Despite its positive effects on glycemic control and cardiovascular health, exercise has not been recommended for people with diabetes and peripheral neuropathy because of concerns about increased risk for skin ulcers and falling. Authors Kruse and LeMaster discuss their article "Fall and Balance Outcomes After an Intervention to Promote Leg Strength, Balance, and Walking in People With Diabetic Peripheral Neuropathy: 'Feet First' Randomized Controlled Trial" (November 2010). The good news, according to Kruse, is that people with diabetes and peripheral neuropathy can walk without increasing their risk of falls or foot ulcers. Mueller asks the authors about the challenges of conducting a community-based research study and the challenges of motivating this patient group to exercise.

In the October 2010 issue, PTJ published the first nationwide practice analysis of acute care physical therapy: "Nationwide Acute Care Physical Therapist Practice Analysis Identifies Knowledge, Skills, and Behaviors That Reflect Acute Care Practice." Lead author Sharon Gorman, Jim Smith, and Patricia Ohtake discuss the results of this practice analysis and how they can be used by education programs in preparing students to meet the unique needs of the complex acute care environment. What makes a successful acute care physical therapist? Are there specific personality characteristics that enable a physical therapist to be effective in the acute care setting, or does success depend more on the professional evolution from novice to expert practitioner?

Listen to the 41st Mary McMillan Lecture--"Destiny Is Now"--delivered by Dr Andrew Guccione at the opening ceremonies of PT 2010: the Annual Conference and Exposition of the American Physical Therapy Association on June 16, 2010, in Boston, Massachusetts. Introducing Dr Guccione is APTA President Dr R. Scott Ward.

The following PTJ podcast is the 2010 Rothstein Debate "Health Care Reform: Can We Take Advantage of Different Models of Care to Demonstrate the Value of Physical Therapy?" The 2010 Rothstein Debate took place at PT 2010 the Annual Conference and Exposition of the American Physical Therapy Association on June 17, 2010, in Boston, Massachusetts. The participants are Anthony Delitto, PT, PhD, FAPTA, Alan Jette, PT, MPH, PhD, FAPTA, Colleen Kigin, PT, DPT, FAPTA, and Gail Deyle, PT, DPT, DSc, OCS, FAAOMPT. The moderator is Gerard Brennan, PT, PhD, FAAOMPT. APTA President R. Scott Ward, PT, PhD, introduces the debate. This podcast is a mono recording. Running time: 01:21:49

In their September 2010 Perspective article "Individual Expectation: An Overlooked, but Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain," Joel Bialosky, PT, PhD, and colleagues argue that a patient's expectation of a treatment's effectiveness may influence the clinical outcome of that treatment. Frequently, however, physical therapists don't account for patient expectation during an episode of care. How much of the outcome is the result of expectation rather than the intervention? Is the outcome determined more by the process of care rather than any individual intervention? And how do clinician expectations affect clinical decision making? Can clinicians modify patient expectation and "use" expectations in selecting interventions? In this podcast. Bialosky is joined by Nadine Foster, BSc Hons (Physiotherapy), DPhil, PGCE, and moderator and PTJ Editorial Board Member Chris Main, PhD, FBPsS, to discuss the role of patient (and therapist) expectation in treatment outcomes.

In "Adherence to Clinical Practice Guidelines for Low Back Pain in Physical Therapy: Do Patients Benefit?" (August 2010), Geert Rutten and colleagues concluded that greater adherence to clinical practice guidelines when treating patients with low back pain was associated with better outcomes, such as better functioning and fewer treatments. This podcast focuses on the related problems of variation in care and how to encourage clinicians to adhere to clinical practice guidelines. Do guidelines lead to "generic" care and restrict the clinician's ability to individualize treatment based on patient presentation? Participants: Geert M. Rutten, MPH, PT, MPT; Julie M. Fritz, PT, PhD, ATC; and Gerard P. Brennan, PT, PhD. Moderator: Christopher Maher, PT, PhD, Editorial Board Member, PTJ.

Changes in health care, the focus on patient-centered care, and the push for evidence-based practice have led to the use of qualitative approaches across all health care professions. Townsend et al explore ethical implications in “Qualitative Research in Ethics: Enhancing Evidence-Based Practice in Physical Therapy” (April 2010). Participants: Laura Lee Swisher, PT, MDiv, PhD, and Anne Townsend, PhD. Moderator: Diane Jette, PT, DSc.

Physical therapists sometimes have hard decisions to make in today's health care systems. In this discussion podcast, Ernest Nalette, author of "Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute Care Setting" (June 2010), Gail Jensen, Beth Smith, and moderator Diane Jette discuss the moral dilemma of Mary, a physical therapist in an acute care hospital where resource constraints on the provision of physical therapy care cause her to provide less care than one of her patients needs. Jensen sees Mary's dilemma as a case of allocating or rationing a scarce resource-- physical therapy--in an equitable manner. Mary, says Jensen, "is actually being forced into a rationing decision." Nalette observes that rationing "has become common practice," resulting in the reduced provision of service to patients, particularly to racial and ethnic minorities and those who are poor. Does the model of physical therapist practice in acute care actually inflict this lack of fairness? If the acute care setting routinely forces physical therapists into these types of moral dilemmas, what is the role of the physical therapist in the acute care setting?

The Patient Protection and Affordable Care Act of 2010 (commonly known as the "Health Care Reform Bill") contains a pilot project on bundling acute and postacute payment into one payment for Medicare beneficiaries. In this discussion podcast, Gerben DeJong, author of "Bundling Acute and Postacute Payment: From a Culture of Compliance to a Culture of Innovation and Best Practice" (May 2010); Justin Moore, Vice President for Government and Payment Advocacy, APTA; and moderator Rebecca Craik, PT, PhD, FAPTA, discuss the possible ramifications and opportunities of a bundled payment system for physical therapy and rehabilitation.

Olaf Verschuren, PT, PhD, PCS, lead author Eileen Fowler, PT, PhD, and moderator Carolynn Patten, PT, PhD, PTJ Editorial Board Member, discuss the March 2010 article “Pediatric Endurance and Limb Strengthening (PEDALS) for Children With Cerebral Palsy Using Stationary Cycling: A Randomized Controlled Trial.” The group also discusses specific clinical aspects related to exercise for children with cerebral palsy (CP) as well as the broader issue of fitness for this population.