/job-openings for our most up-to-date postings, and feel free to share! Call Jenn or email at Jenn.Detlefsen@ptsmc.com for PT Aide positions. Call Karen or email at karen.havlicek@ptsmc.com if you are interested in another position.
EMPLOYEE NEWS
NEW EMPLOYEES
Billy Barber, Westbrook PT Aide
Lydia Batista, Watertown PT Aide
Chris Burkle, Guilford PT Aide
David Cusack, Wethersfield PT Aide
Katie Dadio, New London Athletic Trainer East Lyme High School
Cara DiMercurio, Windsor PT Aide
Gyujin Kim, Essex Athletic Trainer Valley Regional High School
Keaton Mangi, New London Athletic Trainer Waterford High School
Jennifer Prasam, Fairfield PT Aide
Amanda Cabush, Windsor PT Aide
Nolan Freeman, New Milford PT Aide
Liza Peressini, Danbury Physical Therapist
NOT PICTURED:
James Coburn, New London PT Aide
Bill Gigiuseppe, Guilford Athletic Trainer Guilford High School
Adam Petrosino, Fairfield PT Aide
Daniel Schaffer, Avon PT Aide Jacob Rooney, Orange PT Aide Cory Wolski, Avon PT Aide Nathaniel Biega, Avon PT Aide Aneri Patel, Plainville PT Aide Joel Greenwood, Groton PT Aide Patricia McLean, New Milford PT Aide Nicole Carroll, Plainville PT Aide Matt Turo, Glastonbury PT Aide
Tatyana Vega, Glastonbury PT Aide
Employee
Spot light Erin Walsh, PT,DPT, MSPT Waterbury Partner & Director
Erin Walsh has been with PTSMC as long as someone possibly could– 21 years! Erin is the Partner & Director of PTSMC Waterbury and as her story goes, she, “took the scenic route to becoming a Partner.” Erin’s PT career started at Griffin Hospital where she quickly realized outpatient was the path for her. She was then given the opportunity to work for PTSMA under Hank Balavender (Alan Balavender’s older brother) where she recalls Steve Platt (Guilford & Wallingford Partner) was a PT Aide and Scott Cameron (Westbrook Partner) was a PT Student! In 2000, Erin was looking for a job closer to home when she learned Alan was hiring for the original PTSMC Waterbury location on Vernon Street. It was the perfect match! In 2006, Erin became the primary physical therapist fulfilling our management contract at Restore, owned by Waterbury Orthopedics at their West Main Street location. In 2011, Erin then became Director of PTSMC Waterbury on Vernon Street. Under Erin’s leadership in 2021, PTSMC merged with Restore, the practice owned by Waterbury Orthopedics and consolidated both practices on West Main Street. PTSMC Waterbury has been there ever since. It was at that time that Erin became the first female Partner of PTSMC! When asked how she decided on her career path, Erin replied she had always known that she wanted to be a Physical Therapist. She attributes her “lazy defense” while playing basketball to the reason she became a PT. It resulted in a sprained ankle, and she needed Physical Therapy to recover. From that point, she began researching schools within neighboring states that offered PT programs and decided on Quinnipiac College. She received her BS in Physical Therapy and later obtained her MS degree from Quinnipiac University concentrating in Orthopedics. Erin also earned her transitional DPT degree in Private Practice Management from EIM. Although Erin settled in CT with her career and family, she did not live here her whole life! She grew up in Hudson, New Hampshire and has one older brother who lives in California with his family. Her husband, Tom is a carpenter by trade and is currently a carpentry instructor at Oliver Wolcott Tech in Torrington, CT. Erin and Tom have two daughters, Ryann (14) and Raegan (10) who both play soccer. As a family they love spending time outdoors whether it's hiking, doing water activities such as kayaking or just relaxing on a beach and breathing in some fresh ocean air! Erin enjoys listening to music, especially when she needs to take her mind off things and has always been a huge U2 fan. As hectic as a Partner’s schedule can be, keeping a clinical schedule, filling in with administrative time and attending meetings are all made possible because Erin loves the people she works with. Above all else Erin appreciates how both staff and patients not only make her a better person, but they allow her to improve their quality of life. Erin is confident she chose the right career because, “there are so many kinds of people with different mindsets and diagnoses that every day is different and never boring!” Waterbury’s Patient Services Administrator, Tracy Caligiuri, says that a pet peeve of Erin’s is when her employees reply to her with “Okay, boss!” She will quickly say with a smile “don’t call me that” and laughter is shared by everyone. One of the things Erin enjoys the most is developing a team of people to reach a common goal and working together to make sure everyone succeeds.
