November 2021 PULSE

NOVEMBER 2021

USA! USA! USA! THIS NEVER GETS OLD! In September, it was announced that PTSMC was named to the Hartford Courant and Hearst Media’s lists of Top Workplaces in 2021 for the 11th CONSECUTIVE YEAR! We received special recognition as one of only nine employers to have the honor of receiving 11 nominations in 11 years!

You may be thinking, this is old news, Alan.

I assure you, this type of news never gets old! However, I have another amazing recognition to share. Based on our performance in the Top Workplace survey, PTSMC was once again entered into the national “Best Places To Work” pool. I am extremely proud to share that we have been recognized as a Top Workplace USA, again!

This is the second year in a row we have received this incredible award, earning top honors in two specific categories: “Employee Well-Being” and “Professional Development.”

“Employee Well-Being” describes organizations that employees believe put health and wellness at the center of their workplace culture. Coming out of the “COVID Era,” I am proud of all that our leadership has done to put our people’s well-being at the forefront of decision making, as well as the extra efforts our employees made to maintain safe environments for their colleagues and patients.

The health and safety of our PTSMC community will continue to be a top priority. Offering programs that encourage health and wellness, be it financial, mental, or physical, are important to PTSMC. I have always believed that “all we have is our people,” and so it is essential that we keep them healthy, happy and safe.

WALLINGFORD HAS RELOCATED Congrats to PTSMC Wallingford on their move to a newer, larger space at 860 North Main Street Extension in Wallingford.

The second area of recognition, “Professional Development,” recognizes Top Workplaces that place a special focus on developing their employees’ careers and enabling their people to grow professionally. I am proud that PTSMC employees value our commitment to growing our people. I have a deep-rooted belief that PTSMC’s success throughout the years is a direct result of hiring the best people we can find and providing opportunities for them to grow personally and professionally.

The insights provided by those who took the time to participate in the Top Workplace survey is greatly appreciated. There is so much to be proud of! Many of you completed a detailed and highly confidential questionnaire with areas of focus including values, leadership, communication, wages, benefits, and culture. Thank you again for taking your time to recognize our organizational strengths, and to help us continue to improve and be better.

IN THIS ISSUE

Clinician’s Corner by Brianne Dwyer, Southington Physical Therapist Dance Specific Assessment Tools HR Buzz Holiday Schedule Attendance Award Retired Dependent Care Savings Account/(DCSA) 401(k) Wellness Program #GetMoving Team Challenge Flut Shot Raffle Peloton Access for UHC Members BRAGs Residency Pico Article: Spine Meghan Blanusa, Naugatuck Physical Therapist, and Andrew Kalach, Fairfield Physical Therapist

It is truly rewarding to read the overwhelmingly positive comments about PTSMC. The common themes that emerged this year continued to reflect our mission, our commitment to those we serve, and the shared purpose we have as an organization.

“Professional, caring and a great atmosphere.

Matt (Baronowski) has come up with a plan that has finally helped my back. I have had Thanks for making us a “Top Workplace” in Connecticut and in the constant pain for 4 months and I am finally USA! getting relief. The ladies in front are very helpful in booking appts and trying to work around my YOU are what makes us great…and that will never get old. schedule. I would definitely recommend PTSMC.” - Avon Thanks, “The individualized professional treatment, the excellent staff booking appointments and reminders, the direct line of communication for Alan questions or bookings, the facility cleanliness and considerate protection against spread of COVID, the friendly personalities of all the Glastonbury staff so much so that even the Patient Trends patients are pleasant and kind....an overall excellent experience. This is a very unique medical experience compared to all other PT New Patients per Month experiences I have had with other injuries.” Glastonbury

StriveHub Fab 5

“Natalie (Peterson) is extremely knowledgeable, professional and caring. The atmosphere is fun and engaging and I am grateful to be able to undergo PT there.” - Plainville

Visits per Month

Blue = Actual | Orange = Budgeted

“I especially like my PT, Roy (Colter). He is knowledgeable, patient, and charming.

Everyone there is so kind and attentive. It’s a happy, healing atmosphere.” - Newington “The entire Middletown staff treat you like family. The therapists focus on you the patient and makes sure that your therapy regeiment is what is best for you and not the old ‘No pain no gain adage.’ ” - Middletown

CLINICIAN’S CORNER DANCE SPECIFIC ASSESSMENT TOOLS

By Brianne Dwyer, PT, DPT Southington Physical Therapist As a performing arts physical therapist that specializes in dancers, it is important to understand the dancer’s specific genre or style. Just like when treating sports injuries, knowing if you are working with a soccer player versus a basketball player is important for proper return to sport. For example, hip hop artists typically have more upper extremity injuries specifically with weight bearing activities, whereas ballet dancers are more prone to lower extremity and back injuries. Therefore, it is key to have the most appropriate assessment tools to return dancers to the stage.

Early assessment and intervention starts much like most physical therapy, measuring and restoring range of motion, strength, etc. However, for the purpose of this article, the focus will be on assessments of dancers performing concert dance styles, most specifically ballet. These assessments can then be turned into dance specific interventions.

The following assessments include: • Functional vs. Active Turnout • Airplane Test • Heel Raise/Sauté Test • Topple Test Functional versus Active Turnout Ideal turnout in ballet can be defined as 180 degrees of external rotation of the lower extremity. Functional (uncompensated) turnout is a measurement of hip external rotation along a longitudinal axis, not taking into account the friction between the feet and floor to assist in maintaining turnout.1 Active (compensated) turnout is taking this into account, as well as compensatory movements such as anterior pelvic tilt, tibial torsion, and pronation.1 Functional turnout can be assessed with Functional Foot Prints and active turnout can be assessed using a whiteboard with a central line dissecting the board. The individual is asked to perform a first position (heels together with bilateral lower extremity external rotation) like they would in class.1 This test will highlight the difference between the two, but also potential compensations that can be addressed through interventions. While studies on this assessment tool have only addressed the inter-intra rater reliability, expert opinion has suggested no more than 15 degrees of discrepancy between the two measurements.

Airplane Test Typically, dancers have a ceiling effect with balance testing used on the general population. The Airplane Test is a great assessment of dynamic balance and lower extremity neuromuscular control, requiring “the trunk to be pitched forward and the non-support leg extended to the back keeping the pelvis square.” 2 The patient then performs at least 4/5 single limb squats drawing the hands horizontally towards the floor and returning to the starting position.2,3 Additionally, assessing for compensations that may be addressed later.

Relevé/Sauté Test Adequate calf complex strength is crucial for dancers. All dancers, specifically ones starting pointe or returning en pointem should be able to pass this criteria. All ballet dancers should be able to complete 25/25 relevés (heel raises) if not more!

