Manhattan Research conducted an online survey of 2,950 practicing physicians and found that seventy percent of doctors report that at least one patient is sharing some form of health measurement data with them. Only one in five of these trackers used digital tools, however. Manhattan Research found that the most common ways of sharing data with a doctor were writing it out by hand or giving the doctor a paper printout (1). A possible reason for this could be that the 65+ population is (as a group) less likely to be online but also more likely to have (at least one) chronic condition that requires some level of tracking (2).
Patients are encouraged now more than ever to take responsibility for their own health as online websites and mobile applications become increasingly available for them to track their symptoms, medications and personal history.
At TEDMED 2013, USCF Chancellor Susan Desmond-Hellmann, MD discussed the need for patient engagement in our healthcare system.
“As medical care becomes more complex and technology has become more available, the responsibility of any individual’s health is not just on their physician but on themselves. Physicians should take the necessary steps to find ways to encourage patients to feel like they are in charge — not taking orders.” (3)
Research on self-tracking was also conducted by Pew Internet and American Life Project in January 2013. Pew spoke to patients, not doctors, and found that 69 percent of people tracked at least one health metric, although half of those people were just tracking in their heads.
This report found that about 60 percent of US adults track weight, diet or an exercise routine, while 33 percent track another health indicator like blood pressure, sleep patterns or headaches. Some 12 percent of adults track health indicators for a loved one (2).
Pew’s research found that about a third of trackers share their data with someone else, and of those who share, about half share with a clinician. According to MobiHealthNews, if all the numbers are accurate, about one sixth of Americans are sharing health data with clinicians, but seven out of ten physicians have at least one patient in that group (2).
“Self-tracking is already a part of the care paradigm and its prevalence is going to accelerate rapidly as digital connection, payment reform, and outcome-focused delivery make advances,” James Avallone, Director of Physician Research at Manhattan Research, said in a statement. “We are seeing physician attitudes toward self-tracking aligning with policy, which is encouraging for all stakeholders involved”. When doctors were asked what they thought of self-tracking, 75 percent believed that self-tracking leads to better patient outcomes (1).
The challenge is to get patients who are tracking in their heads or on paper to begin doing so using digital tools instead. With a push from healthcare providers and increased ease of use of available technology perhaps the paradigm shift is closer than we think.
(1) Comstock, Jonah. "Seven in ten doctors have a self-tracking patient." MobiHealthNews. Chester Street Publishing, Inc., 15 Apr 2013. Web. 10 May 2013. <http://mobihealthnews.com/21639/seven-in-ten-doctors-have-a-self-tracking-patient/>.
(2) Dolan, Brian. "Pew: Most US adults track health data but few use digital tools." MobiHealthNews. Chester Street Publishing, Inc., 28 Jan 2013. Web. 10 May 2013. <http://mobihealthnews.com/20040/pew-most-us-adults-track-health-data-but-few-use-digital-tools/>.
(3) Doku, Stesha. "Patient Engagement Through Self-Tracking." MedCrunch Hacking Health. MedCrunch, 30 Apr 2013. Web. 10 May 2013. <http://www.medcrunch.net/patient-engagement-selftracking/>.
FORCE Therapeutics designs web and mobile applications for injury rehabilitation and prevention.
FORCE TherEx and FORCE Premium are known to be the BEST EMR and HEP products in Physical Therapy and Rehab.
Please visit our website at www.forcetherapeutics.com
NEW YORK - April 18th, 2013 - FORCE Therapeutics is proud to announce the release of FORCE Injury Packs for iPhone, iPad and iPod touch, available now on the App Store. FORCE Packs are injury specific rehab solutions with custom flights of care and can be e-prescribed by doctors or directly downloaded by patients.
FORCE Packs give patients with musculoskeletal injuries (such as back or shoulder pain) access to injury-specific rehab exercise videos, expert advice, treatment information, common symptoms and the ability to set and track goals. Patients are prompted to engage in their rehab with easy to use and immediately accessible mobile tools. Success and progress can be automatically shared, motivating patients on their road to recovery through Facebook and email.