SEPTEMBER BIRTHDAYS Eric Horne Jen Powers Maddie Moran Nicola Ciccomancini Peter Decoteau Nick Scott Emily Claros Justin Esty Shradha Rana Lauren MacDonald Matt Baronowski Sam Dassatti Jacey Bissell Pete Cambi Zach Gardner Melissa Boutagy Trish McLean Erik Wagner Carson Mendoza Roy Colter Joe Caligiuri Mario Paredes Brian Greer Mike Durand Erica Breive Madi Sides Wanda Figueroa Malanie Young Keren Deoliveira Amy Demers Colin Ketchel Makayla Bigard Andrea Petramale Amy Bellone John Augustine Skylar Vumback Sam Ostrowsky Sam Donahue Logan Deros Jacob Rooney
1 1 1 1 4 4 4 6 6 7 8 8 9 9 10 11 12 12 13 13 14 14 16 17 17 17 19 19 19 20 20 20 23 23 25 27 29 29 29 30
Simsbury Fairfield New London Wallingford Admin Westbrook Wethersfield Danbury Lock St Essex Avon Fairfield Branford Southington Glastonbury Guilford & Admin New Milford Lock St Branford Newington Naugatuck Orange Wallingford Admin New Milford Simsbury Admin Middletown New Milford Branford Branford New Haven Newington West Hartford Guilford Essex Guilford Guilford Watertown Orange
SEPTEMBER ANNIVERSARIES Amy Demers Christine Hill Justin Esty Mackenzie Anderson Iris Morales Marcus Santamaria Carole Pimenta Alex Rosenberg Caley Nigro Tom Mango Erica Breive Keren Deoliveira Caroline Murphy Olivia Schaub Drew DaSilva Stephanie Santos Pamela Subtil
Physical Therapist Referral Coordinator PT Aide PT Aide PT Aide PT Aide PSA Physical Therapist PT Aide Physical Therapist Physical Therapist PT Aide PT Aide PT Aide PT Aide Physical Therapist PT Aide
Branford Admin Danbury Essex Essex Essex Guilford Lock Street Lock Street New London New Milford New Milford Orange Simsbury Southbury Watertown Westbrook
The
Extra MILE
By Kristen Forster, Director of Operations
“How Much?” Hopefully, our patients never say this. Hopefully, they know how valuable the service they are getting is and don’t even question the cost. Hopefully, they realize the investment in their health and wellbeing will pay them back tenfold in their lifetime. How can we make this a guarantee and not a “hopefully...?” First, we must understand why patients come to us. We need to listen to their story and let them know they are in good hands by showing understanding and compassion. Second, it’s important to know if they have ever had physical therapy before. If they haven’t, we need to explain in clear and simple terms what physical therapy is – and is not – and what to expect. If they have experienced PT before, what was their experience like? Was it positive, negative or are they indifferent? In any case, explain how we are different; tell them about all the great services and treatments we can provide, our “PT for Life” approach to care and, of course, our highly qualified staff. Sadly, many people still don’t realize the extent of education and training that PTs and OTs have. It can help even more to allow the patient to get to know their PTs or OTs story for a personal connection and bigger picture of how qualified they really are. Third, we need to make it easy for them to get to us and begin treatment. Explain our digital intake process, where to go, what to wear, and let them know if they have any questions they can call and ask for YOU by name. It’s the small, personal touches that truly make a difference. Fourth, make sure the check-in process is smooth and everything is prepared. Pay close attention to the patient and be available to answer questions. Finally, once the treatment is complete, make sure the patient understands the plan their therapist has created for them. Explain the importance of following the plan of care to get the best results, including doing their home exercises and attending their scheduled appointments. Be sure to get them scheduled for the full course of care at the end of their first visit. By explaining the scope, purpose and timeline of their treatment, they are more likely to follow-through with it.