Furthermore, dancers going en pointe for the first time should be able to complete at least 8/16 single limb sautés (jumps).2,3 In my opinion, seasoned dancers returning en pointe should be able to complete 16/16 sautés.

Topple Test The Topple Test is a full 360 degrees revolution of the entire body on a single leg, also known as a single pirouette (turn) for a dancer. The therapist is looking for full knee extension on the standing leg, proper retiré position of the gesturing leg, minimal body sway and good control during the deceleration phase.4 In conclusion, there are a multitude of tests for higher-level athletes and great age related normative values, but they do not always apply to dancers directly. The above tests are just a handful of the ones available for dance specific assessments and functional criteria for return to activity.

References:

1. Greene, A., Lasner, A., Deu, R., Oliphant, S., & Johnson, K. (2019). Inter-rater and intra-rater reliability of a clinical protocol for measuring turnout in collegiate dancers. Physiotherapy theory and practice, 35(1), 94–99. https://doi.org/10.1080/09593985.2018.1434708 2. Functional Criteria for Assessing Pointe Readiness. (2015). IADMS Bulletin for Dancers and Teachers, 6, 6-7.

3. Filipa, A., & Barton, K. (2018). Physical therapy rehabilitation of an adolescent preprofessional dancer following os trigonum excision: A case report. Journal of Orthopaedic & Sports Physical Therapy, 48(3), 194-203. doi:10.2519/jospt.2018.7508 4. López-Ortiz C. (1994) Kinematic Trend of Pirouette Performances as a Function of Skill Level [thesis]. Brockport NY: State University of New York at Brockport.

CLINICAL EXCELLENCE Upcoming Courses

Pictures from Concussion: A Framework to Guide Evaluation And Treatment, instructed by New Haven PT Rick Purdy.

INTERNAL COURSES Introduction to the Assessment and Treatment of the Concussed Patient December 4 8:30 am - 2:15 pm PT for Life Southbury Taught by Rick Purdy DOCS Requirement

Email Mallory Mason at ConEd@ptsmc.com for all sign ups or questions.

SAVE THE DATE!

“Navigating the Behavioral Health Field: How to Help Our Patients with Depression & Anxiety”

November 16th, at 7:15pm - 8:15pm, Virtual Presentation

This presentation will be hosted by Sam McMullen, Southington Physical Therapist and PTSMC Orthopaedic Resident, and Megan Long, Psych PhD Candidate at University of Hartford. Sam will present his research and findings on behavioral health & helping physical therapy patients, then Megan and Sam will open the floor for discussion and questions of any scenarios you’ve experienced.

Please RSVP to ConEd@ptsmc.com if you plan to attend.

Here are a few details on the presentation: Navigating the Behavioral Health Field: How to Help Our Patients with Depression & Anxiety • Case Format Overview • Medical & Psychological Treatment • Levels of Care • Family Perspectives on Coordinating Care • Clinical Practice • Evidence Based Screening • How to Direct These Patients in the Moment of Need • Local Resources • Open Clinical Discussion • Questions with Megan Long (Psych PhD Candidate at UHart)

STUDENT PROGRAM UPDATE This month, PTSMC welcomes the following students beginning clinical affiliations: Newington: Joe Allen and Christina Mogelnicki are hosting Michaela Hunt from Nova Southeastern.

West Hartford: Katie Newton Redman and Vlad Smolgovskiy are hosting Thomas Gallagher from University of Hartford.

Again, THANK YOU to all of our PTSMC clinicians who “give back” by helping to educate future PTs!

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.

HUMAN RESOURCES

DEPENDENT CARE SAVINGS ACCOUNTS/DCSA

Are you paying for dependent care for your children or elderly parent? Did you know that PTSMC offers a program where you can get reimbursed for those expenses with PRE-TAX dollars through payroll?

Employees meeting the following eligibility requirements can have PRE-TAX deductions from their paychecks so that they can be reimbursed for dependent care expenses tax free.

The November and December Holidays for 2021 and New Year’s Day Holiday for 2022 will be observed as follows: Thursday, November 25th

Thanksgiving

Closed

All clinics have the option of opening 7:00 am – 5:00 pm on either Wednesday, November 24th or Friday, November 26th.

Friday, December 24th Friday, December 31st

Christmas Day New Year’s Day

Closed Closed

HOLIDAY SCHEDULE – DO YOU WORK 4 10-HOURS-DAYS?

Reminder: for employees working other than a traditional eight-hour-day schedule during the holiday weeks, employees are expected to adjust their work hours and use holiday time.

Examples for adjusting work schedule: • An employee works a 4 ten-hour-days schedule. In this situation, the employee should adjust their schedule to work 4 eight-hour-days and use 8 hours of holiday time on the holiday.

• An employee works a 3 long-day and 2 short-day schedule. Adjustments may include: work 4 eight-hour-days that week or shift days and use 8 hours of holiday time based upon director discretion.

• A part time eligible employee, who is scheduled to work 20 hours per week, should adjust their schedule to work 16 hours and use 4 hours of holiday time.

ATTENDANCE REWARD IS OFFICIALLY RETIRED

PTSMC’s Attendance Reward program was put on hold in the first quarter of 2020 due to the pandemic and it is now officially retired.

CONGRATULATIONS! Congratulations to the following PT Aides who have completed the SIPTA (Skills Introduction for PT Aides) Program: Luke Manjooran, West Hartford Francesca Esposito, West Hartford Claire Johannesen, Wallingford

Eligibility Requirements • Employee has a child or disabled parent or spouse who needs daily care while you are at work.

• Incurring the expense allows you to work.

• Employee must be scheduled to work 20 or more hours per week • Eligible expenses may include the costs for dependent care at home or in a day care center or after school care for children under age 13.

• Employee may contribute up to $5000 in a calendar year to the dependent care savings account if you are married and file a joint return or if you are single and file as head of household.

There are a few government rules and regulations regarding this benefit. If you are interested, please contact Sandra Boccialetti at sandra.boccialetti@ptsmc.com for specific details. All employees currently in the plan will receive the required paperwork from Sandra by November 26, 2021. Enrollment for January 2021 must be completed by December 17, 2021. .

401(K)

Employees who would like to make a change to their 401(k) biweekly contributions for the 1st quarter of 2022 must complete the request by Friday, December 17th to be effective with the first 1st quarter payroll. It only takes 3 quick steps to change your contributions.

• Login https://myplan.johnhancock.com/login • Click on “Manage and Contributions” • Your current Before Tax and/or Roth contributions will be displayed. Click on the arrows to adjust your percentage then click continue at the bottom of the page.

• Sandra Boccialetti will be notified of the change and it will be effective with the January 12th payroll.