FORCE Injury Packs benefit healthcare professionals who treat patients requiring physical rehabilitation. Physicians can instantly prescribe specific FORCE Injury Packs via web-based widget tools or paper-based prescription pads. Physicians can also build their own customized protocol packs for pre or post surgical patients. Three years of research by a team of prominent physical therapists have produced the FORCE video exercise library. These high definition rehab exercise videos are easy to follow, promote proper technique and offer a smart first response to common injuries.
Starting rehab within the first 14 days of injury has been shown to significantly reduce the cost of care and shorten time to full recovery*. Rehabilitation is a major healthcare cost -- a recent report by Optum Health cited musculoskeletal injuries as the top medical expenditure in the US over the last three years. FORCE Injury Packs are recommended as an adjunct to traditional physical therapy and can also be used to find local specialists via the FORCE mobile directory.
FORCE Therapeutics designs and builds best in class, web and mobile apps for injury rehabilitation and prevention. FORCE Therapeutics was founded in 2010 by Bronwyn Spira, a prominent physical therapist and industry leader with 20 years of clinical experience, and Mark Lieberman, a health technology executive, serial entrepreneur and Emmy nominated content producer. Early success with FORCE TherEx, an online suite of rehab solutions for physical therapists, inspired a broader line of mobile injury rehab products including FORCE Connect and most recently FORCE Injury Packs. FORCE Therapeutics is one of the global leaders in mobile injury rehab and prevention.
*Fritz, Julie, John Childs, and et al. "Primary Care Referral of Patients With Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and Costs." Spine. Lippincott Williams & Wilkins, Inc., 26 Mar 2012.
For more information, press inquiries or to interview Bronwyn Spira, CEO of FORCE Therapeutics, please contact:
Introduction to the Industrial sector and prevalent Challenges:
Poor patient compliance is one of the major factors contributing toward unsatisfactory patient outcomes. In order to boost patient outcomes and compliance tracking, several healthcare-IT firms are engaged in developing Web-based solutions for physical therapists. In the US physical therapy industry, both patients and physical therapists are on a constant lookout for all-in-one Web platforms that support patient management, comprised of professional exercise videos and compliance monitoring tools, that can be customized to include integrated scheduling tasks. Digital health applications, which fundamentally improve the patient experience and patient outcomes, are increasingly of interest to the physical therapy industry professionals. Digital technology that includes video and social media tools are helping patients adhere to their physical therapy regimens. Mobile health applications are emerging to become ideal tools for patient management, monitoring, communication, and video exercise prescription needs. This rising growth and integration of mobile platforms within healthcare delivery is compounded by the fact that within the mobile content market, mobile healthcare information usage is identified to be the fastest growing segment with a growth percentage of 135% recorded in 2011 alone. One such company is New York-based FORCE Therapeutics. The company was founded in 2009 by a group of veteran physical therapists, world-class engineers, and video content producers who are uniquely positioned to understand physical therapy workflow and patient challenges, and develop innovative digital health applications. This firm is engaged in developing mobile application suite for achieving excellence in physical therapy solutions.
Introduction to the Developer of Technology/Product:
FORCE Therapeutics has an innovative cross-channel platform that extends the relationship between patient and physical therapist outside the office using digital technology. FORCE Therapeutics creates mobile and Web-enabled solutions for physical therapists and their patients to enable physical therapists to improve level of service and quality of care provided to patients through the company’s suite of mobile video solutions. The company’s first product is FORCE TherEx, a Web and mobile application for physical therapists. The product helps therapists prescribe and monitor their patient’s compliance and home exercise program schedules. Through the FORCE TherEx platform, patients have the ability to view exercise videos, track daily progress, purchase equipment, and communicate with their physical therapist via their mobile phones. Some of the notable features integrated into the FORCE TherEx platform to enable tracking of patient and staying connected in an online environment includes drag and drop functionality for exercise programs and protocols, automated sign-up procedures, customizable exercise videos, which stream to the mobile device, and an intra-office messaging center. In addition to FORCE TherEx mobile application, FORCE Therapeutics has also developed a FORCE Mobile platform that offers professional exercise solutions for muscular skeletal disorders, directly to the consumer. The FORCE Mobile app. is designed to recommend exercises based on sports, area and type of dysfunction, thereby creating a playlist of rehabilitation exercise videos, which directly stream to the user's mobile device.
