March 2022 PULSE

MARCH 2022

MOVING FORWARD...

On February 15th, PTSMC’s leadership met with the goal of transitioning back to “playing offense.” A lot of our leadership team’s energy over the last few years has been spent in “crisis” or “survival” mode. The uncertainty of the pandemic’s twists and turns left us to go on the defensive. It was critical to dig in and focus on the immediate and unpredictable; to focus on the question, “What do we need to do right now to protect our people, those we serve, and PTSMC?” It was great to be together in person again. It was an extremely positive experience to celebrate some recent accomplishments as we continue to move beyond Covid, and it was also exciting to return to putting our brain power to the task of looking towards the future – to making PTSMC better and stronger. I want to share some of the day with you.

The “MAG Awards”(Milestones, Achievements, and Growth) had been part of these annual meetings for years. They were abruptly put on hold in March of 2020. Areas regularly recognized include highest NPS scores and most targets hit. We also applaud clinics that reach visit and new patient milestones. Annual new patient “clubs” include the 1,000, 1,500 and 2,000 new patients. Visits per year “clubs” include 10,000 and 20,000 visits per year.

It was great to cheer on the new “members” based on their 2021 accomplishments! To be honest, we ignored 2020 altogether. Not a year we’re looking to relive any time soon!

The floor was then opened to discuss the 2022 Administrative Leadership Goals and Measurables.

Following clarifying the goals and measurables, we pivoted to highly participative group discussions on critical organizational issues. We used the “Group Nominal Technique” on several topics. The technique facilitates individual, small group, and full group engagement, during which dialogue and debate are expected and welcomed.

We challenged ourselves to: • Examine and revamp the Clinical Incentive Plan • Determine the “three greatest challenges” PTSMC will face in 2022 • Determine the “three greatest opportunities” PTSMC must execute on in 2022 We are now in the process of condensing and refining the ideas and opinions generated. The goal is to reduce the broad range of insights and information gathered into themes and, ultimately, action steps to move our people and our organization forward. We are back on offense!

Thank you for all you do to make PTSMC better!

Of course, we did sprinkle in some competitive fun for the crew. In anticipation of March Madness we held a 16 team putting competition! Each team was challenged to take 6 putts; 3 each. The team with the highest successful putts moved on! The winners in a highly competitive match were Brian Vo and Tom Kirsch, outputting Anthony Ciaburri and Steve Platt 5-4. Check out more photos on the Happenings page!

Thanks,

Alan

IN THIS ISSUE Clinician’s Corner: Residency PICO

by Conner Gavin, Orange PT and Liza Peressini, Danbury PT HR Buzz

ADP Homepage D4Ds and Goals and Objectives Raffle Winners

Wellness Program LifeBeat - Sheet Pan Quesadillas #GetMoving Champions Challenge Health and Wellness Resources for UHC Members The Extra Mile Tips to Stay Kind through Rough Times Employee Spotlight Michelle Gallerani, New London Assistant Director

StriveHub Fab 5

“I cannot be happier to be working with Nick (Almonte). He has proven to not only have kind characteristics but his knowledge and expertise on how to improve my current pain and the obstacles that it has caused has brought on immediate results. I am really grateful for the treatment plan that he has put me on and for the genuine interest in my well-being.” - Shelton “This is my 3rd time using this facility, and have been very happy with their professionalism, mixed with humor and laid-back supportive atmosphere. So far, I have had improvement in my muscular issues this time and in the past.”

- Windsor

East hampton renovations

“Brian Greer is the best therapist that anyone could ever ask for. His patience and personality with all ages is fantastic, and his ability to show you what exercises to do and repeat them to you when you don’t get it makes you feel really comfortable.” - Glastonbury

Congratulations to Partner & Director Todd Cacopardo and his team at PTSMC East Hampton for their recent renovations.

The clinic expanded into a bigger space - check out photos of the new space below!

PTSMC is doing a company-wide March Madness competiton. Each clinic will get to submit one bracket for each tournament. The winning clinics will receive a staff lunch!

Read about it on page 7!

“Mary Clark is a great PT and is very personable.

The office staff is accommodating in scheduling appointments to meet my needs, and in general everyone is attentive, kind, and respectful.”

- New Haven “Kristin (Gilbey) has worked with me twice.

She's very knowledgeable and experienced, and I appreciate the skill in which she addressed my surgical recovery and now ankle break. The office is very professional and runs smoothly even when filled with patients. I can be in and out within an hour if I need to be. Personable front desk. Would highly recommend.” - Avon

CLINICIAN’S CORNER Statistical PICO

By: Conner Gavin, Orange, PT and Liza Peressini, Danbury PT P: Women single-fetus pregnancy I: General full-body muscle strengthening exercises C: Pelvic stabilization belt O: Validated pain scales and functional outcome measurements Question: Within the population of women who are pregnant, what are the effects of general muscle strengthening exercises and use of a pelvic stabilization belt on self-reported pelvic girdle/symphyseal pain or low back pain as reported by functional outcomes during pregnancy?