CURRENT JOB OPPORTUNITIES Athletic Trainer East Hampton Westbrook Physical Therapy Aide Essex Groton Lock Street New Haven New London Southbury Southington Watertown West Hartford Westbrook

Physical Therapist Fairfield Groton Lock Street Naugatuck/Watertown New Haven New London Shelton Wallingford Watertown Patient Services Coordinator Middletown Orange Waterbury Westbrook Windsor

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

Olivia Brunelle, New Haven PT Aide

Jeffrey Hoerst, Glastonbury Physical Therapist

Merin Matthews, Middletown PT Aide

Micah Lee, Guilford PT Aide

Kilah Mendes New Haven PT Aide

Shelby Pocius, Admin Employer Services Specialist

Liannie Negron, Naugatuck PT Aide

Welcome Back!

Sara Miller, Wethersfield Physical Therapist Assistant Former Southington PT Aide

Stephen Strong, Westbrook Physical Therapist Former Groton and Newington Physical Therapist

Jared Lynch, Admin Data Analyst

Linda Mullin, Lock Street PT Aide

Lauren Zimmerman, Fairfield PT Aide

NOT PICTURED Jacqueline Gargano Branford PT Aide Michele Sember Branford PT Aide Zoe Trotta Wallingford PT Aide Mackenzie Wiley Middletown PT Aide

Employee Spot light Emma Belval Patient Services Administrator, Westbrook Does this name sound familiar? You likely saw Emma’s name in an article about her promotion to Patient Services Administrator and a recent photo of her wedding day in last month’s PULSE! Here we are again writing about Emma because she is just so awesome.

Emma grew up in Westbrook, CT and currently lives in the neighboring town of Clinton.

Before joining PTSMC (5 years ago this December), Emma was working at Jake’s Wayback Burgers. She knew it was not her “forever” job and always had an interest in the medical field. Emma began looking for local positions in the medical field when she found the PSC opening at PTSMC Westbrook. Soon after, Emma expanded her knowledge and skills by completing a Health Claims Specialist certification from Branford Hall Health Claims Specialist Certification Program. Emma explained that the certification was helpful with the insurance side of her job the most. The classes provided great insight about different insurances and billing. This knowledge of insurances and billing makes Emma love what she does even more because she truly enjoys helping people, even with something as “simple” as scheduling appointments or insurance questions.

She says “people are really appreciative of the billing side because insurance can be super confusing. Especially the Medicare plans, it can be difficult!”

The PSA role was always a goal of Emma’s, and she had a plan to work her way up. She loves working with her team in Westbrook and continuously acknowledged how they work well together and with patients, and they get everything done!

Through Westbrook’s success, Emma has taken on being the go-to person for Scott Cameron, Westbrook Partner & Director, and enjoys not only the work but the company. She said, “There’s always something funny going on in the back with Scott.”

Helping Scott with hiring, scheduling, and filling a managerial role for both patients and the Westbrook staff are some of the parts of the PSA role that Emma enjoys.

As mentioned, Emma and her husband Dennis were married in August of this year. They have a 7-year-old Siberian Huskie named Keeda. He is grey and white with one blue eye and one brown eye. He loves to swim, and though he has crazy energy, they love him all the same.

Emma and Dennis also have an awesome hobby: traveling the world! Although much of the last few years was time spent with their local families, they were eager to travel again for their honeymoon. Each year they plan a trip to somewhere in Europe or a new country. They have been to Italy, Germany, Paris, Prague, and their honeymoon was in the Maldives! Emma said her favorite part was, "being able to be outside and on the beach for two weeks straight! Also being able to relax with my husband after all the wedding planning and our crazy work schedules." Want to know something even more magical? They got engaged in PARIS (the city of love)!

With a love for exploring new places, Emma does have some tips for anyone looking to get out there: First, her favorite place so far is Italy. Her advice: go to any part of Italy. Emma and Dennis spent one week in Rome and the Amalfi Coast. They enjoyed the beautiful towns, scenery, food and said the people are all so fun. They also were in Vatican City on a Sunday, and totally by accident saw the Pope speak! He was standing out on a balcony and speaking to the crowd out on the street.

NOVEMBER BIRTHDAYS Justin Santamaria Pauline White Emily Hansen Sharon Hallahan Nicole Skirkanich Matt San Angelo Sarah Barney Hailey Boulanger Emily Fillion Amanda Cabush Susan DeCarli Sandy Wickman Mason Mia Martinez Todd Cacopardo Liza Peressini Cindy Hales Ryan Balavender Brian Vo Dave Domkowski Amber Manville Mike Antunes Quinn McAnaney Cara DiMercurio Kelly Hoisl Vladimir Smolgovskiy Joe Mabry Christine Rasile Matt Turo Amanda Staheli

2 2 3 3 3 6 9 11 11 11 13 13 14 16 16 16 16 16 17 18 18 19 21 23 25 26 28 29 29

Westbrook East Hampton & Admin Simsbury Essex Orange Southbury Essex Watertown Admin Windsor Wethersfield Admin Middletown East Hampton Danbury Admin Admin Windsor Orange Southbury Middletown Guilford Windsor Windsor West Hartford Waterbury Admin Glastonbury New Haven

NOVEMBER ANNIVERSARIES

Juliana Colonis Angela Perricone Stephanie Bologa Vladimir Smolgovskiy Emma Berger Emily Tucker

PT Aide PSC Physical Therapist Physical Therapist PT Aide PSC

Branford New Haven Middletown Waterbury Westbrook Windsor

Bella Olmstead

PSC

Guilford

Second piece of advice, try to do local tours. There’s a site they like to use because the tours are led by someone local to the community. It’s not crazy, very small groups and usually includes hands-on things like wine tastings and cooking classes. The site is called “With Locals.”

Third bit of travel advice, book AIR-BNB’s. Being in an apartment, for example, makes it more of an experience and more fun than a hotel because you get that local feel!

Fourth and final tip, if you're up for somewhere like the Maldives, have a beach hut for the whole trip. Emma explains, "We had beach hut for the first half then an over the water villa to end the trip. Both were super cool to experience but the beach hut was better!" Can you think of a better way to honeymoon?!

Emma and Dennis are ready for another adventure across the world and have picked Portugal next. They both are very into history, and Dennis likes to watch Formula 1 races, so that is their next stop!

PTSMC and PT for Life Happy Hours!

PTSMC SOUTHINGTON Thursday, September 30th

PTSMC NEW LONDON Tuesday, October 5th

PTSMC NEWINGTON Wednesday, October 6th

PTSMC NAUGATUCK Thursday, October 7th

Holiday Food Drive - 2500!

The Holiday Food Drive is a cherished tradition at PTSMC. Alan began this initiative many years about to give back and serve our local communities in need.

These donations come from patients, employees, friends and family- anyone and everyone!

In 2020, PTSMC set out to collect at least 2,020 items. We crushed that goal and collected 2,477 items that we donated to our local communities! It seems only fitting that our goal as a company for 2021 is:

2500 donations How can your clinic start preparing? Follow these steps: 1. Designate a Food Drive Leader.