Analyst Insights on Product Development:
Since both FORCE therapeutics’ products allow therapists to track patient compliance seamlessly and enables real-time clinical documentation changes to be made to the patient’s data, the applications spectrum and competitive pricing varies according to the individualized patient portal. The FORCE TherEx platform can be integrated seamlessly into an orthopedic or chiropractic practice as well as for primary care physicians examining injuries such as, lower back pain, sports medicine, and emergency care medicine. All of which benefit from using mobile video enhanced services and care. Clearly, FORCE Therapeutics' platforms takes physical therapy management into the next-generation by employing mobile solutions for on-the-go patients in a secure electronic setting and enables tracking of patient compliance using both home computer networks as well as mobile tools. Integration and adoption of such mobile physical therapy tools empowering patients and clinician' practice is expected to take another three to four years.
Please visit our website at www.forcetherapeutics.com
By Alexis Fotiu and Bronwyn Spira PT
The number of medical apps that can be found in the App Store is increasing exponentially as healthcare professionals realize the benefits these apps provide patients. There are currently over 38,000 health and fitness apps and over 24,000 medical apps available today (1). This comes as no surprise since consumers are becoming increasingly interested in tracking and managing their health through their mobile devices. 19% of smartphone owners have downloaded an app to track or manage their health and 41% have a strong interest in remote monitoring devices to check conditions and send information to their doctor (1). According to Research2Guidance, 500 million smartphone users worldwide will be using a health care application by 2015 (1).
The vast number of medical apps available can be overwhelming to consumers. As we covered in our previous blog post, “Beware of Fraudulent Medical Apps,” not all medical apps are trustworthy, which is why the FDA has put together the Draft Guidance for Industry Food and Drug Administration Staff –Mobile Medical Applications.
Mobile medical apps are not a new focus for the FDA—about 100 mobile medical apps have been reviewed since 1997 (2). However, with over 24,000 medical apps how will the FDA keep up with the constant innovation and new releases of apps? In the final congressional hearing on FDA regulating medical apps, a representative for the FDA responded to this question saying “We get about 20 a year right now. That is 0.5 percent of the medical devices we get in our 510(k) process each year (2)”. Many companies planning to introduce a medical device to the US market need to submit an application to the FDA called a 510(k). A 510(k) is a premarketing submission made to the FDA to demonstrate that the device to be marketed is as safe and effective as a legally marketed device that is not subject to premarket approval. 510(k) (premarket notification) to FDA is required at least 90 days before marketing unless the device is exempt from 510(k) requirements (3).
On their website, the FDA issued the following statement:
The FDA encourages further development of mobile apps that improve health care and provide consumers and health care professionals with valuable health information quickly. The FDA has a public health responsibility to oversee the safety and effectiveness of a small subset of mobile medical applications that present a potential risk to patients if they do not work as intended. In order to balance patient safety with innovation, it is important for the FDA to provide manufacturers and developers of medical applications with a clear and predictable outlines of our expectations. (4)
In the final congressional hearing on FDA regulating medical apps, Christy Foreman, (Director Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration), stated it takes about 67 days on average for mobile medical apps to get FDA approval through the 510(k) clearance system (2).
The Draft Guidance states that the FDA intends to apply its regulatory authority to mobile apps that are medical devices under the current definition: an instrument, apparatus, implement, machine, contrivance, implant, or in vitro reagent that is intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease in man, or intended to affect the structure or function of the body and either transforms smartphones or tablets into a medical device (as defined above) or is used as an accessory to a medical device (as defined above). (1)
This definition can cause confusion and introduces a gray area—a mobile app that meets the definition of a medical device but is not necessarily transforming a mobile platform into a medical device or acting as an accessory to a medical device, and hence is not a “mobile medical app” (1). For now, developers can classify their apps using the following criteria:
Mobile medical app:
• Control a medical device or display, store, analyze, or transmit patient-specific medical device data
• Attachment, display screen, or sensor that transforms a mobile device into a medical device
• Diagnosis, treatment recommendations, or clinical decision support applying formulae or algorithms to patient-specific inputs (1)
Some examples that FDA is trying to regulate? Foreman says it has been regulating apps for a decade. Apps that translate heart rate, SpO2, ultrasound technology that allows transducers to plug into an iPhone. – these types present patient risk (2).