Intro: During pregnancy, women may experience several areas of pain and discomfort, ranging from minimal pain to intense pain. The regions where pregnant women feel pain are most common in the inner thigh, groin, pubic and suprapubic regions, sacroiliac (SI) joint, and the low back.1 The prevalence of these symptoms are associated with instability and laxity of the SI and pubic structures such as ligaments, fascia, and muscles, most commonly caused by the rapid hormonal changes and center of gravity relocation.1,3 The pain intensifies with weight-bearing activities, making it difficult to perform activities of daily living (ADLs) and functional movements, thus reducing quality of life (QOL).1 Along with functional disabilities, pregnancy-related low back pain (LBP) increased healthcare costs, as seen in Scandinavian countries with one out of five women experiencing seven weeks of sick leave time due to back pain during their perinatal time, with a heightened intensity at 24 to 36 weeks gestation.2,6 This time period is the end of the second trimester and the beginning of the third at twenty-seven weeks, which could be the reason behind the increase in leave time. While we know the overall benefits and functional gains on maintaining proper health in the pregnant population, the research and recommendations for specific exercises to best prevent and modulate LBP, pelvic girdle pain (PGP), and symphyseal pain to improve overall QOL and ADLs has not been investigated deeply enough. Furthermore, there are numerous interventions utilized to reduce LBP, PGP, and symphyseal pain such as exercise, manual manipulation, education, acupuncture, pelvic belts, water exercise, and use of a wedge-shaped pillow.2,7 The use of pelvic stabilization belts is one of the most common interventions to activate stabilizing musculature and minimize pain during pregnancy. The clinical rationale describes the belt as an “external force” that can “stabilize the pelvic joints,” specifically the SI joint.1,5 It is most common in clinical practice to use these stabilizing belts in conjunction with other interventions such as exercise and education/information.5 Another common method is performing exercises, whether they are home-based or clinical-based exercises, to strengthen the muscles of the pelvic girdle and larger, global muscles in order to improve stability and relieve women of their pain. We conducted an electronic search to question current evidence on interventions to best address LBP, PGP, and/or symphyseal pain. We are investigating whether full-body general strengthening exercises or the use of pelvic stabilization belts would yield the greatest overall reduction in LBP, PGP, and symphyseal pain in the pregnant population. The databases utilized during the electronic search were Google Scholar, Pubmed, Sacred Heart University Library Database, and APTA Article Search with keywords of, “pregnancy, LBP, PGP, exercise, pregnancy related low back pain, and pelvic support belt.” Instead of looking at age, we focused on women who are beyond the first trimester of pregnancy (≥13 weeks). From the article search we found four randomized clinical trials (RCT) and

one pilot randomized trial. Of the RTCs, two looked into exercises for LBP and PGP using therapeutic exercises3 or Pilates4, and two compared the use of a pelvic support belt and exercise, or a combination of both along with education/information.6,7 The pilot investigated two different types of belts to reduce symphyseal symptoms.5 We chose RTCs as they are the highest level of evidence aside from meta-analyses and systematic reviews, which we did not use in order to be as specific as possible in our research.

Kokic et al. performed a single-blinded RCT to investigate the effect of a supervised, structured exercise program on the occurrence and severity of pregnancy-related lumbopelvic pain. Forty-five pregnant women recruited from the University Hospital Centre Zagreb and the University Hospital Merkur, Zagreb, in Croatia were assigned to two groups. The subjects were not blinded due to the nature of the study, but the assessors were. The two groups were an experimental group (n=20) and a control group (n=22). Inclusion criteria for all subjects were between the age of 20-40 years of age and the ability to read and speak Croatian. All subjects were healthy or diagnosed with mild gestational diabetes only treated with diet and lifestyle changes, but with no other medical condition. The upper limit for inclusion was set at 30 weeks gestation to allow a minimum exercise period of six weeks, until at least the 36th week of pregnancy.

Women were excluded from the study if they had a medical history of miscarriages, were receiving pharmacological treatment during pregnancy, had contraindications for exercise as set out in the criteria published by the American College of Obstetricians and Gynecologists (ACOG), were smokers, previous trauma to the lumbopelvic region, or a history of severe lumbopelvic pain prior to pregnancy. Participants were randomized by computer into an experimental group (EG) and a control group (CG). Baseline information, taken at the initial interview, included: demographic and occupational data, medical and obstetric history, lifestyle habits and physical activity levels, height and body mass at the start of the pregnancy, and the existence and onset of pregnancy-related LBP. Questionnaires used for data collection were; the Pregnancy Physical Activity Questionnaire (PPAQ), Numeric Rating Scale (NRS), Roland-Morris Disability Questionnaire (RMDQ) and Pelvic Girdle Questionnaire (PGQ). Women from the EG participated in an individualized, supervised, structured exercise program twice per week, along with standard antenatal care. The duration of the exercise session was 50-55 minutes. The participants were also instructed to undertake at least 30 minutes of brisk walking once per day. Participants in the CG received only standard antenatal care, but were not discouraged from exercising on their own. Each exercise session was broken up into three sections; aerobic exercise for 20 minutes on treadmill at 65-75% max heart rate and a 13-14 on the Borg Rating of Perceived Exertion Scale, resistance exercises of 20-25 minutes incorporating all muscle groups with focus on the lumbopelvic area, upper and lower limb muscles, back extensors and deep abdominal muscles using theraband, body weight, and handheld weights of 0.5 and 1 kilogram (kg), pelvic floor exercises, stretching and relaxation at the end of the session for 10 minutes. Six resistance exercises were performed per session with three sets of 10-15 repetitions, along with three exercise protocols developed and used in rotation throughout the study.

Continued on page 10!

CLINICAL EXCELLENCE Upcoming Courses INTERNAL COURSES

SPONSORED COURSES

Cervicothoracic

Myopain Dry Needling 3: Advanced

March 5, 2022 8:30 am - 3 pm PTSMC Wallingford Instructor: Danielle Dunn DOCS Requirement Lumbar June 4, 2022 Time TBD PTSMC Glastonbury Instructors: Brian Greer & Melissa Boutagy DOCS Requirement Email Mallory Mason at ConEd@ptsmc.com for all sign ups or questions.

March 18-20, 2022 Quinnipiac University, North Haven Campus *Myopain DN-2 prerequisite required

Pelvic Health & More: Assessment and Treatment Strategies For Pelvic Pain

UPCOMING JOURNAL CLUB AND CASE DICUSSION DATES Case Discussion (DOCS Requirement) 3/8/22 Upper Extremity focus 4/5/22 Spine focus

April 30 - May 1, 2022 PTSMC Wallingford Instructors: Michelle Nesin PT, OCS, FCFMT, FAAOMPT, and Julie Sarton PT, DPT, WCS

Journal Club (open to all clinicians) 3/22/22 Upper Extremity focus 4/19/22 Spine focus

EXTERNAL COURSE

All meetings are 12:00- 1:00 pm on TEAMS.

Personalized Blood Flow Rehabilitation March 5, 2022 8 am - 5:30 pm Hosted at PTSMC West Hartford APTA Sponsored Course Details, Cost, and Registration at:

Email Danielle.Dunn@ptsmc.com to be added to the meeting group.

https://www.ctpt.org/ChapterEvents/eventView.asp?EventID=179

DIGITAL INTAKE INTEGRATION UPDATE Tuesday, March 8 @ 7:00 pm Intake Integration Includes: • Date of Injury • Pain Scale • Injury Location

RSVP to Emily at Emily.Fillion@PTSMC.com

by Friday, March 4th.