2. If you are the leader, email Mallory Mason and include the following information: a. Name of the local group your clinic will donate to. b. The dates your clinic will collect items. For example, in preparation for Thanksgiving (11/1 - 11/20), or in preparation for the December holidays (11/15 - 12/15) or all the way through New Year’s Day. *Both are important to know for the Marketing Department to create signage.

3. Mallory will be sending flyers specific to each clinic’s collection dates. Post these in the Welcome Center and around the clinic.

4. Once it’s time to start collecting set up a collections box. Lots of clinics like to decorate around their box with the theme of the holiday they are collecting for. Make sure to send Emily Fillion pictures!

CONGRATULATIONS MICHAEL SOUSA

Promoted to Patient Services Administrator!

Congrats to Michael Sousa on his promotion to Patient Services Administrator in our Southington clinic. Michael began working in Southington in 2010 as a part-time PT Aide shortly after we acquired the practice. In 2018, he stepped into the role of Patient Services Coordinator.

Michael’s rapport with patients demonstrates our PT for Life culture and is balanced with his astute attention to detail. More recently, Michael has been sharing his expertise by participating in new PSC training. Partner and Director Peter Cambi remarked, “Michael does so much for our patients, staff and for me to make the quality of our lives better. And always with a smile and quick wit. I rely on him for all front desk operations, which are just about perfect. In addition, he is team player, willing to assist or lead what is asked of him. I look forward to his contributions at a higher level as a PSA in Southington.”

When not delivering on the PTSMC mission, Michael enjoys working out or spending a quiet evening at home with his fiancé Paul. When asked what he looks forward to most in his new role, Michael commented, “I am excited to take on more responsibilities and help Pete out even more!”

TECHY TIPS

By Dave Lawrence, Information Systems Coordinator

DATA PRIVACY

Privacy is on everyone’s mind, and we want to ensure we are secured at the same time. We live in a mobile world, so with that here are some Techy Tips to stay safe while on the move: • Turn off “Location” services on your mobile phone as it allows your Apps to track your whereabouts. You can restrict which Apps have access to your location as well by modifying the settings under the “Privacy” section of your mobile device.

• Turn off “Hotspot” on your mobile device if you have it available when not in use. By leaving it on, it allows other users to obtain personal data off of your mobile device without you being aware they were able to access to it. While using hotspot, ensure you have a complex password so that it’s not easily guessed.

PTSMC Happenings!

Simsbury ran Hartford Marathon races and raised money for Healing Meals, a local non-profit that Partner & Director Emily Hansen works closely with.

Wethersfield celebrated their two-year anniversary with a beautiful cake made by PT Jillian Cristaldi.

The Leadership Management & Development Group met in Admin on September 30th.

Pictured left to right: Last Row - Mike Durand & Erik Olsen Second to Last Row - Alyssa Griffo, Erik Schmitt & Brian Greer Second to Front Row - Channing Harwood, Christina Mogelnicki & Alan Balavender Front Row - Mike McGowan, Katy Sullivan, Sandy Wickman Mason & Matt Baronowski

PTSMC Partners, Directors, & Leadership got together at the Delamar West Hartford for the Fall 2021 Management Meeting.

Plainville attended the Plainville Pumpkinfest.

Naugatuck got together for a night out at The Hub.

Avon dressed as different versions of Partner & Director Travis Lytle for Halloween.

Guilford played a cornhole tournament to support the Sheehan High School Soccer Team. Pictured right is Partner & Director Steve Platt.

SoCIAl Media Sensation Everyone!

Amber Manville, Southbury PT got engaged to Josh Carlbert.

Lauren Mariotti, Watertown PSA married Tony Test.

Thank you to everyone who sent in pumpkin photos!

Congratulations to our winner: ORANGE! To view all of the amazing pumpkins that were submitted this year, visit our Facebook at Facebook.com/PTSMC.

Engagement & Wellness Calendar November

#GETMOVING TEAM CHALLENGE The first ever Team Challenge of #GetMoving is in full swing and our challengers are showing their true competitive spirit! Currently, the “Bad Acetabulums” (a little PT humor there) are in the lead, but anything could happen. This week, our challengers have two fun bonus opportunities to gain individual points and help advance their team: #GetMoving with a buddy = 0.25 additional points for their team Share a picture of them dressed up for Halloween or wearing Halloween themed clothes for a workout on the weekend = 1 full day added to their personal total.

We have four weeks to go still - if you see anyone participating in the challenge be sure to give them a high-five!

Pumpkin Decorating Contest Winner

Announced Nov 1

Food Drive

Dates vary by clinic Nov-Dec

PT For Life Deliveries!

Nov 8 - 10

Gratitude Initiative

Nov 22- 26

#GetMoving Team Challenge

Oct 17 – Nov 27

Flu Shot Raffle

Submit by Nov 30

December Food Drive

Dates vary by clinic Nov-Dec

Flu Shot Raffle Winner

Announced Dec 1

Ugly Sweater Contest

Voting Dec 21 – 23

Did You Get Your Flu Shot?

LET US KNOW and you will be entered into a raffle drawing.

There will be 4 different winners, each receiving a $50.00 gift card!

PELOTON for PTSMC UHC Members If you are a UHC member though PTSMC, you now have the benefit of 1-year free access to the Peloton App or 4-months All-Access membership!

Click HERE first Then click Check Eligibility (don’t worry, your plan is eligible) Log in with your My UHC account To review more information, scroll down to Frequently Asked Questions Then proceed to choose the Peloton plan you want and sign up!

Contact wellness@ptsmc.com, send a picture with your band aid or include the date of your shot and you could be one of the lucky winners.

The winners will be picked on December 1st.

PTSMC UHC Members can use this link to find the best location to get your flu shot: http://uhc.com/flushot

BRAGS! Admin Sports Medicine Coordinator and Westbrook Athletic Trainer Caty Halpin Caty Halpin has played an integral part in helping our new young professional athletic trainers learn how to best navigate working in the schools while representing our PTSMC offices. She wears many hats and still manages to put her athletes first. Her efforts most certainly will continue to promote the athletic training profession.

Bragger: Heather Feiner

Admin Practice Liaisons Sara Gareiss and Janet Tarasuk I want to thank Sara & Janet for all of their efforts to help me transition into the practice liaison position. While I have been with PTSMC for many years, they both have helped me learn new ways to help promote what our offices do and how to better interact with providers in our community. I am excited to be part of what we call the "dream team" to help support our partners and clinicians. They are out there advocating and bragging about what PTSMC does with the utmost sincerity and enthusiasm, and it motivates me every day. They embody our "teamwork" model.