In the final congressional hearing on FDA regulating medical apps, Foreman stated they have not yet encountered a Class III mobile medical device (2).
Not a medical app if:
• Electronic reference materials
• Training materials
• Log, record, track evaluate, or make decisions related to general health and wellness
• Healthcare administration, including billing, appointments, and insurance transactions
• EHRs or PHRs
• Generic aids not marketed for medical indication (1)
Which apps will the FDA not regulate? Foreman says an e-version of a textbook. If risk is low, FDA would rather focus on higher risk ones. Pedometers, for example, will not be regulated (2).
Undoubtedly the FDA will continue to alter their guidelines and introduce new standards as they navigate through regulations and are introduced to new medical apps. Prior to the release of the Draft Guidance the FDA encouraged everyone to send comments and suggestions regarding the guidelines so they could take every position under consideration—developers, patients, healthcare professionals—so they could implement guidelines that ensure safety but don’t inhibit innovation and advancement in the delivery of healthcare.
As any new regulations will, the Draft Guidance has received opposition and uncertainty from those feeling it will hinder development and innovation. As stated by in an article on MobiHealthNews, “For mobile apps FDA regulates, the quality system requires that manufacturers use rigorous design controls to document and organize the software development process. But that’s not how app developers have traditionally operated, and this requirement potentially slows down development to a snail’s crawl (5)”. For some the new regulations may deter them from even considering developing a new app due to clearance or approval uncertainty.
Others view it as a benefit—providing a safety net for users who depend on these apps for accurate information and analytics. By providing these regulations, the FDA is attempting to prevent medical apps with fraudulent content from being available to users.
“For a huge percentage of digital health companies, following FDA regulations will actually make them a better company, with a higher quality process, and open the door to the entire healthcare market, including enabling them to bid on contracts with some of the largest government institutions. Entrepreneurs should embrace, not fear, the FDA (1) ” – Geoff Clapp Co-Founder and Former CTO Health Hero Network, Mentor, Rock Health
Foreman says the final guidance will come out in the coming months and is a priority for the FDA (2).
1) Ghandi, Malay, and Deborah Pascoe. "FDA 101: A guide to the FDA for digital health entrepreneurs by @Rock_Health." A Rock Report by Rock Health. Rock Health. 2013. Lecture.
2) Dolan, Brian. "Liveblog: Day 3 Congressional hearing on FDA regulating apps." MobiHealthNews. Chester Street Publishing, Inc., 21 Mar 2013. Web. 4 Apr 2013. <http://mobihealthnews.com/21142/liveblog-day-3-congressional-hearing-on-fda-regulating-apps/8/>.
3) "Device Approvals and Clearances." U.S. Food and Drug Administration. U.S. Department of Health and Human Services, 18 Jun 2012. Web. 4 Apr 2013. <http://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/default.htm>.
4) "Mobile Medical Applications." U.S. Food and Drug Administration. U.S. Department of Health and Human Services, 22 Dec 2011. Web. 4 Apr 2013. <http://www.fda.gov/medicaldevices/productsandmedicalprocedures/ucm255978.htm>.
5) Merrill Thompson, Bradley. "After FDA’s mobile medical apps final guidance, what’s next?."MobiHealthNews. Chester Street Publishing, Inc., 26 Mar 2013. Web. 4 Apr 2013. <http://mobihealthnews.com/21252/after-fda’s-mobile-medical-apps-final-guidance-what’s-next/>.
About the author: Trent Nessler, P.T., D.P.T., M.P.T., is a physical therapist and founder/CEO of Accelerated Conditioning and Learning (A.C.L.), LLC. He is the researcher and developer the Dynamic Movement AssessmentTM, author of the textbook Dynamic Movement Assessment and Correction: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.