A Message from Melissa Boutagy, Clinical Compliance Officer To All Staff, Exciting news; my husband and I are expecting a baby boy in mid-September. At the time of his arrival, I will be taking a short leave. During my leave, compliance does NOT stop! While I am out, Emily Hansen Partner & Director of Simsbury, our former Compliance Officer, will be filling in. As a reminder, a compliance issue can be emailed or called in to anyone on the Compliance Board of Directors, who include myself and: Sandy Wickman Mason Sandra Boccialetti Mike Durand Todd Cacapardo, East Hampton Partner & Director Emily Hansen Simsbury Partner & Director & Interim Clinical Compliance Officer To remain anonymous when reporting, you can send a letter by mail to the office of any of the board members- address with the attention to their name. We are also launching a new anonymous reporting platform (details to come). Thank you for all you do to be compliant at PTSMC. My appreciation to Emily for stepping in, allowing me time so I can adjust to life as a new mother! Kindest Regards, Melissa Boutagy
If we deliver on all of these crucial parts of the patient experience, there is no question of the value of the services we provide, which means less “How much?” and more “Thank you!”
Welcome Jack Pearce to the Authorization Team! Jack Pearce joined PTSMC Groton while still in high school, in 2013. There is some truth when we say that he has grown up with PTSMC! Jack has always worked in our Groton clinic, working part-time or full-time with some breaks over the past eight years. It has also been a family affair. Jack had the opportunity to work with his mom, Alison and sister Chloe during the course of his tenure in Groton. He has formally fulfilled the roles of PT Aide and PSC. However, partner Steven de Castro coins him as his “Jack of All Trades!” Jack recently made the decision to move further north in Connecticut, making it unrealistic to commute to Groton. He loves PTSMC and really wanted to stay with the company. The Authorization Coordinator position was the perfect opportunity. Sadly, the Groton crew bids Jack a farewell from his day to day in Groton, however, they are excited for Jack and his new opportunities personally and professionally. Steven says, “I will miss Jack every day. He has been a constant for the Groton clinic and me, particularly these last two years and through the pandemic. He has been the glue and will be extremely difficult to replace. With that said, really happy he can stay with PTSMC.” Jack is excited to move upstate with his girlfriend and thrilled to continue working for a company he truly loves. He is looking forward to interacting with more of the PTSMC team across the state outside of who he already knows from Groton.
PTSMC Happenings!
PTSMC employees participated in the 95 mile RiMaConn Relay race on various teams. Their teams ran from Rhode Island to Hartford in one day! Pictured left: Mike Durand and Janet Tarasuk (Admin) Pictured center: Ali Durand and Mike Durand (Admin) Pictured right: Kristina Lipeika, second from right, and Stephanie Santos, far right, (Watertown PTs)
Fairfield Physical Therapist Jennifer Powers (left) and Partner & Director Rebecca Petrosino celebrated Jennifer’s name being added to the front door.
Lock Street has been celebrating Summer Spirit Days! Pictured above is their Sports Day and pictured left is their Crazy Sock Day.
New Haven received donuts and flowers from a patient as a thank you! Pictured is PT Aide Sona Pinela.
A few of our athletic trainers met with PA Erika Skinnon and Jessica Testani Creem, MS, LAT, ATC, of Orthopedic Associates of Middletown to go over casting techniques and discuss how athletic trainers and physicians work together to keep athletes safe and injury-free. Jessica is pictured doing a cast on Gyujin Kim, Essex AT at Valley Regional High School.
Congrats to our Olympic Challenge Winners New Milford!
SoCIAl Media Sensation Channing Harwood, Plainville Physical Therapist
Katie Newton, West Hartford Physical Therapist married Matthew Redman.
Quinn McAnaney, Westbrook Physical Therapist welcomed a daughter, Elle Catherine McAnaney, with his wife.
Matt Baronowski, Avon Physical Therapist married his wife Becca.
Channing recently put together videos for PTSMC’s social media, including a video on exercises for neck stiffness and shoulder warm-up exercises that have already been shared. Stay tuned for more videos from Channing! Check out the videos on our Facebook, Instagram, and Twitter accounts @ptsmc.
Engagement & Wellness Calendar September
#GETMOVING TEAM CHALLENGE Moving your body benefits your physical and mental health as well as brings people together. In 2015, PTSMC created the #GetMoving Challenge, and since then it has evolved into a fun and motivational space for employees to challenge themselves, share a common goal and interact with others. This time around, we are adding a twist… the first ever TEAM Challenge. The #GetMoving Team Challenge runs for 6 weeks: Sunday, October 17th – Saturday, November 27th Individual component: Get active for 30+ minutes for 30 of the 42 days and you will earn a reward. Team component: In addition, each day you #getmoving a point will be earned for your team. Participants will be randomly put into teams on Day 1. The team with the most points at the end of six weeks will win an additional prize!