Guilford PT Aide Emma Rusconi Miss Emma's energy, compassion, humor (she has a really good sense of humor) and diligence is a winning combination for the Guilford clinic. Emma is very mature, smart and patient. She works seamlessly with all staff, a team player for sure.

Patients adore her as well. We are all very fortunate to work with Emma.

Bragger: Jane Rosadini

Lock Street Director Danielle Butsch Danielle is the most thoughtful manager I have ever had. She is always looking for ways for our team to get together in a less formal setting to connect and have fun outside of the clinic. She is always looking for ways for our clinic to be better and how to provide the best patient care. She also takes the time with her patients to connect and build a relationship to better help the patients recover. I don't know what we would do without Danielle to keep the wheels turning and still make coming to work fun!

Bragger: Anonymous

Lock Street PT Kailey Hanks Kailey is an excellent physical therapist that is always going above and beyond for her patients. She does a great job creating a fun environment to work in while setting an exemplary work ethic. She is very genuine and attentive to the needs of our clinic and strives to create strong relationships with her patients/co-workers.

Bragger: Anonymous

Bragger: Heather Feiner Lock Street PT Shradha Rana

Danbury PT Liza Peressini Liza has been a great addition to the Danbury office! She has been eager to learn and help out patients and coworkers however they are needed! Her positive attitude is infectious! Keep up the good work Liza.

Bragger: Anonymous

We have a VIP at Yale Health who commented about her husband's care. She said, "Shradha was pleasant, professional and treated her spouse as if he was Shradha's own father, which was very nice considering he has a hearing impairment. Progress came along beautifully."

Bragger: Christine Hill Shradha is the most caring and empathic clinician I've worked with. She continues to learn from her experiences and her patients every day to further improve her skills in and out of the clinic. She goes above and beyond with her patients, giving them a listening ear and helping them improve their overall well-being. Shradha brings life and excitement into the clinic each and every day.

Bragger: Anonymous

Lock Street PT Alexandra Rosenberg Alex continues to show her dedication and commitment to giving her patients the best care she can offer. She goes out of her way to help other clinicians problem solve and learn new skills/techniques. She is a great helping hand around the clinic as well when we are short handed. She continues to advocate for her patients and connect with them on a personal level to form a better connection.

Bragger: Anonymous Lock Street PTA Natalie Swanson Natalie is a very skillful and thoughtful problem solver who can gracefully understand all of the Therapists' expectations and carry all aspects of the Plan of Care for patients. I can't say enough about the creative skills that she brings in and out of work. Whether they are office projects, creating fun exercises or holiday events for everyone. She is also, so involved in making our office run smoothly and efficiently and never hesitates to take on extra responsibility to help other coworkers or her patients. She is a teammate and we are fortunate to have her work in our office.

Bragger: Anonymous

Newington PT Aide Noah Tedeschi Noah is a valuable member of the PTSMC Newington team. He has shown a lot of growth over the past 8 months as an aide and has taken on many responsibilities in the clinic including training new aides.

Noah is a consistent friendly face for our patients and always goes above and beyond to provide the best patient experience. PTSMC would not be the same without him!

Bragger: Christina Mogelnicki

Orange PT Aide Dan Rosati Dan is an excellent example of a leader in our group of PT Aides. His knowledge of exercise physiology and his experience as a personal trainer benefits our patients. His calming, optimistic personality is a favorite among staff. Dan is very good at helping keep our working environment chill, even when we are swamped. He always makes sure patients are engaged and is an excellent multitasker. I really enjoy working with Dan and look forward to seeing him during my shift.

Bragger: Anonymous

New Haven PSA Amanda Staheli

Orange PT Aide Dave Domkowski

Amanda is amazing! As the PSA in the New Haven office, she keeps us all organized (including Fred). She is our resource for all questions about scheduling, authorizations, office supplies, patient issues, and everything else. She is on top of everything - sometimes knowing answers before I finish the question. I can see that she is in constant communication with Admin and other clinics to make sure we have all the information we need to treat patients efficiently and effectively. She is amazingly calm and respectful in the few instances where patients have become combative or abusive (rarely happens but there's always that "one"). She learned her job in a very short amount of time and has pursued and accepted new responsibilities with enthusiasm. She is a valued member of the New Haven staff - without her we would not be able to provide our patients with exceptional experiences.

I’d like to acknowledge Dave for his amazing work over the past few years. Dave has really grown to become a leader amongst our PT Aides. Dave is a team player, takes feedback well and takes pride in his work.

Patients enjoy his demeanor and staff enjoy his sense of humor. I commend his ability to change and adapt over the years. It is a true sign of his development as a leader.

Bragger: Anonymous

Orange PSC’s Becca Furlow and Nicole Skirkanich These girls deserve all the praise! They are our gatekeepers, make sure we get our auth completed and are extremely organized. They have excellent customer service skills and are loved by our patients! Thank you for all you do!

Bragger: Anonymous

Bragger: Anonymous Simsbury Health Fitness Specialist and PT Aide Shelby Howe My first thoughts would be "energizer bunny with hugs!" Shelby is everything, health and exercise and an all-around awesome person. She is relentless with her multitasking abilities. She is always considerate and very capable of all facets of the gym and office. I am not out often, however when I am she has my back, in turn that means the office is covered. She also is a very compassionate and kind individual who keeps me smiling and upbeat throughout the day. Her laughter is contagious. If you have not heard her laugh you are missing out. We have grown in the Simsbury office rapidly and sometimes that can put a strain on the staff, and to be honest sometimes it does, but we have an ability to step up when someone else is busy. I work with superheroes. Shelby together with Emily, Jenn and Eric our gym aides Madison, Jake and Cody we are an unstoppable team!!

Bragger: Betsy Holt

Southington PSC Cindi Theriault I'd like to take the time to "BRAG" about my co-worker who I also call a friend, CIndi Theriault. No matter how bad it is outside the doors of PTSMC, she comes in with a great warm infectious smile. Always pleasant to be around and has such a great positive attitude. She may only be here a few days a week, but she leaves a remarkable presence in her absence. Cindi is always happy to help patients and coworkers in whatever needs we may have. We are so lucky to have her in Southington!!!!!!

Wallingford PSC/ PT Aide Hannah Stamm Hannah has done a wonderful job stepping up into a part-time front desk role for our office. She is detail-oriented and efficient with getting the job done when she walks in for her shift. She goes above and beyond to assist our patients. Thank you is not enough, and you are appreciated!

Bragger: Danielle Dunn

Bragger: Anonymous Wallingford PTs Kenny Kregling, Lauren Randall, Jared Schiffer Kenny, Jared and Lauren - you have been a wonderful addition to our Wallingford Team.It has been wonderful watching you grow as clinicians over the past several months. You have all stepped up to help us during our short staffing and moving, learning new skills including minor construction projects. You take wonderful care of your patients and treat everyone with empathy. I have enjoyed the many laughs over the past months and continuing to work with you!