Over the course of the last 10 years, there have been some tremendous strides and advancements in technology. Many of these technologies have had a direct impact on athletics and coaching, especially in the last 5 years. With advances in motion capturing technology, like DartfishTM , coaches now have the ability to film and take very quick and complex movements, and break them down frame by frame. This provides them with the ability to take a movement or a technique that may take seconds to complete and critically analyze it millisecond by millisecond to see where they can have the most impact. For many coaches, this has opened their eyes to ways they can be more effective and efficient in directing their intervention with the athlete. For now, they are able to see things they may not have captured before. This new knowledge has resulted in improving, not only their knowledge of the movement, but has improved their effectiveness as a coach.
However, this technology also aids the athlete that is being coached. Many times, when attempting to teach athletes complex movements, having the ability for them to “see” how they are moving and how they are supposed to move is “key” to improving the technique and motion. As a result of this technology and the impact it can have on effectiveness of coaching as well as the athlete’s ability to change motor patterns to improve technique, many organizations are implementing this as a regular part of their tool kit. Currently, this technology is being used in professional baseball, tennis and hockey, just to name a few. The US Olympic Teams have been using this same technology for over 10 years and it is an integral part of their working with their athletes.
Knowing the impact this can have on coaching and performance improvement is there a place for this technology in screening of professional athletes, Olympic athletes and tactile athletes (SEALs, SWAT, est.)? Are there certain movements that we can assess, outside the complex sport specific movements themselves, which can give us an indication of potential for injury? Are there certain movements, if improved, would result in improved athletic performance, even in higher end athletes?
Over the last decade, there has been a plethora of research that shows a strong correlation with “pathokinematics” (abnormal movement patterns) and increased risk for injury in high impact sports. These same pathokinematics present in a predictable pattern and can be assessed with certain movements. Yet, quantifying them in a meaningful way has always been difficult. However, with the use of video technologies, it is allowing clinicians to accurately quantify movement and more importantly to use that knowledge gained to improve movement. Knowing pathokinematics are more pronounced with fatigue, some researchers have even begun combining these technologies to capture and quantify movement post fatigue.
One such study being currently performed by the American Sports Medicine Institute (ASMI) is showing dramatic results. In this study, researchers are using technology and a movement assessment to identify those athletes at risk. Using the information that is gained from the movement assessment, the team developed a corrective exercise program that improves improved their performance these tests. Over the 2 year period, this has resulted in 100% reduction of non-contact ACL injuries, 58% reduction on non-contact musculoskeletal injuries and over a $200K health care savings. Based on these preliminary results, we know improving these movement patterns has been shown to not only reduce the risk for lower extremity injury but also to have a significant impact on individual and team athletic performance.
Taking the athlete in fig. 1, she is currently competing at a very high level (nationally ranked). Knowing she is a sprinting athlete, using technology as a screening tool allows us to “see” where her deficits are with movements which are representative of how she moves in sport. Using this knowledge, we can then develop strategies to prevent injuries and aid in making a great athlete a superior athlete. In this instance, improvements in these pathokinematics would equate to better power output and increased sprint speed. In a sport where rankings are determined in milliseconds, this can make a huge impact on rankings and performance.
In professional athletics, this more even more critical. In a profession where decisions are based on the last performance and player’s salaries are defined in the millions, last thing you want is to make the wrong decision on a player. The more information you have about an individual player can make the difference from playing in the championships and the team being the national champions. In tactile athletes, this can mean the difference between life and death. When using movement and technology as a screening tool with these individuals, one can have a more complete picture of what the individual will look like post fatigue, a time at which performance and injury prevention are critical.
(1) Butcher,S;Craven,B;Chilibeck,P;Spink,K;Grona,S;Springings,E. TheEffectofTrunkStabilityTraining onVerticalTakeoffVelocity. JOSPT37:223-26.2007.
(2) Chappell, J. D., Yu, B., Kirkendall, D. T., and Garrett, W. E.: A comparison ofknee kinetics between male and female recreational athletes in stop-jump tasks. Am. J. Sports Med. 30:261-267, 2002.