• Medical conditions and ‘Pain Type’ are not included in the recent digital intake integration.

• It is best to manually enter in the medical conditions at a minimum to support case complexity for authorization plans.

• In the case of the patient utilizing paper medical intake form, key information must be manually entered in the document. For Workers Comp and Auto Cases, the “Date of Injury” is required.

STUDENT PROGRAM UPDATE This month, PTSMC welcomes 3rd year DPT student Alexandra Szymanski from Stonybrook University. She’ll be working with Mario Paredes in Orange.

It’s time for the annual “March Mailing” where schools reach out to clinics looking for slots for the upcoming year. Please reach out to Juliann Chacko if there are any schools/slots you’d specifically like to offer.

2022 Continuing education opportunities list https://ptsmc.egnyte.com/dl/RCnzB8GqVU/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.

HUMAN RESOURCES

D4DS AND GOALS AND OBJECTIVES All employees should be nearing or have completed 2021 D4Ds and 2022 Personal Goals and Objectives.

Employees fillable D4Ds and Goals and Objectives will be uploaded into ADP. To view, click on Myself – Employment – My Documents.

ADP HOMEPAGE Check out the ADP home page when you sign in. Here you will find short cuts to important information. Less clicking and less searching!

• Complete your timecard • Request Time Off • View all issues of the PULSE • See what is happening at PTSMC! • Company Documents & Links

CONGRATULATIONS! Congratulations to the following PT Aides who have completed the SIPTA (Skills Introduction for PT Aides) Program:

Click on the Forms Library under Company Documents & Links to view the following:

Samantha Knight, Lock Street Liannie Negron, Naugatuck Courtney Nissel, Wallingford Tatiana Papuashvili, Fairfield Jennifer Pasram, Fairfield Zoe Trotta, Wallingford Jake Wall, West Hartford

CONGRATULATIONS RAFFLE WINNERS! I Read the PULSE Raffle Winner: Katie Redman, West Hartford PT Booster Shot Raffle Winners: Jen Bastos, Naugatuck PT Aide Sharon Hallahan, Essex PT Keaton Mangi, New London AT Rebecca Petrosino, Fairfield Partner & Director Jacky Severance, Middletown PSA

EMPLOYEE NEWS

NEW EMPLOYEES CURRENT JOB OPPORTUNITIES

Bilikisu Amunikoro, New London PT Aide

Kate Duffy, Wallingford PT Aide

Ann Mallon, Middletown PSC

Dylan Carneiro, Admin Content Coordinator

Sydney Camacho, Orange PSC

Athletic Trainer

Westbrook

Customer Service Representative

Lock Street

Patient Care Coordinator

Essex

Patient Services Coordinator

Essex (part-time) Guilford Naugatuck (part-time) Plainville (part-time) Southbury Watertown (part-time) Westbrook Wethersfield

Physical Therapist

Fairfield (per diem) Groton Lock Street New Haven New London Newington Orange Wallingford Waterbury (part-time) Watertown

Physical Therapist Assistant

Danielson Groton

PT Aide

Danbury Danielson Groton Middletown Plainville Putnam Southbury

Benjamin Ferreira, Southington PT Aide

Emma Morales, Orange PT Aide

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.

Matthew O’Toole, Watertown PT Aide

Amy Placeres, Waterbury PSC

Call Karen or email at karen.havlicek@ptsmc.com if you are interested in another position.

Employee

Spot light Michelle Gallerani New London Assistant Director Michelle Gallerani: Physical Therapist, Assistant Director, Senior Auditor, Compliance support, Yale Health Utilization Reviewer, mom, athlete, coach, potential Amazing Race candidate … is there anything she can’t do? For those who are unaware of this super woman, Michelle is a Physical Therapist and the Assistant Director of the New London office. She has been with PTSMC and the New London clinic since its opening in 2005, 17 years ago!

In 2003, Michelle was working with Scott Olmstead (New London Partner & Director) at a company called Healthsouth. They were both looking for an exit plan from the company, and fortunately for everyone involved, the opportunity arose for them to join PTSMC together. At the time, Scott was an ATC, so a requirement of the deal was also that he obtain his PTA certification within a year of opening the clinic. As a PT, Michelle was his key to joining PTSMC as a Partner and operating a clinic in the interim. As you can see, Michelle has been his right-hand woman since day one.

Prior to working at the New London office, Michelle grew up in Westfield, MA. She attended Sacred Heart University for undergrad and graduate school. At the time, the PT track was still a master’s degree. Michelle has always been a great athlete, and still is!

Michelle played soccer for SHU, and in her sophomore year the school jumped from D-II to D-I. The competition in the highest collegiate division presented Michelle, an intense competitor, with some serious adversity – after a childhood of winning, this was the first time she was playing for a losing squad. If you know Michelle, you know that as much as she loves to win, she really hates to lose. Still, the experience was an opportunity to learn about the value of grit and perseverance.

Soccer still plays a role in Michelle’s life. She coaches her daughter Avery’s (10) soccer team. Avery also plays softball and runs cross country. Michelle’s son, Carson (12), plays baseball and is a great basketball player. As Avery puts it, “We are a sports family!” With such an active family, the past few years have been tough. A highlight for them was when they were finally able to get out and travel to visit Michelle’s sister in South Carolina. The entire family got to fly down to SC to spend quality time with their extended family.

Something else that kept Michelle going through the last few years was her personal challenge that she “kind of fell into” to run every day from Memorial Day 2020 to July 4th in 2021. Of course, always a competitor, she didn’t stop there, and she didn’t miss a day of running for more than a full year!

Michelle officially gained the title of Assistant Directors in 2013, shortly after completing the PTSMC Leadership Management & Development Program (LMDP). She did not originally have intentions of coming out of LMDP “with an office,” meaning as a Partner in her own clinic. Instead, the program enhanced Michelle’s abilities to lead in the ways she already had been leading, and to confidently step into the title of Assistant Director.