Wallingford PT Aides Claire Johannesen and Allyson Hickey You two have been an amazing addition to our team of PT aides. Your attention to detail with tasks, multi-tasking and making sure that everything is handled in the clinic creates a wonderful patient experience. You both handle the demands of our busy, short-staffed clinic with a smile even when I know that stress levels may be running high. Thank you for all you do!

Bragger: Danielle Dunn Watertown PSCs Molly Deely and Cindy Mazzarella

Bragger: Danielle Dunn

Cindy and Molly are PSCs in our office and recently covered while Lauren was away for her wedding. They did a great job keeping up with everything and were able to answer all of my questions regarding scripts, authorizations, etc. while Lauren was away.

Wallingford PT Aide Naomi Rascati

Bragger: Lindsey Scianna

Words cannot describe how rock-solid Naomi has been to our Wallingford Team over the past many months. She is the ultimate multi-tasker and always assists our patients with a smile on her face. Our patients have nothing but kind, wonderful things to say about her attention to detail and interactions with them. Us PTs would be lost without her as she plays the role of PT aide, front desk and trainer for new aides with grace.

She makes our chaos a little less crazy:). Thank you is not enough. However, thank you a million times. You are always appreciated.

Bragger: Danielle Dunn

Watertown PT Stephanie Santos Stephanie has recently increased her hours in our clinic to help with the increase in demand. Our volume has significantly increased recently, and Ted has taken a position elsewhere which has left us a little short staffed. So, thank you Steph for taking on extra work!

Bragger: Lindsey Scianna

Wallingford PSC/PT Aide Sierra Gelsomini Sierra has stepped up as a part-time front desk in our office after being a long-time aide with us. She handled the transition seamlessly. She is super-efficient and does a wonderful job of cleaning up our mess from the day when she comes in with grace and a smile. She often stays late to help get the tasks finished for the day. We truly appreciate her support. We all breathe a sigh of relief when we see Sierra walk in the door. Sierra is a rock-solid contribution to our staff and we say thank you over and over again!

Bragger: Danielle Dunn

Shelton PSC Dominique Riley Dominique has gone above and beyond to help the Wallingford clinic while we have been short staffed.

She always arrives with a smile on her face and happy to help in any way she can to make our days smoother. She has saved us many days from going out of our minds not having a PSC. Thank you Dominque for being the greatest fill in PSC! Bragger: Anonymous

ORTHOPAEDIC RESIDENCY PROGRAM PICO PROJECT: SPINE

By: Meghan Blanusa, Naugatuck Physical Therapist, and Andrew Kalach, Fairfield 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: Patients with acute or chronic low back pain I: Aquatic Physical Therapy C: Standard (Conventional) Care or No Care (Control) O: Pain and Disability (VAS & Oswestry or Modified Oswestry Low Back Pain Index) Do patients with low back pain, both acute or chronic, have improved outcomes including pain and disability when receiving a course of aquatic physical therapy in comparison to those who receive standard physical therapy or no care at all?

Intro Low back pain is a common diagnosis that affects approximately 80% or more of today’s population at least once in their lifetime. Recent publications have come to light regarding the current treatment/management of low back pain in the realm of physical therapy. These publications have highlighted the difficulties and shortcomings of treating the acute and/or chronic low back pain patients we encounter in the clinic. These revelations left us wondering, what more could we be doing and what are we potentially missing? One possible answer to this question is aquatic therapy. This unique setting for physical therapy intervention is widely regarded as a safe and comfortable alternative to land based therapy sessions. The buoyant property of water allows for effective offloading of the patient during sessions allowing for the potential of increased movement and increased tolerance to physical therapy interventions. With this basic level of knowledge, we began to wonder, could aquatic therapy make a larger impact on patient pain and disability compared to traditional land based physical therapy in those who suffer from acute or chronic low back pain?

We started our search for answers by completing a thorough literature review through PubMed, APTA article search, and the Sacred Heart University Library.

Using search terms such as low back pain, chronic low back pain, acute low back pain, aquatic therapy, hydrotherapy, conventional therapy, physiotherapy, and physical therapy, we yielded 27 relevant results. Of these results, we screened and ultimately selected six articles for inclusion, two systematic reviews and four randomized control trials. Two of the four randomized control trials were included in one or both of the systematic reviews so we opted to leave summation of those RCTs to those review articles, leaving us with four total articles to discuss.

Waller, B., Lambeck, J., & Daly, D. (2009). Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clinical Rehabilitation, 23(1), 3–14. https://doi.org/10.1177/0269215508097856 The first systematic review (SR) we came across in our literature review was published in 2009 by Waller et al. This review identified seven articles published between the years of 1990 and 2007 that meet their inclusion criteria and were therefore selected for review. This systematic review looked at articles that researched low back pain in people older than 18 years old who underwent all types of therapeutic exercise excluding spa therapy and balneotherapy due to their non-active nature. All articles included in the review were determined to be either randomized control trials (RCT) or quasi-randomized control trials (CCT) and used outcomes assessment via the oswestry disability index (ODI), McGill pain questionnaire, visual analog scale (VAS), or days lost as a direct result of low back pain.

While all studies used some form of aquatic therapy intervention compared against a control group, interventions for both control and experimental groups were widely variable and lacked consistency between studies. Variability also existed in regards to frequency of intervention amongst studies with durations lasting anywhere from one session to 21 sessions. The one exclusion to this is two articles that investigated pregnancy related back and pelvic pain. Both of those studies were similar in terms of interventions and frequencies.

As far as outcomes are concerned, most studies in this SR found that while aquatic therapy did provide improvements in pain and disability, it was not significantly greater than alternative land based techniques. Both pregnancy related back pain trials found that aquatic therapy was superior to their control intervention in regards to pain as measured by VAS and number of days lost at work due to low back pain. The one other study that reported superiority of the aquatic therapy identified a significant improvement in ODI scores when compared to their no treatment control group. Of all seven studies, only one study reported no improvement as a result of aquatic therapy intervention.

Overall, the studies in this SR were able to show that aquatic therapy can provide meaningful improvement in pain and disability as it relates to low back pain.

While meaningful, not all studies were able to determine that improvement from aquatic therapy was statistically significant when compared to the improvement in pain and disability that was also documented in control groups. It should also be known that most studies included in this SR had various methodological faults, not limited to lack of reporting on randomization and intention to treat analysis as well as moderate to high risk of bias. While more research via high quality trials is needed, this early SR offers some insight into aquatic therapy as a possible alternative for those who may have difficulty with traditional land based physical therapy interventions.