(3) Chappell,J.D.,Herman,D.C.,Knight,B.S.,Kirkendall,D.T.,Garrett,W.E.,andYu,B.: Effect of Fatigue on Knee Kinetics and Kinematics in Stop-Jump Tasks. American Journal of Sports Medicine. 33:1022-1029, 2005.
(4) Farrokhi,S;Pollard,C;Souza,R;Chen,Y;Reischl,S;Powers,C. “Trunkpositioninfluencesonkinematics,and muscle activity of the lead lower extremity during the forward lunge exercise.” Journal of Orthopedic and Sports Physical Therapy. 38:403-409, 2008.
(5) Hart,J;Kerrigan,C;Fritz,J;Ingersoll,C. Jogging Kinematics After Lumbar Paraspinal Fatigue”.JofAth Training. 44:475-481, 2009.
(6) Herman,D;Weinhold,P;Guskiewicz,K;Garret,W;Yu,B;Padua,D. The effects of strength training on the lower extremity biomechanics of female recreational athletes during a stop-jump task.” Am. J. Sports Med. 36; 733-740, 2008.
(7) Mizer, R; Kawaguchi, J; Chmielewski, T. “Muscle strength in the lower extremity does not predict postinstruction improvements in the landing patterns of female athletes.” Journal of Orthopedic and Sports Physical Therapy. 38: 353-361, 2008.
(8) Robinson,K;Nessler,T. Decrease in lower extremity pathokinematics resulting in Improved Athletic Performance. Unpublished Study. 2009
(9) Westin,S; Noyes, F; Galloway, M. “Jump-land characteristics and muscle strength development in your athletes: A gender comparison of 1140 athletes 9 to 17 years of age”. Am j sports med. 34:375-384, 2006.
(10) Wilson,J;Binder-Macleod,S;Davis,I. “Lower extremity jumping mechanics of the female athletes with and without patellofemoral pain before and after exertion.” Am. J. Sports Med. 36: 1587-1596, 2008.
(11) Withrow, T; Huston, L; Wojtys, E; Miller, J. “The relationship between quadriceps muscle force, knee flexion, and anterior cruciate ligament strain in an in vitro simulated jump landing”. Am j sports med. 34:269-274, 2006.
By Alexis Fotiu and Bronwyn Spira PT
Are you one of the 31 million Americans who experiences lower back pain? You certainly aren’t alone. According to the American Chiropractic Association 80% of the US population suffers from back pain at some point in their lives (1). Some of the possible causes of low back pain include poor posture, incorrect workplace set-up, improper bending, lifting or exercise techniques and weight gain. Back pain can also result from more-serious injuries, such as a vertebral fracture or ruptured disk; from arthritis and other age-related changes in your spine; and from certain infections (2). I know what you’re thinking: What doesn’t cause back pain? With so many contributing factors, no wonder so many people are suffering. Whether your pain is mild, moderate or severe, one thing is for sure—back pain is debilitating and pervasive, making it difficult to participate in daily activities.
Back pain covers a spectrum of severity and chronicity. You may experience acute or short-term low back pain that lasts from a few days to a few weeks. Most acute back pain is mechanical in nature resulting from repetitive or sudden trauma to the lower back. Addressing the causative factors and correcting the biomechanics of the contributing behavior can often be curative. Chronic back pain typically persists for more than 3 months and is often progressive. Once back pain reaches the chronic stage it is generally more difficult to establish the underlying etiology and becomes increasingly difficult to treat.
Lower back pain is the most common cause of job-related disability and is a leading contributor to missed work (2). A report by Consumers Medical Resources found that Fortune 500 companies spend over $500 million a year on back surgeries for their workers and they lose as much as $1.5 billion in indirect costs such as lost productivity (4).
Patients bear much of the burden of back pain related costs. Trying different types of healthcare professionals—chiropractors, orthopedists, physical therapists, acupuncturists—can become exhausting and extremely expensive. Diagnostic tests such as X-rays, MRIs, discographies and other procedures add to these costs. Americans spend at least $50 billion each year on low back pain—and that’s just for the more easily identified costs (1).
