June 2020 PULSE

JUNE 2020

StriveHub Fab 6

MOVING FORWARD...

I really wanted to write about something other than COVID. This pandemic has consumed all of our lives. I wanted to go elsewhere and couldn’t. Every time I started, I found myself having to justify not talking about it, and I couldn’t, yet.

The Connecticut news continues to be favorable regarding hospitalizations. They are now below 500 cases statewide. In speaking with a physician friend, he was extremely optimistic about “what we learned about this virus.” He is absolutely convinced the medical system is learning the best ways to treat and ultimately defeat COVID-19. Our conversation gave me greater hope than I have had in some time.

As you can see from the graphs of March-May, PTSMC continues to rebound. As we continue to rebuild, our first priority remains the safety and health of our people and those we serve.

In speaking with Partners and Directors, everyone is making adjustments. Navigating increased staffing and volumes while maintaining social distancing could be considered a “good problem,” yet it requires constant consideration. How do we optimize safety, space, schedules, and relationships while maximizing our potential to treat patients?

When we consider a patient returning to one of our clinics, we must consider what will make their experience exceptional in terms of safety and outcome. We know that often “perception is reality,” and there are a number of questions you can ask yourself that may help optimize this reality: Can we take some time to “walk in their shoes?” What will make them feel safe? What do they see? What do they feel emotionally? What will they touch? The same questions also apply to each of us and everyone on our teams. It is imperative, that as we adapt we continue to ask questions and prepare for the answers that emphasize safety and outcomes over what’s easiest.

“Kevin Connellan is my PT, and he is such a bright, caring individual. My pain has subsided and my function has improved with telehealth. I feel safe staying at home and having my PT via telehealth. I have referred others to Kevin for telehealth PT.” - Plainville “First of all, Nancy (Chilson)'s rapidness to get me in especially because of my chronic need. Second, Travis (Lytle) has exceeded my expectation and has cared for me and alleviated the initial spasm that wasn't allowing me even to breathe.

Thank you!” - Avon “Pete (Cambi) is so kind, helpful, and

The road ahead is uncertain, and no one has all the answers. I have patient! He always takes the time to always believed in who we are and what we do, and I have great answers my questions and I feel so confidence that together we will figure it out.

Thanks,

Alan

Congratulations to our New Clinical Compliance Officer: Melissa Boutagy!

We are so excited to announce that PTSMC’s new Clinical Compliance Officer is Melissa Boutagy. Melissa is currently a full time clinician in our Guilford clinic. She will transition to her role over the next few weeks and will be dedicating sixteen hours a week to PTSMC’s Compliance program.

Melissa started with PTSMC in 2015. In October 2017 she completed her Manual Physical Therapy Certification program through the Evidence in Motion Institute of Health Professions. She quickly followed that by becoming an Orthopedic Clinical Specialist in June 2018. Most recently she completed her Trigger Point Dry Needling certification with MyoPain and she is a graduate of PTSMC’s Leadership and Management Development program, completing the program in 2019. Melissa is very active in PTSMC’s Clinical Excellence program as an instructor and mentor. She has a love of dance and is recognized by the Connecticut Theater circuit as a physical therapist for coverage when shows come to state theaters. As a clinician, Melissa is well qualified for the role.

Born and raised a Long Island, New Yorker, Melissa grew up as a dancer, and now she helps them!

She now enjoys running, and spending time by the water. Pre-quarantine, she put lots of miles on her car visiting family in different parts of New York, New Jersey and the DC area. Now time is spent with her husband on home improvements (painting, landscaping) to their new home in Orange.

Melissa is excited to make an impact. In her new role, Melissa is most looking forward to taking part in company wide planning and decision making, bringing a clinical perspective to compliance related topics and issues. She is also committed to ensuring our mission continues with each new clinical member we onboard! Melissa also commented that she is least looking forward being torn between two offices during PTSMC office competitions, including the ugly sweater day and the pumpkin contest!

confident in his ability to improve my conditions. I cannot say enough positive words about Pete. His staff also has such warm personalities and as a group they all set such a welcoming environment perfect for healing.” - Southington ”I have been to you a number of times in the past when rehabilitating from sports injuries. The entire staff, especially Ann Hall who I enjoy working with, has been very knowledgeable, professional and has gotten me back to being "normal" again in short order. Thank you all for your great service!” - Essex “It's a wonderful office with a great staff!