Shi, Z., Zhou, H., Lu, L., Pan, B., Wei, Z., Yao, X., Kang, Y., Liu, L., & Feng, S. (2018). Aquatic Exercises in the Treatment of Low Back Pain. American Journal of Physical Medicine & Rehabilitation, 97(2), 116–122. https://doi.org/10.1097/phm.0000000000000801 A second SR and meta-analysis was published in 2018 by Shi et al. This SR focused on randomized control trials published from their inception up until November of 2016. Similar to the previous SR, some inclusion criteria for their search required that the study design be a RCT and that participants had back pain and were intending to undergo aquatic therapy as treatment. Inclusion criteria differed in this SR from the previous publication in a variety of ways. The current SR further defined low back pain as needing to be pain located between the lower ribs and above the gluteal folds in order to be included. This SR also differed in selected outcome measures as authors decided to measure VAS and Short-Form 12 or Short-Form 36 Health Survey (SF-12/SF-36) rather than ODI scores.

Following their literature search and article selection process, eight articles were included in this SR. Only two articles in this SR overlapped with articles from the 2009 SR by Waller et al. In their selection process, authors ensured improved bias analysis compared to the previous SR, with seven of the eight articles being labeled as low risk. Additional improvements in this SR were the clearly defined aquatic therapy, land based therapy, and standard general practice interventions.

Aquatic therapy interventions included warming up, jumping, jogging, fast running, active range of motion, stretching, strengthening and relaxation. Land based therapy included warming up, flexion and extension exercises, mobilization, stretching, strengthening, relaxation, and aerobic exercise. Lastly, standard general practice included a consultation with a physician and administration of an educational booklet. Despite these improved intervention definitions, duration of intervention in all studies continued to be variable by ranging anywhere from four to 15 weeks. Length of sessions varied anywhere from 30 to 80 minutes and frequency varied anywhere from two to five times a week.

By performing a meta analysis of all study results, this SR found there was a statistically significant reduction in pain intensity as measured by the VAS in the aquatic therapy group versus the control group. Heterogeneity as measured by I^2 was found to be 78% with all studies included but was lowered to 43% when one outlier trial was removed from the analysis. Despite a lowered heterogeneity, the percentage for I^2 remains moderately high which led authors to perform a sensitivity analysis. Results from the sensitivity analysis showed stability of the standard mean difference, meaning that changes between experimental and control groups were more likely due to true changes than chance. Similar results were found for physical function scores for SF-12/SF-36 in the aquatic therapy group, however no improvement in general mental health as measured by the same forms was noted in the results. Authors believe the lack of improvement in the mental health sub category may be related to the lack of direct intervention aimed at the psychosocial aspects of low back pain.

Similar to the results of the 2009 SR, this current SR found that aquatic therapy intervention in the treatment of low back pain was able to make sufficient improvement in pain and physical function as measured by the VAS and SF-12/SF-36 respectively. While the 2018 SR resolved various flaws of the 2009 SR, limitations still remained. Perhaps the largest limitation for this SR continued to be the lack of studies to pool results from which left authors with relatively small subject numbers to analyze, making it harder for statistical testing to pick up on significant differences between groups.

Mahfouz, M. M., Sedhom, M. G., Essa, M. M., Kamel, R. M., & Yosry, A. H. (2018). EFFECT OF AQUATIC VERSUS CONVENTIONAL THERAPY IN TREATMENT OF CHRONIC LOW BACK PAIN. International Journal of Physiotherapy, 5(6). https://doi.org/10.15621/ijphy/2018/v5i6/178055 This study assessed the efficacy of utilizing aquatic physical therapy in patients with chronic low back when compared to those who receive conventional land based modalities and treatment. This randomized control trial utilized forty patients, 20 of which received the intervention of aquatic therapy while the other 20 acted as a control, receiving standard care that will be discussed further later. Inclusion criteria included age 30 to 50 and either gender. Interestingly the inclusion criteria did not define what chronic was. Exclusion criteria was indicated for previous lumbar surgery, neuromuscular disease, spondylolisthesis, hip arthrosis, vertigo or dizziness, pregnancy, uncontrolled HTN, as well as those with cardiovascular disease that restricts exertion. Primary outcomes included pain (VAS) and the ODI while secondary outcomes included lumbar range of motion. The conventional (control) group engaged in 6 weeks of treatment that included Infrared, Ultrasound, IFC, as well as therapeutic exercise. Specifically the US called for continuous in order to elicit plastic deformation while exercises included lower body strengthening, PPT, trunk flexion and extension, as well as flexibility work. The aquatic therapy group received one 60 minute session with (3) phases within each treatment: (1) Warm Up (2) Progressive Aquatic Exercises (3) Cool Down. Progressive aquatic exercises included UE / LE ROM, stretching, as well as

strengthening for the core, back, and UE / LE. The results found initial homogeneity within and between groups for physical characteristics including height, weight, and mean age. In relation to pain on the VAS both saw significant reduction (Control: -3.95 / Aquatic: -4.1) however the difference between the two was not statistically significant. This is true of the remaining outcomes as well with ODI improving in the control group by 17 points and aquatic group by 17.45, lumbar flexion 12.8 and 12.4 degrees respectively, as well as extension gains of 2.5 and 2.8 degrees .

These findings reflect the efficacy of any level of exercise and mobility in the setting of chronic low back pain, regardless of setting. The control group interestingly had a large amount of passive modalities while the aquatics group had a largely active program. The aquatic group did demonstrate increased gains in all parameters compared to control, however these again were not significant enough to result in clear benefit in comparison to control. These findings are consistent with previous studies that found aquatic therapy to be efficacious in those with chronic low back pain. These findings may be useful in the event a patient has comorbidities or contraindications to land based therapy including weight bearing restrictions, obesity, or poor outcomes with land based treatment.

This RCT has multiple limitations that include poor clarity of interventions, low sample size, unclear inclusion criteria including lack of a definition for chronic symptoms, as well as no formal assessment of strength nor definition for exercise intensity. The study itself additionally did not discuss limitations, which is standard in scientific literature. The study should be used with caution when generalizing to a larger population due to the above mentioned limitations, however it is safe to prescribe aquatic exercise to those with chronic low back pain if available.

Abadi, F. H., Sankaravel, M., Zainuddin, F. F., Elumalai, G., & Razli, A. I. (2019). The effect of aquatic exercise program on low-back pain disability in obese women. Journal of Exercise Rehabilitation, 15(6), 855–860. https://doi.org/10.12965/jer.1938688.344 Abadi et al sought out to specifically assess the impact that aquatic based exercise would have on the obese population, and more specifically obese women.