Michelle admits that, like many of us, she experienced some “burn out” in the last year. What ended up getting her out of that feeling was talking through her feelings out loud. She explained it was specifically expressing her emotional state to Scott that helped; that verbalizing her feelings to her longtime colleague and friend was the key that she felt “flipped the switch,” allowing the two to look for opportunities to avoid this feeling in the future.

MARCH BIRTHDAYS Donna Baribault Lindsey Scianna Renee Gallant Alison Pearce Erica Rabe Pat Kinsella Jeremy Mercier Tom Kirsch Mackenzie Anderson Brian Callegari Danielle Pilgrim Michelle Madorran Angela Riehl Nicole Carroll Zack Currie Lauren Jameson Dave Lawrence Julianne Balavender Sona Pinela Sydney Camacho Jared Schiffer Sara Miller Kevin Howard Amanda Leiss Katie Redman Lorraine Esposito Danielle Jaffer Nancy Chilson Jeff Hoerst Mikayla Raffone Sophia Shea Shelby Howe Noah Dargenio Karin Larsen Micah Lee Courtney Nissel Caidyn Galovich Tyler Carmen Jenna Bouffard Corrin Garraty Jamie Collimore Heather Feiner Liannie Negron Lauren Cummins Ted Raczka Annemarie Gigante Dominique Riley Gabby Didiano Mikele Cokani Connor Doherty Jacquelyn Beltram

1 1 3 4 4 4 4 8 8 8 10 10 12 12 12 12 13 13 13 13 13 13 14 14 14 15 15 16 16 17 18 18 18 19 19 19 21 21 21 22 23 24 24 24 26 26 26 27 27 28 30

Admin Watertown New Haven Admin East Hampton Guilford Southington Avon Essex Windsor New Milford New Milford Branford Groton Guilford New Haven Admin Admin New Haven Orange Wallingford Wethersfield Orange Wallingford West Hartford Branford Southington Avon Glastonbury New Haven Glastonbury Simsbury Southbury Groton Guilford Wallingford East Hampton Wallingford Watertown New London Southington Admin Naugatuck West Hartford Branford Fairfield Shelton Middletown Waterbury Wethersfield New Haven

Scott and Michelle have developed a system that drives New London’s continued success. As Assistant Director, Michelle oversees all PT Aides and their scheduling. According to Michelle, she “keeps Scott in check” and always has his back by reminding him, “Hey did you do this?” and asking, “Do you want me to do this thing for you?” She also manages the office when Scott is gone, and explaining, “...because there’s always some sort of tragedy when he leaves for vacation.”

MARCH ANNIVERSARIES

On top of her roles as AD and PT, Michelle is PTSMC’s Senior Auditor . She originally took on the Auditor role in an extremely part-time capacity with Wallingford Director, Michelle Kijewski, auditing at night to leave enough time to take care of her very young kids. Since then, the position has grown to a team of 5 under Michelle’s supervision. She is now the Senior Auditor, with eight hours per week dedicated to this role through the administrative team, and she “absolutely LOVES IT!” Michelle explains, “I am old now! I would not be happy working 40 hours a week in the clinic.” Every Tuesday and Thursday she is auditing and supporting administrative projects in compliance, as well as with the Yale Health Utilization reviews. Her brain loves tackling the challenges of auditing, and she even claims to have a “spreadsheet obsession.” As part of this role, Michelle also meets with every new PT at their two-month mark.

Michelle explains, “I love organizing and finding solutions to help others.” It brings her joy to help make things usable for other people.

Angela Riehl Camille Mogelnicki Bella Lanata Liz Rubbo Nicole Brissette Noah Tedeschi

A few other things Michelle loves are working out (who’d have thought?), reading and family time. She reads both fiction and non-fiction books and is on a current kick of reading books that can potentially make her a better person. In the midst of all of this, Michelle and her family do find time sit down and watch Survivor or the Amazing Race together. Avery nonchalantly believes that one day Michelle and her should do the Amazing Race together as a mother-daughter team, and frankly we wouldn’t put it past them! For now, they will stick to a family vacation, and are preparing to head down to Florida in April.

Jen Ashman Jared Schiffer ‘

Peter Decoteau Dominique Riley

PT Aide PSC PT Aide Physical Therapist PT Aide Patient Care Coordinator Physical Therapist Physical Therapist

Branford Glastonbury Glastonbury Guilford Lock Street Newington Simsbury Wallingford

Director of Marketing Admin PSC Shelton

Game on PTSMC & PT for Life!

It’s bracket time for NCAA Basketball, and time for a full company competition. Each clinic can enter one bracket for the Women’s tournament and one bracket for the Men’s tournament. The WINNING clinic of each tournament will receive a staff lunch!

UPCOMING END OF MONTH

Post your bracket for patients to see and create some fun chatter. Standings can be seen live through the PTSMC bracket group via ESPN and will be emailed out after the conclusion of each round.

WOMEN’S Study up with Bracketology: http://www.espn.com/womens-college-basketball/bracketology “First Round” March 18-19 Final Four & Championship: Minneapolis, April 1 & 3 Start your clinic’s bracket: https://bit.ly/PTSMCWomens PW: PT4life MEN’S Study up with Bracketology: https://www.espn.com/espn/feature/story/_/page/bracketology/ncaa-bracketology-projecting-2022-march-madness-men-field

“First Round” March 17-18 Final Four & Championship: New Orleans, April 2 & 4 Start your clinic’s bracket: https://bit.ly/PTSMCMens PW: PT4life

FEBRUARY END OF MONTH Timeframe Documentation FD Balancing 2/1 - 2/28 3/3 at 6:00 am 3/4 at 7:00 pm Timeframe 3/1 - 3/15

MARCH MID MONTH Documentation FD Balancing 3/21 at 6:00 am 3/22 at 3:00 pm

MARCH END OF MONTH Timeframe Documentation FD Balancing 3/1 - 03/31 4/5 at 6:00 am 4/6 at 7:00 pm

Brackets must be completed before the commencement of each tournament’s first game.

Email Mallory.Mason@ptsmc.com with any questions. Good luck!

The

Extra MILE Tips to Stay Kind Through Rough Times As we adapt to this new normal, it’s important to understand how our patients have been affected by this pandemic as well. For some patients, we might be the people they see most in-person. Giving our patients the best experience possible is more important than ever during this draining, scary, and lonely time.