They take the time to talk with you about your injury and they work with you to heal and recover. I recommend Scott (Cameron) and the entire team at PTSMC Westbrook if you need PT!” - Westbrook “Three years ago my son suffered a devastating knee injury playing college rugby....we feared that he would never be an athlete again...Fortunately we were given a recommendation for PT for Life...They remained open during the Covid closure, taking every precaution possible to protect patients and helped my son towards an incredible recovery.

Words can't explain the way it feels to watch him run around a pickle ball court, strong, aggressive, competitive, and happy. THANK YOU!!!” - Southbury

CLINICIAN’S CORNER PAIN SCIENCE AND THERAPEUTIC ALLIANCE

By Tom Kirsch, PT, DPT, CSCS Physical Therapist at PTSMC Avon The International Association for the Study of Pain defines pain as, “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.”1 The key words in this definition are actual and potential. Not all of our patients are experiencing actual tissue damage when they are reporting pain.

It is very important for us, as physical therapists, to recognize those patients and determine when it is appropriate to use specific strategies to teach patients about their pain. It will be helpful to build trust with our patients and offer them the best recommendations for their future care; whether that be imaging, referral, or appropriate care through interventions and education.

Do we rely too heavily on pathoanatomical diagnoses and imaging?

We all come across patients that express the need to know exactly what is going on at a pathoanatomical level. These patients most likely will bring up the need for imaging multiple times throughout their care, discuss that they have always had a “bad back,” and frequently bring up structural faults that may presume they have or have been told in the past. It is important that we properly educate our patients on what the literature says about imaging, when appropriate. For example, Brinjinkji et al(2015) examined MRI imaging of lumbar spine in asymptomatic people2:

Clinical Implications: One simple method to put a patient’s mind at ease during initial evaluation is to screen for red flags and express to the patient that their symptoms are treatable and not abnormal, in order to ensure confidence. Another very important strategy for day one is building a therapeutic alliance, which is described as a working rapport or positive social connection between the patient and the therapist. The time you spend educating your patient and building a good relationship and trust can be just as important as picking the proper intervention, treatment, or HEP. Fuentes et al (2013) studied the effects of using an active vs sham IFC treatment combined with minimal therapeutic alliance or enhanced therapeutic alliance. Their findings showed that the group that received sham IFC with enhanced therapeutic alliance had greater reduction in pain that the group with active IFC and limited therapeutic alliance.4

Other strategies to consider: - Create goals with patient with a focus on function and patient’s desires - Promote self efficacy - Educate patient on pain science - Mental imagery - Breathing strategies A 2017 clinical study by Herzog et al researched a patient that received - Graded exposure 10 different lumbar spine MRIs from 10 different MRI centers. The results of his MRIs showed 49 distinct findings, 0 findings were Although this is a very brief discussion of a very complex subject, there is consistent in all 10 reports, and 37% appeared only once on the a lot of literature to support the effects of building a therapeutic alliance reports.3 Even though this is a singular case, it makes me contemplate and education patients on their pain, and I encourage everyone to how accurate some MRI findings can be. For some patients, dependconsider this when encountering situations that warrant a more ing on the presentation, imaging may not be the best next step. Think in-depth conversation of pain science. about the patients that are presenting with symptoms consistent with centrally mediated pain.

References: Findings: - People over the age of 30: 50% presented with disc degeneration - After age 80: over 80% - Disc bulge was present in 50% of people over 40

How do we know when a patient’s symptoms may be centrally mediated? Well, discussing the science behind central sensitization and the pathways in the CNS is for another time. However, we can think about a typical presentation for a patient that may benefit from pain science strategies.

- Focus on history, presentation and findings - History will most likely be chronic with pain felt “all the time” - Patient will have pain without consistent mechanical pattern of provocation - Patient’s pain will most likely be diffused - All motions and movements may be painful - Use pain catastrophizing scale on follow up for objective measure

1. International Association for the Study of Pain (IASP), Pain terms, A Current List with Definitions and Notes on Usage. Classification of Chronic Pain, Second Edition. IASP Task Force on Taxonomy. IASP Press. Seattle. 1994 2. Brinjikji, W., et al. "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations." American Journal of Neuroradiology 36.4 (2015): 811-816 3. Herzog R, Elgort DR, Flanders AE, Moley PJ (2017) Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J 17:554–561 4. Jorge Fuentes, Susan Armijo-Olivo, Martha Funabashi, Maxi Miciak, Bruce Dick, Sharon Warren, Saifee Rashiq, David J. Magee, Douglas P. Gross; Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study, Physical Therapy, Volume 94, Issue 4, 1 April 2014, Pages 477–489, https://doi.org/10.2522/ptj.20130118

JUNE BIRTHDAYS

401(k) - John Hancock has a new look. Check it out!