This is of particular relevance for clinicians in the United States as the CDC estimates that up to 42% of the adult population is considered obese by BMI standards. Of added value is the consideration that more severe obesity has a higher prevalence in women than men, with 9.2% of obese Americans considered to have severe obesity. Additional evidence has shown that obesity is a contributing factor to those who develop low back pain. When coupled with recognition that low back pain leads to disability and inactivity that exacerbate weight gain, one can see the particularly challenging circumstances the healthcare community faces when addressing these complex issues. Recent guidelines suggest exercise therapy as a first line treatment in managing acute and chronic low back pain, and within the obese population prior RCT’s have demonstrated effectiveness of aquatic therapy over land based and control groups. This RCT included 39 women with an average BMI of 32.35, age of 38.5, and pain intensity of 2.10. Additional inclusion criteria included pain duration > 6 months and prior intervention. Exclusion criteria included prior surgery, cardiovascular issues, fear of water, and inability to enter or exit a pool. Twenty females were randomly assigned to a control group and provided outcome data at pre / post testing, however were given no restriction of other exercise or care (other than aquatic rehab). Nineteen females were selected to an aquatic rehab group that consisted of 12 weeks of (2) 60 minute sessions that involved a 10 minute warm up and cool down as well as a 40 minute primary program led by an exercise specialist. Their program consisted of: • Water Walking and Jogging - 10-25 meters by 4 to 8 sets • Forward and Side Lunges - 3x10 ea • Supine Kicks, Cycling, Pedaling - 3 sets by 5 to 20 repetitions • Shoulder Movements - 3 sets by 6 to 15 repetitions • Deep Water Cycling with Noodle - 3 sets by 30 sec to 1 minute • Pool Plank with Noodle - 3 sets by 3 to 10 reps • Wall Push Up - 3 by 5 to 10 repetition • Warm Up: Static Stretching, ROM and Relaxation • Cool Down: Stretching, Deep Breathing, Free Water Time An overall progression was achieved that involved movement from shallow to deeper water over the 12 weeks with general increase in volume, intensity. An RPE of 13-17 was targeted which equates to 60-70% of maximal heart rate. The primary outcome measure was the modified Oswestry questionnaire which was recorded one day before and after the 12 week time interval. Additional outcomes were BMI, waist to hip ratio (WHR), as well as percentage of body fat (PBF).

Each item of the Oswestry was calculated individually during data analysis to further break down the effectiveness of the control vs intervention group.

Results showed excellent retention, having 100% of control responses, and 1 drop out of the intervention group due to pregnancy. The intervention group attended 92% of the possible sessions, with 100% attendance after the 6th session. 15% of the control group received physiotherapy over the 12 week program interval of pre to post testing and reported as irregular 2-3x per week at 15-20 minute home sessions. Homogeneity was found in the groups at the start of the trial in areas including age, weight, BMI, WHR, and % Body Fat. A multivariate analysis of covariance (MANCOVA) was performed between groups with pre and post data and identified a clinically significant improvement in the aquatic therapy group versus control in: • Pain Intensity • Personal Care • Sitting • Standing • Sleeping • TOTAL DISABILITY

There was no statistical difference found for the parameters including lifting, walking, social life, and traveling. Of particular interest was an additional improvement of patients in the aquatic therapy group that progressed from moderate impairment to minimal as based on their ODI Total Disability score.

Minimal is 0-20 while moderate is considered 21-40. The aquatic therapy group had 14 moderate subjects at baseline and ended with 3 while the control began with 15 and ended with 13.

The study included multiple strengths and limitations. Limitations include a lack of blinding within the study protocol and a particularly glaring neglect to control the behavior and variables of the control group. 15% sought outside care, while both they and additional subjects were not limited to what they could and could not perform. While this may be a pragmatic approach it hinders the internal validity of the findings. External validity of the study is limited to females and those with obesity, however it has previously been mentioned that nearly half the US population is considered obese. Strengths of the study were its detailed reporting of their intervention program which included dosage, intensity, and the depth at which patients exercised. They additionally conducted initial between group testing to assure homogeneity as well as an analysis of power to ensure relevance of their results. Overall, the study reflects the need for additional research in the area with particular interest paid toward increasing sample size and controlling variables in the non-intervention group.

In conclusion, the study reflects the particular benefit of aquatic therapy for those in the obese population. It may be an appropriate treatment when land based rehab is not practical or the patient has had a previous poor response. Some suggest that the buoyancy of water is an added benefit, reducing up to 90% of body weight during aquatic rehab and concomitantly reducing joint compression and ground reaction forces. Others have identified that patients can work at higher intensities in water as compared to land, in areas such as running, jumping, and change of direction. Clinicians can utilize the results of this study to apply reasoning to the appropriate patient and feel confident in referral or utilization of aquatic rehab in the setting of chronic low back pain and obesity.

The body of literature reviewed confidently suggests the benefit of aquatic physical therapy and exercise in the setting of chronic and acute low back pain across varying patient populations including but not limited to pregnancy as well as obesity. Two systematic reviews agreed on benefit compared to baseline values while data was insufficient to identify clinically significant differences when compared to other forms of intervention or control groups. The findings of the 2018 meta-analysis assist the clinician in confidently knowing aquatic rehab is an appropriate decision for the low back pain patient, as significant reduction in VAS scores was noted across all studies utilized. Abadi’s findings suggest patients with a co-morbidity of obesity will benefit from aquatic rehab, while two studies found reduction in VAS for pregnant women who engaged in aquatic rehab for low back pain. A general consensus can be utilized that suggests the need for additional studies including randomized control trials and other higher level research methods that utilize larger patient populations to assist in increasing external validity and ability to generate broad based conclusions. Overall, aquatic therapy for low back pain can be considered a safe and beneficial alternative for improving pain and most functions and activities of daily living when assessed by the Oswestry and other outcomes including the SF-36.

References Abadi, F. H., Sankaravel, M., Zainuddin, F. F., Elumalai, G., & Razli, A. I. (2019). The effect of aquatic exercise program on low-back pain disability in obese women. Journal of Exercise Rehabilitation, 15(6), 855–860. https://doi.org/10.12965/jer.1938688.344 Mahfouz, M. M., Sedhom, M. G., Essa, M. M., Kamel, R. M., & Yosry, A. H. (2018). EFFECT OF AQUATIC VERSUS CONVENTIONAL THERAPY IN TREATMENT OF CHRONIC LOW BACK PAIN. International Journal of Physiotherapy, 5(6). https://doi.org/10.15621/ijphy/2018/v5i6/178055 Shi, Z., Zhou, H., Lu, L., Pan, B., Wei, Z., Yao, X., Kang, Y., Liu, L., & Feng, S. (2018). Aquatic Exercises in the Treatment of Low Back Pain. American Journal of Physical Medicine & Rehabilitation, 97(2), 116–122. https://doi.org/10.1097/phm.0000000000000801 Waller, B., Lambeck, J., & Daly, D. (2009). Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clinical Rehabilitation, 23(1), 3–14. https://doi.org/10.1177/0269215508097856