We’ve all felt overwhelmed at times, and the last thing we want to do is pass on those feelings to our patients. Here are some tips on how to stay calm, kind, and welcoming even when you’re not feeling it!

1. If you’re feeling overwhelmed, take a few minutes to destress Breathe, you can do this. It’s easy to get worked up and stress ourselves out. Taking a few minutes to decompress can really help us to stay calm. If you’re looking for tips on how to center yourself, check out the recorded Mindfulness Session from the PTSMC Wellness Program. Try getting to work 5-10 minutes early and taking that time to mentally prepare and get yourself in the right mindset. Don’t hesitate to take a few minutes to step away if you feel your mind spiraling. It only takes a few deep breaths to re-center.

2. Smile and be aware of your body language Presenting yourself in a positive, open manner will make patients feel better. It’ll make you feel better too! Science shows that smiling can actually make you happier, even if you’re faking it. Since patients don’t see your actual smile under a mask, make sure to smile with your whole face, so it reach your eyes.

3. Make sure to fill your own cup You can’t be your best if you’re not nourishing your mind, body, and soul .Taking steps to feel your best will also increase your positivity at work. We’ve probably all experienced being “hangry” before, and it’s not fun for anyone. Eat foods that keep you satiated and energized, and remember to stay hydrated. Make sure to get outside! Fresh air and sunshine are instant mood boosters. Getting outside for 10 minutes a day can have a huge impact on your mood. Remember, positive energy is as abundant as negative energy. If we fill our cups with feel-good energy, it will naturally overflow into everything we do.

PTSMC Happenings!

Stephanie Weyrauch (top), Orange PT presented at the ATPA CSM in Texas on “Interprofessional Management of Complex Older Adults with Type 2 Diabetes.”

Happy 10th Anniversary to Orange! They celebrated 10 years this February.

Katie Dadio, New London AT, looks on as her East Lyme High School Varsity Women’s Basketball Team plays.

Danielle Dunn, Director of Clinical Excellence & Residency Program, also attended a residency info session to promote PTSMC’s Orthopaedic Residency Program.

Westbrook celebrated Aloha Fridays to combat the winter blues and bring some much needed warmth to the clinic!

New Milford showed some spirit for the 2022 Winter Olympics!

SoCIAl Media Sensation Here are some more photos from the Management Meeting!

The Avon staffNick donatedAlmonte, gift items/gift cards to create Shelton Holiday Cheer Bags for families in need.

Partner & Director

Shoutout to Nick Almonte for filming an informative video about Blood Flow Restriction Therapy. Check out the video on Blood Flow Restriction Therapy on our social media accounts @ptsmc.

Engagement & Wellness Calendar March

#GetMoving Champions Challenge April 10 – May 19

It’s time to #GetMoving again this Spring in a new version of PTSMC’s favorite challenge to get up and get active. This April, gather a team of 4 champions to compete with other teams of #GetMoving challengers. Teammates can be any PTSMC/PT for Life employee, from any location!

For every day a team member gets active for 30+ minutes, your team earns points. A running total will be kept throughout the 40 days. The top three teams with the highest scores will be rewarded.

Additionally, if you personally #getmoving for 35 or more of the 40 days you will earn an award. More information coming soon via email. If you are eager to join and have your team ready, submit your list of teammates to wellness@ptsmc.com.

Health & Wellness Resources for UHC Plan Members Employees enrolled in PTSMC’s UHC 2022 health plan have access to a number of health and wellness resources, many of which reward you for healthy behaviors! If you are not enrolled in UHC through PTSMC’s employer plan, many health plans offer wellness benefits so be sure to check with your personal health plan.

UHC Motion: “You’re already moving. Make your activity count.” Walk or get active to meet daily goals and receive financial reward. Earning up to $3/day = $1,095/year! https://unitedhealthcaremotion.com/

Peloton: 1- year free access to Peloton App or 4-months All-Access membership, a $155 value. https://lp.uhc.com/peloton?cid=EI_BRAND|LPM|SB|UHC_Search|Peloton|NA|NA|Awareness|2021_08_2 1|UHC_Search_Redirect

Apple Fitness+: 1-year subscription to Apple Fitness+, at no additional cost, a $79.99 value. https://lp.uhc.com/applefitnessplus?cid=EI_BRAND|LPM|SB|Redirect|Apple_Fitness_Plus|21-971700||Si te_Visits|2021_09_22|Redirect

The following can be found in the Health Resources tab at myuhc.com:

RALLY: “Build Healthy Habits. Win Cool Stuff.” Take charge of managing your health with a personalized digital experience that includes missions, challenges, and communities. Earn “coins,” then redeem your coins in a wide variety of sweepstakes for chances to win health related prizes, fitness tracker, gift cards and more.

Real Appeal: Online weight loss program that provides personal coaching to help you and eligible family members lose weight and keep it off. On average, participants lose 10 pounds after attending just four online sessions.

Quit For Life: Make quitting tobacco easier with coaches, tools to conquer cravings, and a Quit Plan just for you! It is like having a coach right at your fingertips any time you need support.

EAP: Contact the Employee Assistance Program for “Help Whenever You Need It”- confidential support, 24 hours a day, 365 days a year.

To access all of these health & wellness resources, first activate your myuhc.com account. If you already activated your online access, simply use your existing login credentials. My UHC also has an app for quick and easy access to your health insurance resources.

If you have any questions or want more information about any of these resources, please reach out to mallory.mason@ptsmc.com.

Mindfulness Series Session 3

March 5

PTSMC Gear Order

March 14 - 25

April #GetMoving Challenge

April 10 - May 19

BRAGs Submissions

Deadline April 15

PTSMC Gear Order

March 14 – 25

BRAGs shared in PULSE

April 29

May #GetMoving Challenge

Ends May 19

Life Beat Sheet Pan Quesadillas

Sheet pan quesadillas are easy to make, customizable, and the perfect meal for sharing with friends. This recipe is plant-based and is packed with protein.

It can easily be converted to fit your dairy and protein preferences.