Happy Hour in Wallingford
September 14th, 5:30-7:30 pm
Financial Wellness Webinar #2
September 22nd, 7:30-8:30 pm
Happy Hour in Southington
September 30th, 5:30 -7:30 pm
October Happy Hour in New London
October 5th, 5:30-7:30 pm
Happy Hour in Newington
October 6th, 5:30-7:30 pm
Happy Hour in Naugatuck
October 7th, 5:30 -7:30 pm
Fall/Winter Gear Order
October 11th - 22nd
#GetMoving
October 17th - November 27th
FINANCIAL Wellness WEBINAR
How to participate: We will be using the Slack app to submit activities and support each other and work together over the six weeks. Each DAY you #GetMoving, post your activity in the group and it will count towards your personal and team’s running total. Posts can include a picture of your activity, you, your watch/activity tracker, your view, your dog, or you can just send a description, no picture required. Other participants will be able to see your post, “like” the post and support you. No one outside of the group will see the messages. The Slack group will also be where you get the latest challenge information, updates, and fun activities. How to sign up: Email Mallory Mason at the PTSMC Wellness Program email- Wellness@ptsmc.com. Signups will run through October 16th. Once the full group is established, teams will then be created and there will be an email sent out with more detailed instructions for participants. Join in on the first ever #GetMoving TEAM Challenge to stay connected, and enjoy a friendly competition with other PTSMC go getters.
Save the date for Wednesday, September 22nd from 7:30 - 8:30 pm Connecticut Wealth Management is back in action teaching PTSMC about Financial Wellness, this time with a focus on Family Transitions. This includes: new marriages, preparing for a new baby, elder care/aging parents and more! Speak to your partner/director to arrange your schedule to attend live. The webinar will be recorded for those unable to attend live. Email Wellness@ptsmc.com to RSVP.
PTSMC & PT FOR LIFE
Happy Hours Reconnect with the PTSMC family! Let’s get together to spend time with the BEST people and enjoy good food and a few beverages. All employees 21 and older are invited to join at their clinic’s regional location.
All Happy Hours are 5:30 pm - 7:30 pm TUESDAY, SEPTEMBER 14th
Wallingford THURSDAY, SEPTEMBER 30th
Details This is a 21 and older event Food and beverages provided by PTSMC
Southington
Two alcoholic drink tickets/person
TUESDAY, OCTOBER 5th
BYOC - bring your own chair
New London
All Happy Hours are outside; weather permitting
WEDNESDAY OCTOBER 6th
Newington THURSDAY, OCTOBER 7th
Naugatuck
RSVP by September 7th (Turn over for your clinic’s regional location & RSVP contact)
Location Assignments & RSVP Contacts RSVP yes or no to your clinic contact. Your contact will submit a full clinic RSVP list to Mallory Mason. If you are unavailable & would like to attend a different location, reach out to mallory.mason@ptsmc.com
TUESDAY, SEPTEMBER 14th | Wallingford 5:30 pm - 7:30 pm 97 Barnes Road, Wallingford, CT
Branford Guilford Middletown Wallingford
Jacey Bissell Carole Pimenta Jacky Severance Nikki Matarazzo
TUESDAY, OCTOBER 5th |
New London
5:30 pm - 7:30 pm 635 Broad Street, New London, CT New London East Hampton Essex Groton Westbrook
Michelle Gallerani Randi Gallagher Lauren MacDonald Karin Larsen Emma Belval
THURSDAY, OCTOBER 7th |
Southington
5:30 pm - 7:30 pm 18 South Center Street, Southington, CT Danbury New Milford Plainville Southbury Southington Waterbury Watertown
Kirsten Reaves Natalie Pereira Kelly Cozzolino Erik Olsen Michael Sousa Tracy Caligiuri Lauren Mariotti
WEDNESDAY, OCTOBER 6th |
Newington
5:30 pm - 7:30 pm 64 Market Square, Newington, CT Avon Glastonbury Newington Simsbury West Hartford Wethersfield Windsor
Nancy Chilson Camille Mogelnicki McKenzie Daniels Betsy Holt Amy Bellone Leah Szot Meaghan Brunelle
Naugatuck
5:30 pm - 7:30 pm 100 Prospect Street, Naugatuck, CT Fairfield Lock Street Naugatuck New Haven Orange Shelton
THURSDAY, SEPTEMBER 30th |
Jennifer Powers Alina Lisowitch Debra Philcox Amanda Staheli Juliann Chacko Dominique Riley
Admin Staff
RSVP to Mallory Mason the date and location you would like to attend.