Employees who would like to make a change to their 401(k) biweekly contributions for the 3rd quarter of 2020 must complete the request by Monday, June 15th to be effective for the July 1, 2020 payroll. See below process to make changes.

Login https://myplan.johnhancock.com

When you log in you will be sent an Authentication code to either your cell or email, whichever you chose when you registered. Enter the code and confirm your personal information to keep your account secure.

Betsy Holt Drew Hungerford Mackenzie Cattaruzza Molly Maine Dan Rosati Josh McAdams Marianna Nasiakos Tatjiana Cvjetinovic Karen Bronson Diana Cao Kyle Wolf Steven deCastro Ben Roman Dorine Crapio Lauren Mariotti Jillian Cristaldi Kyra Thomas Chlesea Searles Kristen Ludwig Joe Allen Megan Burke Hailey Lugo Cassidy Elm Abru Santhosh Harrison Picard Sara Gareiss Jason Smutnick Kate Carlson Natalie Swanson Aileen Pingol Kasey Adinolfi

1 1 1 1 2 4 4 7 8 11 11 11 12 12 12 13 13 15 16 17 17 20 22 24 26 26 27 27 27 28 29

Simsbury Windsor New Haven Westbrook Orange New Milford/Danbury Middletown Waterbury Watertown West Hartford Newington Groton Plainville New Haven Watertown Newington Admin Southbury Avon Newington Westbrook New London Waterbury Newington Fairfield/Southbury Admin Windsor Admin Middletown Orange Wethersfield

Greg Schlossinger Natalie Swanson Madison Edmunds

Empolyer Services Coordinator PT Aide PT Aide

Amy Belllone Ashlee Smestad Daniel Gonzalez Emilee Wargo Matt Baronowski Sam McMullen Sammi Seger Suhani Patel Tyler Naef

PSC PT Aide PT Aide PT Aide Physical Therapist Physical Therapist PT Aide PT Aide Physical Therapist

West Hartford Plainville New Milford Guilford Avon Southington Southington Branford East Hampton

Meagan Hoffman Stevie Fell Tom Kirsch

Physical Therapist PSC Physical Therapist

Westbrook Waterbury Avon

Traci O'Brien

Physical Therapist

New London

Amanda Baldwin Christina Mogelnicki Dave Domkowski Erica Drake Gabe May Kyle Wolf Leif Anderson Naomi Rascati Pauline White Rebecca Tantorski Sean Walsh

PSC Physical Therapist PT Aide Physical Therapist Physical Therapist Physical Therapist PT Aide PT Aide PSC PSC Physical Therapist

Westbrook Newington Orange Guilford Avon Newington Windsor Wallingford East Hampton Orange Waterbury

Kevin Connellan Lindsey Scianna Melissa Boutagy

Partner & Director Physical Therapist Physical Therapist

Plainville Watertown Guilford

APRIL ANNIVERSARIES

MAY ANNIVERSARIES

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JUNE ANNIVERSARIES

Admin Middletown Naugatuck

Perspectives & Practices of Telehealth and Its Future We reached out to Ann Hall, Essex Physical Therapist, and Stevie Fell, Waterbury Patient Services Coordinator, for their experiences and insights regarding Telehealth (TH). Although the future of Telehealth PT is uncertain, Ann (AH) and Stevie (SF) explain how they are making the most of the TH option now, and how they hope to extend its benefits moving forward.

What kinds of patients are asking for/scheduling TH with you? What types of patients are you suggesting utilize TH? AH: I have seen post-op knee and hip replacements and I am even seeing post-op shoulders that are in the later phases of their rehab and no longer need manual intervention. Patients that I am seeing either have comorbidities (and their doctors have advised them to refrain from being in the community) and/or those who are anxious about attending PT in the clinic. My age population ranges from 10-20 years old to the geriatric population. I have advised patients who have high levels of comorbidities and do not need manual intervention at this time to take advantage of our Telehealth services. If they express reservations about being in the clinic during their initial evaluation, I also offer Telehealth as an option, explaining to them the advantages and disadvantages of utilizing it with their specific condition.