Ingredients: • 8 large tortillas (burrito size, I like whole wheat) • 1 pkg beyond ground beef • 1 pkg firm tofu (drain and crumbled) • 1 can beans (black or pinto) • 1 pkg of taco seasoning • 1 can diced tomatoes (fire roasted adds extra flavor) • 2 pkg Shredded cheese (Violife and So make great non-dairy options) • Optional: mushrooms, onions and peppers Step 1: Cook your veggies and protein on stovetop. Prepare your veggies and choice of protein as you would for tacos. Feel free to sub in ground beef, chicken, or ground turkey. For this recipe sauté the veggies, cook off the ground beefless beef, and then add in the tofu. Mix in the seasoning, beans, and canned diced tomatoes.

Step 2: While your protein is cooking, preheat the oven to 400. Line a baking sheet with aluminum foil (for easy clean up). Arrange the tortillas so they are overlapping the perimeter of the pan so that half of the tortillas overhang the rim. Place one tortilla in the center. It should cover the entire cookie sheet.

Step 3: Add one full bag of your cheese, making sure to create an even layer.

Once your protein is cooked, add it on top of your first cheese layer. Top the protein with cheese, once again being sure to create nice even layers. Add your last tortilla into the center of the pan then fold over the overhanging tortilla. Everything should fold together nicely sealing the entire quesadilla.

Step 4: Place another cookie sheet on top to weigh down the top tortilla layers and place in the oven. Bake for 25 min and then remove top baking sheet. Bake for another 10 - 15 minutes until the tortilla is golden brown.

Step 5: Slice the quesadilla into rectangles and serve with your favorite toppings. This is excellent with guacamole, Pico de Gallo, salsa, and sour cream. (Tofutti makes a great nondairy!) Enjoy!

Clinician’s Corner Continued At the end of the trial, 42 of the 45 women fully completed the RCT (20 EG, 22 CG).

Mean adherence by participants throughout the study was 83.7%. No warning signs or adverse effects caused by exercise were reported. There was no significant difference between the groups in the number of women with existing pregnancy related lumbopelvic pain prior to inclusion in the trial. After the 6 weeks of intervention women in the EG had a significantly higher level of overall activity, with increased levels of sport/exercise and transportation activities when compared to the CG. There was no significant difference between the groups in the number of women who developed pregnancy-related lumbopelvic pain, however, a lower percentage of women (EG=55%; 11/20) from the EG developed pain compared with the CG (CG=81.8%; 18/22; p=0.064). Of the 11 women in the experimental group that developed LBP, only 36.4% (4/11) developed pain after the start of exercise.

Lumbopelvic pain in the EG negatively correlated with both number of performed exercise sessions (r=–0.470, p=0.036), and duration of the intervention in weeks (r=–0.445, p=0.049). It also negatively correlated with the number of vigorous walks performed (r=–0.470, p=0.036). The result of the NRS for intensity of pain was significantly lower in the EG in the 36th week of pregnancy (p=0.017). The EG also saw a significant difference in PGQ score in the 36th week (p=0.005), showing a lower level of disability experienced and fewer symptoms reported. A significant difference in the RMDQ scores was also found in the 36th week for the EG (p<0.001), showing a lower level of experienced disability.

This study showed that with tailored strengthening and aerobic exercise, pregnant women were less likely to develop pain during pregnancy compared to the CG, showing the more exercise that was performed the greater the impact it had on reducing pain and severity of pain as well as higher quality of life and lower levels of disability when looking at functional QOL measures compared to CG.3 Sonmezer et al. performed a double-blind RCT to investigate the effects of a twice a week, 8-week Pilates class on pregnant women with self-reported LBP. Forty pregnant women with LBP complaints registered at the Gynecology and Obstetrics Department Outpatient Clinic of Baskent University Medical Facility for routine prenatal care and were allocated to the study. Subjects were randomly selected into a Pilates exercise group (EG) (n=20), and a control group (CG) (n=20). Inclusion criteria for this study was pregnant women in weeks 22–24 with pregnancy induced lumbar pain; maternal age 20–35 years, and the absence of pre-pregnancy lumbar pain.

Participants were excluded from the study if they had multiple pregnancies, history of cardiovascular diseases, medical complications (hemorrhage, preeclampsia, placenta previa etc.) and/or cognitive disorders, contraindication for physical exercise (eg: having severe other musculoskeletal disease, high risk pregnancies, balance deficiencies), and taking part in other exercises or physiotherapy programs.

Participants in the control group followed regular prenatal care consisting of routine medical and nursing care and were given education consisting of ergonomic information about activities that exacerbate LBP during daily living and optimal lifting techniques, sitting, standing and sleeping postures. Participants were not given any exercise prescription. Women in the EG were given Pilates exercises (shown and described in the article) with 18 exercises per session, lasting 60-70 minutes per session under the supervision of a physical therapist who was a certified Pilates instructor. Exercises progressed in repetitions and sets at week three and week six. The program was started between weeks 22-24 and finished between weeks 30-32 of gestation.

To measure disability levels, the study used the valid Turkish version of the Oswestry Low Back Disability Questionnaire (ODI), pain intensity was measured using the visual analog scale (VAS), and the Nottingham Health Profile (NHP) was used to measure general health related to QOL. Lumbopelvic stabilization was evaluated by a pressure biofeedback unit placed under the lumbar spine in the hooklying position and inflated to 40mmHg. Participants were asked to perform pelvic tilts and hold for 10 seconds in order for change in pressure to be measured for strength of contraction.

Of the 50 subjects randomly assigned, 40 subjects completed the study with final measurements taken: n=20 for EG and n=20 for CG. There was no difference in demographic data or outcome measurements at baseline between groups. After the 8

week intervention women in the EG saw a significant reduction in disability measured by the Oswestry ((p = 0.003)( Pre 9.20 ± 6.87, Post 5.40 ± 4.70)), with a significant difference between groups at end measurement as well (p = 0.004). VAS scores were significantly lower in the EG ((p < 0.001) Pre 43.60 ± 13.20, Post 17.20 ± 10.80)) post intervention as well as between groups (p < 0.001) post intervention.

The EG saw significant changes in sleep (p = 0.048) and physical mobility (p = 0.007) portions of the QOL assessment with the NHP. Changes in pressure of the pelvic tilt in the EG was significantly higher after 8 weeks ((p = 0.013) (Pre 44.50 ± 11.49 mmHg, Post 50.35 ± 14.55)). The CG saw no significant change pre-post intervention in any of the outcome measures taken.