ORTHOPAEDIC RESIDENCY PROGRAM PICO PROJECT: SPINE
By: Sam McMullen, Southington Physical Therapist, and Tom Mango, New London Physical Therapist Over each 3-month semester, the residents complete a PICO Project - one for each area of the body. PICO is a format used in evidence-based practice to answer a question regarding the intervention or clinical question using an extensive literature search. PICO stands for Patient/Problem, Intervention, Comparison, Outcome.
P: Adults with Lumbar Stenosis (LS) I: Epidural Steroid Injection (ESI) C: Physical therapy (PT) O: Pain & functional outcome measurement Do male & female adults with lumbar stenosis (LS) benefit more from epidural steroid injection (ESI) or physical therapy (PT) in regards to pain and functional outcome measures? Lumbar stenosis (LS) is a common medical diagnosis seen in outpatient physical therapy with a variety of treatment strategies. According to a 2016 article by Lurie and Tomkins-Lane, lumbar spinal stenosis affects over 200,000 adults in the US. Furthermore, it is the most common reason for spinal surgery in patients 65 years and older. The authors report that “in 2007, more than 37,000 laminectomies for spinal stenosis were performed in Medicare alone with an aggregated hospital bill for these procedures of nearly $1.65 bn.” The exorbitant surgical cost burden leads one to consider if other interventions could be of value in negating the need for surgical interventions. Despite the progressive nature of the condition, perhaps non-surgical options can improve pain and overall function. However, there is sparse literature backed by high-quality evidence comparing the non-surgical management options for spinal stenosis. Patients often consider whether they should get an injection, do physical therapy, or both as a first line treatment. We performed a thorough electronic search of literature in PubMed, URI Library Holdings, and the APTA Article Search using key phrases such as “physical therapy, physiotherapy, rehabilitation, lumbar stenosis, epidural, steroid, spinal, injection” which yielded 10,860 results. Out of those results, two studies directly compared PT to ESI in terms of outcomes with pain and functional outcome measure in the adult population. One additional study is currently active and pending results. The focus of this PICO study is on pain and function because patients look to these as their main two measures of improvement. Higher level meta-analysis and systematic reviews for this subject are not yet available. Koc et al compared ESI, PT, and a control group to examine the effectiveness of these interventions in LS for pain and function. This study was set up as a randomized single blind control study utilizing a total of 33 patients. Each group had a mean age between 53-63 years old and a mix of males and females. Patients were included if they were diagnosed with LS based on physical tests, neurological exam, and MRI results (<15mm transverse or <12mm A/P diameter). More specifics about the physical tests and neurologic exam were not given by the study. Exclusion criteria was based on having a history of CAD, PAD, spinal surgery, fractures, and cauda equina. All groups received an HEP utilizing hip flexor/HS/lumbar stretching and abdominal/gluteal strengthening performed twice daily for six months as well as oral diclofenac 75mg twice daily for two weeks. The PT group received PT five days/wk for two weeks. Treatment in the PT group included ultrasound, hot packs, and TENS treatment. The ESI group received two lumbar epidural injections to the most stenotic level under fluoroscopy using an intralaminar method using a standard steroidal cocktail. The third group only did the HEP and oral anti-inflammatory medication. The investigator was blinded to which subjects were in each group. Pain was evaluated by VAS 100mm scale. Function was measured a few ways including finger to floor distance, time to first symptoms during 2mph treadmill walk and total time able to walk until severe symptoms set in (but only up to 15min max), sit to stand one rep, weight carrying (20m with 10% BW) for time, a Roland Morris Disability Index (RMDI), and a Nottingham Health Profile. ANOVA was utilized to study between group effects and paired t tests for within group comparisons. Follow-ups were performed at two weeks, one month, three months, and six months.