They can then make a decision as to how they want to proceed. Some patients are only using Telehealth, while others do some Telehealth sessions and then follow-ups in the clinic from time-to-time for progress notes and manual reassessment.

SF: We had a lot of Workers’ Comp patients utilize Telehealth, I think because they didn't want to interrupt their progress in returning to work but also were reluctant to come into the clinic.

If TH remains covered by most insurance plans in the future, what situations do you see it being used for? How do you see it benefitting the clinic and/or patients?

AH: I think this pandemic will have a huge impact on mental health and I think we will also see a rise in social anxiety and agoraphobia. Having Telehealth as a tool to offer these patients care is a good alternative.

SF: I think it will capture those patients that have tough schedules or those who may have a reason they can't make it to the clinic - no babysitter, car died, etc. I hope it also helps us reduce our number of cancels and no-shows if patients know they have the ability to do one or two visits from home.

What is the best “tip” you have for other clinics/clinicians for successful TH sessions?

AH: Do a trial run with patients before your first session. I have even done a trial run with them on their phones, in the clinic, to show them how easy it is.

This helps "work the bugs" out, so more valuable time can be spent treating the patient on their Telehealth visit. A trial run is especially beneficial to our older population who fear that they may not be technologically savvy enough to do Telehealth. Taking a few minutes to show them how it works, and how simple it is, makes a huge difference. Doing a trial run connection during the initial evaluation, can maintain a patient who might have otherwise chosen to never show up in your clinic again due to unforeseen anxiety they perhaps felt just attending the initial evaluation in the first place. It is also great to see them smiling at you over their laptop/phone when they finally see that they connected with you and that it really works!

SF: Do an initial walk through before/while scheduling the IE and be consistent. Walking patients through the process while I'm scheduling the IE makes them feel more comfortable about the whole thing AND it shows that we take the time and we care about going those extra steps. I feel like consistency is key in anything; having the conversation with the patient about what place works best for a visit, whether that's in a living room or a bedroom if there is space, and sticking to that is important. This way the therapist and the patient get comfortable with their location and they know what to expect for every visit, just like they were coming into the clinic.

We followed up with Mike Durand to get some more behind the scenes details: It’s rumored that the coverage for TH is ending in June.

Have there been any updates on this timeline?

MD: Currently, most providers have end dates for coverage, though some have already extended beyond their original expiration dates. Both Orthonet/Aetna and ConnectCare extended to June 30th, while Cigna/ASH extended to July 31st. Other expiration dates are for later in June with no word on extensions yet. Anthem BCBS did have us sign a contract addendum to enable us to continue Telehealth services beyond the Covid-19 era, so it appears they will continue this service for the long run.

The

Extra MILE

By Kristen Forster Director of Operations

Tips to Give the Best Possible Experience It’s a whole new world out there and it’s hard going into a new place not knowing what to expect on a “normal” day, never mind during a pandemic! We owe it to our patients to give them the BEST experience possible and ease any anxieties they may have about visiting our locations.

1) COMMUNICATE. Let patients know what to expect when they arrive for their first appointment.

2) Clean CONSTANTLY. Allowing patients to see you cleaning is reassuring.

3) Screen EVERY patient.

Take temperatures, ask health questions, be abundantly cautious.

4) Be PATIENT. People are scared right now. Taking a little extra time is comforting.

5) Smile with your EYES. Smile behind your mask and it will show in your eyes.

Let’s continue to deliver an UNMATCHED EXPERIENCE in unprecedented times.

PTSMC 401(k) Plan

A Message From Connecticut Wealth Management Stay invested!

Avoid second guessing your investment strategy due to a pandemic related downturn. History has shown that attempting to time the market in reaction to events rarely results in beating market returns. Your life events should be guiding your investment plan.

Stay focused on the long term!

Three-year returns are strong even when we include this year’s downturn, and 2019 returns outweight poor returns year-to-date.

Our CTWM contact, Megan Trask, is out on leave. In her place, for investment advice and questions, please contact, John Shanley: jshanley@ctwealthmgmt.com.

MEMBERS OF THE PTSMC FAMILY HAVE BEEN PUBLISHED! Liz Saunders, New London Athletic Trainer, recently had her neuroimaging research accepted for publication in Translational Neuroscience. With the guidance of co-authors/mentors, she was able to develop and validate a novel neuroimaging paradigm for use in fMRI studies. The results of this study will enable the team to further-research the integration between spinal muscle recruitment and brain activation patterns, thus helping us answer the question "How do core-stabilizing exercises (i.e. yoga, pilates) help to mitigate low back pain?"