Based on the results of this study, Pilates exercises performed twice a week for an 8-week period was an effective intervention in reducing pain and disability in pregnant women with pregnancy induced LBP as well as increasing core stability to help reduce future incidents. This may be an effective intervention to use if proper screening and vitals are monitored before initiation of program.4 Flack et al. conducted a one pilot, unblinded, 2-arm, single-center, randomized (1:1), parallel-group trial that looked at the comparison of two support belts and their ability to reduce symptoms, comfort when wearing, and adherence with usage in pregnancy-related symphyseal pain. The study took place in Dunedin, New Zealand, with an inclusion criteria of at least 18-years of age, symphyseal pain for a minimum of two weeks, and was positive with at least two out of the three following tests: (1) palpation that reproduced the pain, (2) modified Trendelenberg, and (3) active straight leg raise. The mean gestation age of the participants was 30.8 weeks.

Exclusion criteria included high-risk pregnancy, history of back/pelvic injury, systemic bone disease, condition where a belt was contraindicated, or women taking medications with steroids. Twenty women entered the study, ten in the flexible belt group and ten in the rigid belt group. The individual pre-assessment included pain history, 10-centimeter VAS, and Modified Oswestry Disability Questionnaire (MODQ) along with the primary outcoming of The Patient Specific Functional Scale (PSFS) with the clinical physician. Joint hypermobility was determined using the nine-point Beighton Hypermobility Score, where a score of ≥4 meant the individual had hypermobile joints, with no participants testing positive. Participants were allocated 1:1 to either wide, flexible neoprene support belt or thin, rigid nylon webbing belt with foam lining group with the use of a computer-generated randomization. The women were instructed by the therapist on how and location to wear the belt (low-position) and advise on longevity of use during waking hours. The women had to document via a response to daily text messages with the number of hours the belt was worn, if pain increased, decreased, or remained the same, and the functional activities that were performed. In addition, weekly phone interviews were made to fill out the PSFS and discuss adherence and tolerance to belt usage.

After three weeks, the unblinded researcher re-assessed the PSFS with the participants where they also completed the MODQ and VAS self-assessments. Then, the participants were fitted for the other belt and wore this for one week, with a final assessment consisting of the same questions as the previous weeks and which belt they preferred. After adjusting baseline values, linear regression models were used for between-group differences at follow-up, changes across both groups were measured with paired t-tests, with a p<0.05 defining statistical significance. Of the ten participants in the flexible group, all participated in the 3-week follow-up, but only nine contributed to the phone interview at the 4-week follow-up. All ten participants of the rigid belt group also completed the 3-week follow-up, but only eight performed the 4-week follow-up phone interview. The results determined improvements in ADLs assessed with a 2.3-point difference in PSFS at follow-up and that the flexible belt could reduce pain greater than the rigid belt as seen with VAS (preceding 24-hours). No significant difference was found with the VAS (preceding week) scores and the MODQ. All the participants wore the belts on average five hours/day and found the wider, flexible belt more comfortable than the thin, rigid belt. Combination of both groups data found improvements in function (PSFS, down 36% for flexible belt group and 34% rigid belt group) and pain (VAS), with no statistical significant difference in the MODQ. These results indicate further research and a larger sample size would confirm the pilot study suggestion of using a flexible pelvic support belt to improve ADL performance and reduce pain over a rigid belt. Limitations include the low number of participants without the use of a control group to compare the intervention to, since two different belts was the focus of the study. In conclusion, physicians should

consider the use of flexible support belts to women during pregnancy to reduce symphyseal pain and improve functional activity performance as new information is sought.5 Kordi et al. designed a RCT looking into three different treatment groups: the control group (n=35), who received information on the anatomy and postural advice with sitting, walking, and lying down; the belt group (N=35), who received a non-rigid lumbopelvic belt to wear during the duration of the study, only to be removed while sleeping, along with the information from the control group; finally, the exercise group (n=35) received a home-based exercise program, in addition to the control group information, designed to improve the strength of pelvic girdle musculature.

The exercises the researchers asked them to perform were as followed: 1) aerobic training consisting of a brisk walk of medium intensity defined as 64-76% max heart for 25 minutes for three days/week; 2) stretching the hamstrings, inner thigh, side waist, quads, and back 3 times a week for 10-20 seconds, twice a day; 3) strengthening program such as forward bend, back pressing, diagonal curl, upper body bend, leg lift crawling, kegel exercise, and pelvic tilt three days a week, three to five repetitions twice a day. To participate, the applicant had to be healthy with LBP radiating between gluteal fold and posterior iliac crest, 20-32 weeks gestation, carrying a single fetus, less than forty years old, with a diagnosis of PGP with either a positive PATRIC’s test and posterior pelvic pain provocation test (more SI joint pain) or modified trendelenburg test and direct palpation of symphysis pubis (more symphysis pubis pain). Exclusion criteria included previous history of back surgery, depression, contraindications of exercise, neurologic deficits, integumentary issues with belt use, unable to attend the follow-up evaluations, history of severe conditions in earlier pregnancy(s), systemic diseases, medication, cortisone, or use of analgesic medications used within 30 days. Participants returned to the Sports Medicine clinic of Tehran University to complete the Persian version of the ODI, 100-mm VAS, and the Persian version of the World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF) at the initial examination as well as the third and sixth week. The WHOQOL-BREF has four subgroups regarding QOL: physical health, psychological health, social relations, environmental health.

Statistical significance was set to p=0.05 and the results from the SPSS 16 analysis and ANCOVA demonstrated significant difference within each group and between-group comparison for VAS and ODI scores at the third and sixth-week follow-up. The belt group (n=34) was found to reduce VAS and ODI scores greater than the other two groups at the third and sixth week, and the exercise group (n=31) more than the control (n=31), but only at the sixth week. The WHOQOL-BREF results at third and sixth-week follow-up appointments found improvements also in the belt group over the exercise and control group, except for the social relation section.