Employers and patients aren’t the only ones impacted by high back pain costs. According to an article in USA TODAY, “The U.S. healthcare system spends about as much each year on spine problems as it does on cancer.” In fact, back pain makes up 46% of orthopedic expenses, making it the top cost driver in US healthcare expenditures (5). A report by Reuters stated that treating spine problems in the U.S. costs $85.9 billion per year, an increase of 65% over the past decade (6).
According to the Mayo Clinic, most back pain, even severe back pain, goes away on its own in two to four weeks. Surgery is rarely needed for back pain and is generally considered a last resort. While back pain is the third most common reason for all surgeries performed in the US, fewer than 5% of people with back pain are good candidates for surgery. For those who do receive surgery, it has been found that failed back surgery syndrome is seen in 10-40% of them. This is characterized by intractable pain and varying degrees of functional incapacitation occurring after spine surgery (7). U.S. Public Health Care Policy & Research: Patient Guide states “Surgery has been found to be helpful in only 1 to 100 cases of low back pain problems. In some people, surgery can even cause more problems.” More risks include infection, nerve damage, deterioration of health and postoperative operations. So if surgery doesn’t help in most cases, then what does? According to the National Institutes of Health, the answer might be exercise:
Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor. (1)
Here are some Physical Therapy tips on how to prevent or reduce low back pain:
• Don’t try to lift objects that are too heavy for you. Lift by bending your knees, tighten your stomach muscles, and keep your head in line with your straight back. Keep the object close to your body. Do not twist when lifting.
• Sleep on your side with a pillow between your knees to reduce any curve in your spine. Always sleep on a firm surface.
• Always warm up before exercising and stretch afterward
• Maintain a healthy diet and weight.
• Avoid prolonged inactivity, such as sitting or bed rest.
• Remain active—under the supervision of your healthcare professional
• Wear comfortable, supportive low-heeled shoes.
• Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.
• Sit in an ergonomically correct chair with good lumbar support. If your chair does not support the lower back, use a rolled-up towel or lumbar roll when seated. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension.
• Maintain proper posture. This simple exercise video will help you understand the components of good posture. We recommend doing this exercise periodically throughout the day to train your muscles to maintain ideal posture.
Here is a video of an exercise you can do for low back pain:
(1) "Back Pain Facts & Statistics." American Chiropractic Association. American Chiropractic Association, n.d. Web. 24 Jan 2013.
(2) "Back Pain: Symptom." MAYO CLINIC. Mayo Foundation for Medical Education and Research (MFMER, 11 Sep 2012. Web. 24 Jan 2013.
(3) "Low Back Pain Fact Sheet." National Institute of Neurological Disorders and Stroke. National Institutes of Health, 19 Sep 2012. Web. 24 Jan 2013.
(4) "Back Pain: Symptom." MAYO CLINIC. Mayo Foundation for Medical Education and Research (MFMER, 11 Sep 2012. Web. 24 Jan 2013.
(5) "Study: Companies Lose Fortune on Workers' Back Injuries." Consumer's Medical Resource. Consumer's Medical Resource, 26 Jun 2008. Web. 24 Jan 2013.
(6) Elton, Dave. "Navigating in an ACO and shared savings environment: The What, Why and How." APTA Private Practice 2012 Annual Conference. OptumHealth, 24 Oct 2012. Web. 24 Jan 2013.
(7) Steenhuysen, Julie. "U.S. back pain costs rise but pain still there." Reuters. Thomson Reuters, 12 Feb 2008. Web. 24 Jan 2013.
(8) SpineMed." Active Life Institute. Active Life Institute, n.d. Web. 24 Jan 2013.
A Recent Usability Study of Apps for Rehabilitation at Michigan Technological University Using the FORCE TherEx Platform for Physical Therapists
Katrina M. Ellis, Chad Norman, & Alex Van der Merwe
Michigan Technological University, Houghton, MI
ABSTRACT: Our research investigated instructional materials given to patients of physical therapy, and methods for checking patient comprehension and compliance. We conducted environmental and task analyses by interviewing practicing physical therapists to map the problem space. Responses to surveys taken by patients of physical therapy and practicing physical therapists suggested that video instruction of exercises and video conference meetings between clinic visits would be beneficial to patient rehabilitation. Using a convenience sample of undergraduates, we investigated the influence of self-efficacy and format of instructional materials on willingness to comply, satisfaction with information, and anxiety related to completing rehabilitation. We found that video with text instructions were most satisfying to students.