Stephanie Weyrauch, Orange Physical Therapist, had two pieces accepted for publication. Her article “Using KPIs to Manage a Crisis: A Review of ‘Measure What Matters’ by John Doerr” will appear in this month's PPS Impact Magazine. She also published a chapter called “Developing a successful clinical approach: The partnership of the PT- PTA Team” in the book Clinical Reasoning and Decision Making in Physical Therapy: Facilitation, Assessment, and Implementation.

Congratulations to both Liz and Stephanie on their publications and for representing PTSMC!

#GETMOVING CHALLENGE Blondies Baking is the latest fad of the quarantine craze! Are you seeing flour and sugar fly off the shelves too? This tasty treat has slightly different ingredients that you can still find at the store (or order online) to make gluten and dairy free blondies!

Spring/Summer 2020 #GetMoving Challenge!

We are back! And there is no better time to shake off the quarantine cobwebs and get going for Summer!

The #GetMoving Challenge is a company-wide initiative held to inspire physical activity and well-being with a side of friendly competition.

This Spring/Summer edition of the #GetMoving Challenge has a NEW format. Our focus will shift away from social media to group accountability, support and connection.

The Challenge runs for 3 weeks: Sunday, June 7th – Saturday, June 27th The Challenge is simple: If you #GetMoving for at least 30min a day for 15 of the 21 challenge days you will earn a reward for your commitment and hard work.

What You Need: 1 1/2 cups almond flour 3/4 cup coconut sugar 1/4 cup melted coconut oil 2 eggs 1 tsp vanilla 2 T almond milk 1/4 tsp baking soda Dash of salt Dairy-free mini chocolate chips What You Do: Preheat oven to 350 degrees F In a large bowl, combine your almond flour, coconut sugar, baking soda, and salt In a small bowl, combine melted coconut oil, whisked eggs, vanilla, and almond milk Pour bowl of wet ingredients into the larger bowl of dry ingredients and mix together Sprinkle in chocolate chips Line a brownie pan with parchment paper, and pour batter evenly into the pan Top with chocolate chips Bake for 25 minutes max (Stick a fork in, and when it comes out clean it’s done) Let it cool completely before slicing! It’s nice and gooey- you don’t want to slice it too soon Plan on baking these Blondies? Post on your social and tag us @ptmsc

We will be using an app to submit activities and support each other over the three weeks. Each DAY you #GetMoving, you will post your activity in the group for it to count towards the 15-21 day goal. Your post can include a picture or your workout space, you, your watch, 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. This will also be where you get the latest challenge information, updates, and fun activity ideas.

How to sign up: email the PTSMC Wellness Program (Mallory) at Wellness@ptsmc.com. Sign ups will run through June 7th. Once the group is established there will be an email sent out with more detailed instructions for participants.

Let’s Get Up and #GetMoving together!

What Happened in JUNE of 2000?

June 13, 2000- South Korean President Kim Dae Jung met leader of North Korea Kim Jong-il for the first ever inter-Korea summit.

Spirit day

June 18, 2000- At the 100th US Open Men’s Golf Tournament, Tiger Woods won his first US Open by a major championship record-setting 15 strokes over Ernie Els and Miguel Ángel Jiménez.

Clinics that Opened in JUNE

Waterbury

Plainville in 2016.

They’re pictured here in February 2020 from the Valentine’s Day themed Spirit Day!

Guilford Fairfield (Rebecca Petrosino and family on a hike)

Next Month

TOURIST DAY - Friday, June 19th Let’s pretend we can travel wherever we want and dress up in our best tourist outfits!

PTSMC UPDATES!

Great things have happened over the last few months both personally and professionally for members of the PTSMC family. Here are some updates!

NEW EMPLOYEE

Congratulations to Lindsey Scianna Watertown Physical Therapist!

She gave birth to a baby boy named Finley on May 7th who weighed 8 lbs 3 oz.

SoCIAl Media Sensation

Nick Almonte, Orange Physical Therapist Stephanie Weyrauch, Orange Physical Therapist Alyssa Griffo, East Hampton Physical Therapist Welcome Back!

Kaitlyn Murray, Windsor Physical Therapist former PT Aide

Shoutout to Nick Almonte, Stephanie Weyrauch, and Alyssa Griffo for hosting our first Live Q&As on Facebook.

These were some of our most popular videos ever, reaching over 6,700 people combined!