In conclusion, the belt group was found to have reduced pain intensity as shown with a reduction in VAS scores, improved functional pain tolerance in the ODI scores, and greater QOL with an increase in WHOQOL-BREF scores. Clinicians can take away the use of the lumbopelvic belt and education on structures, alignment changes, and posture can reduce pain in women who are pregnant, however, limitations can be made within this study. The belts used were different from other studies that use sacroiliac belts, women included were in their 20th week to 32nd week of gestation, there continued to be a debate on inclusion criteria for PGP, and only being pregnant for a limited time allowed for minimal exercise gains and benefits. Further studies should focus on the location of the belt, gestational period and postpartum pain, and PGP criteria to better treat for PGP during pregnancy.

Nilsson-Wimar et al. designed a randomized assessor-blinded clinical trial looking at three different intervention groups and their outcomes during 38-weeks gestation as well as three, six, and 12 months postpartum. For this review, we only looked at the results from 38-weeks gestation. Women up to 35-weeks gestation from Stockholm, Sweden were included using the following criteria: at least three positive pelvic provocation tests (palpation over the SI joint, iliac gapping/distraction test, iliac compression/approximation test, Patrick test, posterior pelvic pain provocation test, symphysis pubis pressure test, sacral apex pressure test, and sacral apex pressure test) and a negative test result for radiating pain in the lumbar spine. Each of the 118 participants was allocated to one of three groups based on the number of previous children each mother previously had. All women without previous children were stratified first, then women with one child, etc. All three groups included the interventions from the information group (n=40), such as information on the anatomy, body posture, advice on ergonomics about the condition and a nonelastic SI belt. The exercise group (n=41) also included 3 exercises with the use of a ball and

ended with lower extremity stretches. The clinic exercise group (n=37) in addition performed a warm-up on a stationary bike, four exercises (lateral pull, standing leg-press, sit-down rows, curl-ups) for three sets of 15 repetitions, and ended with stretching. The clinic group was given instructions twice and then left to exercise independently, but all groups were given the chance to ask the physical therapist questions as needed. The clinic exercise group performed exercises twice a week until 39-weeks gestation, with an average of 16 exercise sessions. There was on average 10 weeks of inclusion for the information group, 14 weeks for the exercise group, and 16 weeks for the clinic exercise group until 38-weeks gestation.

At the initial visit, patients filled out a demographic questionnaire that was proven to show agreement with the test-retest method, the 100-mm VAS, drawing types of pain on a body chart using six different types of pain descriptors, and the Disability Rating Index (DRI), which covers 12-items of functional performance. Nonparametric statistics was used due to the ordinal scales measured and ANOVA for changes in outcomes with a p < 0.05 as statistically significant. No significant difference was found from the initial to 38-week gestation examination in regards to the VAS and DRI scores as well as the pain drawing in the information group (n=37), the home exercise group (n=36), and the clinic exercise group (n=30). These results suggest that information and the use of a pelvic stabilization belt are just as helpful in reducing pain and disability in conjunction with exercises, stretching, and aerobic activity. Limitations in this study include the inclusion criteria of mothers with previous children, age, patient motivation to take care of oneself, performing exercises outside the guidelines, and proof of performance for belt adherence and home exercises. Clinicians should consider the use of a SI belt to reduce pain and improve function in women who are pregnant, but further studies are needed to validate this information.

Conclusion: Based on the findings, there is poor evidence on which treatment interventions are best for women with pregnancy-related lumbar and pelvic pain. With the minimal research performed, it is fair to say a multimodal approach to lumbar and pelvic pain consisting of exercises focusing on global strength, core control and endurance, pelvic stabilization and control exercises, and education are the most effecting approach.

Clinicians should consider using each angle during their rehab as well as patient history and measures to provide the best care to their patient. It is important to consider the medical history and physical findings on whether a belt is required and which one to recommend. Future research should focus on specific exercises based on muscle atrophy during pregnancy based on biomechanical changes, identifying which trimester the research is based on, and how frequent the treatment interventions are performed,as well as adherence and longevity of belt use.

References: 1. Jill Depledge, Peter J McNair, Cheryl Keal-Smith, Maynard Williams, “Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts,” Physical Therapy, Volume 85, Issue 12, 1 December 2005, Pages 1290–1300, https://doi.org/10.1093/ptj/85.12.1290 2. James W. George, Clayton D. Skaggs, Paul A. Thompson, D. Michael Nelson, Jeffrey A. Gavard, Gilad A. Gross, “A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy,” American Journal of Obstetrics and Gynecology, Volume 208, Issue 4, 2013, Pages 295.e1-295.e7, ISSN 0002-9378 3. Kokic, I, et al. “Effect of Therapeutic Exercises on Pregnancy-Related Low Back Pain and Pelvic Girdle Pain: Secondary Analysis of a Randomized Controlled Trial.” Journal of Rehabilitation Medicine, vol. 49, no. 3, 2017, pp.

251–257., https://doi.org/10.2340/16501977-2196.

4. Sonmezer, Emel, et al. “The Effects of Clinical Pilates Exercises on Functional Disability, Pain, Quality of Life and Lumbopelvic Stabilization in Pregnant Women with Low Back Pain: A Randomized Controlled Study.” Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 1, 2021, pp. 69–76., https://doi.org/10.3233/bmr-191810.

5. Flack, N.A., Hay-Smith, E.J.C., Stringer, M.D. et al. “Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial.” BMC Pregnancy Childbirth 15, 36 (2015). https://doi.org/10.1186/s12884-015-0468-5 6. Kordi, Ramin. “Comparison Between the Effect of Lumbopelvic Belt and Home Based Pelvic Stabilizing Exercise on Pregnant Women with Pelvic Girdle Pain; a Randomized Controlled Trial.” Journal of back and musculoskeletal rehabilitation 26.2 (2013): 133–139. Web. https://doi.org/10.3233/BMR-2012-00357 7. Nilsson-Wikmar, Lena RPT, PhD*; Holm, Kerstin RPT, MSc†; Öijerstedt, Rolf RPT‡; Harms-Ringdahl, Karin RPT, PhD*§ Effect of Three Different Physical Therapy Treatments on Pain and Activity in Pregnant Women With Pelvic Girdle Pain: A Randomized Clinical Trial With 3, 6, and 12 Months Follow-up Postpartum, Spine: April 15, 2005 - Volume 30 - Issue 8 - p 850-856 https://doi.org/10.1097/01.brs.0000158870.68159.d9