The ESI group significantly improved from baseline with VAS, weight carry, and RMDI tests at all visits. The PT group significantly improved from baseline during the two-week and three-month follow-ups with VAS, treadmill test, and RMDI. The control group improved in the treadmill test and RMDI. Regarding between-group comparisons, PT had significantly better reduction of pain at two weeks and RMDI at two weeks compared to other groups. The NHP subcategory of physical mobility was significantly better for PT at two weeks, one month, and three months while ESI was only better at two weeks. This article unfortunately has significant flaws throughout the study. The control group was allowed to have both anti-inflammatory medication and exercises as opposed to no treatment. The physical therapy group consisted of only passive modalities (heat, US, and TENS) which by today’s standards would be considered substandard care. The subjects were not similar at baseline in age (ESI 62yo, PT 61yo, and control 53yo) or in male:female numbers (control had nine males and one female). The definition of symptoms for LS inclusion criteria was non-specific other than MRI readings. This study gives some insight into the potential benefits of modalities though since the PT group (essentially a modality group) did have some significant differences compared to other groups. Beyond this, the study’s results are questionable due to methodology. Schneider et al. 2019 sought to compare several different nonsurgical interventions to treat lumbar spinal stenosis in a randomized clinical trial. The three-year study analyzed a 6 week course of treatment, with follow-ups at two months and six months. The authors compared a medical group (receiving medications and/or ESI), a group exercise group, and a group receiving manual therapy and individualized exercise. Outcomes consisted of the Swiss Spinal Stenosis Questionnaire and a measure of walking capacity deemed “the self-paced walking test”. As for study design, inclusion/exclusion criteria were established, and 259 participants were randomized into the three groups. Though an interesting study, several aspects of the design could have been improved so that readers could draw stronger evidence-based conclusions. Lack of homogeneity of the medical group (whether study subjects received medication “and/or” ESI) leaves room for bias when trying to compare these interventions to the other groups. If the reader cannot be sure that all study subjects in this group received ESI, one cannot consider the “medical group” a singular cohort that was exposed to the same independent variable. This is a facet of the study that could be improved upon with future research. The study found the greatest amounts of improvements in the manual therapy/individualized exercise group at two months based off their outcome criteria. However, there were no differences between the groups at six months both in outcome measures and responder rate. A guideline produced by the North American Spine Society was referenced in the study. The recommendations only included ESI and surgical decompression based off available evidence. However, it is also pointed out that there is conflicting evidence about the effectiveness of ESI, citing that the existing evidence is of low quality. Contrary to these findings, Schneider et al. reported the short-term benefits of manual therapy/individualized exercise over medical intervention in terms of symptoms, physical function, and walking capacity. However, aside from an improvement in walking capacity in all groups, there were no long-term differences. A more nuanced explanation was offered, suggesting that in a clinical setting, it may be most appropriate to utilize a shared decision-making process that analyzes and pursues any of these approaches, or a combination of these approaches. Furthermore, there is an opportunity for future research comparing the effectiveness of combinations of these approaches. In summary, a lack of cohesive and thorough literature exists when considering pain and functional outcome measures of ESI versus physical therapy in patients with LS. Design flaws in the existing studies make it challenging to draw evidence-based conclusions for healthcare providers to draw upon. Furthermore, conflicting evidence exists, which leaves the clinician in an incongruous state when trying to provide the best and most effective treatment to patients. Future studies will need to utilize the best current concepts in PT treatment as their PT group to accurately compare to ESI. Currently, it cannot be definitively reported based on existing literature whether ESI or physical therapy intervention has better outcomes in pain and functional outcome measures in patients with LS.
References 1. Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine (Phila Pa 1976). 2009;34(10):985-989. doi:10.1097/BRS.0b013e31819c0a6b 2. Lurie, J., & Tomkins-Lane, C. (2016). Management of lumbar spinal stenosis. BMJ (Clinical research ed.), 352, h6234. https://doi-org.ezproxy.lib.uconn.edu/10.1136/bmj.h6234 3. Schneider, M. J., Ammendolia, C., Murphy, D. R., Glick, R. M., Hile, E., Tudorascu, D. L., Morton, S. C., Smith, C., Patterson, C. G., & Piva, S. R. (2019). Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA network open, 2(1), e186828. https://doi-org.ezproxy.lib.uconn.edu/10.1001/jamanetworkopen.2018.6828