METHODS: There were two phases to this experiment. The purpose of the first phase was to compile information from practicing physical therapists and patients of physical therapy on their perceptions of their experiences with physical therapy recommendations and compliance. The purpose of the second phase was to investigate the role of instructional medium on information satisfaction, and to see if medium is a mediator between exercise self-efficacy and willingness to comply.
RESULTS: Recommended length of rehabilitation varied from 3 to 5 weeks to over 12 weeks. The majority of physical therapists reported that 6 to 8 weeks was the typical length of rehabilitation (54%; 3 to 5 weeks, 23%; 9 to 12 weeks, 15%; and more than 12 weeks, 8%). The majority (77%) of PTs encouraged unsupervised exercises after the first visit. The amount of unsupervised exercises between visits varied between 1 to 2 and 5 to 6. The majority of PTs suggested that 1 to 2 unsupervised exercise sessions occurred between face to face visits (54%; 3 to 4, 38%; and 5 to 6, 8%). 100% of PTs suggested that demonstration was the best way to instruct patients on exercises to be performed unsupervised at home. 92% of PTs have not previously used videos for instruction of unsupervised exercises and almost half do not check for compliance. The majority (12/13) would consider a different method for checking compliance. PTs also believed that video instructions should improve patient confidence in their ability to perform the unsupervised exercises and that videos transfer proper exercise technique.
UNDERGRADUATE SURVEY: A few interesting trends which should be noted. Movie & text instructions received the highest rating in satisfaction—this group also had high ratings of compliance and low ratings of anxiety. This further supports the addition of video instruction in physical therapy prescriptions.
DISCUSSION: After our preliminary interviews with practicing physical therapists, it was clear that there needed to be some change in the instructional materials given to patients of physical therapy of unsupervised exercise prescriptions and a change in the procedures for tracking patient compliance. We surveyed current practicing physical therapists, patients of physical therapy, and a convenience sample of undergraduate students to gather perceptions of physical therapy practices, instructional materials, and compliance-tracking.
We did find that instructional medium influenced satisfaction with the information. This result suggested that video & text instructional materials were rated higher than other mediums or combinations of mediums.
CONCLUSIONS: This research investigated the influence of video instruction and video conference feedback on willingness to comply. We found that video instruction was rated higher than text or picture instruction, but power was not sufficient to find additional significant results. Survey of PTs and patients of PTs perceptions suggested that video instruction and video conferences between clinic visits would be beneficial to patient confidence, compliance and rehabilitation.
FORCE Therapeutics designs web and mobile applications for injury rehabilitation and prevention.
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Under the Bundled Payments initiative, Center for Medicare & Medicaid Services (CMS) would link payments for multiple services patients receive during an episode of care. Instead of paying separately for each individual service, the insurer would pay a set amount for the inpatient hospital services and physician services, as well as the post-acute care services (1). Providers will have flexibility to determine which episodes of care and which services would be bundled together.
Because the insurer would pay a fixed amount to health care providers to treat the patient, all providers would have an incentive to coordinate the care that the patient actually needs. And because the providers’ reimbursement amounts would depend in part on meeting quality and patient experience measures, the entire team of providers would be focused on improving quality (1).
In contrast to the current fee-for-service reimbursement system, bundled payments encourage and reward care coordination and cost reduction among a patient’s providers. A bundled payment compensates all of a patient’s health care providers with a single, fixed, comprehensive payment that covers all of the clinically-recommended services related to the patient’s treatment, episode, or condition over a defined period of time (1). These payments can be adjusted based on the patient’s health status.
Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings (2). Payment is based on how much a provider does, not how well the provider does in treating the patient.
Research has shown that bundled payments can align incentives for providers – hospitals, post acute care providers, doctors, and other practitioners– to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery (2).
Bundled payments offer benefits for payers, providers, and patients.
– More coordinated patient care for improved health outcomes and lower costs
– Reduced variation in spending and clinical treatments to reduce costs
– Greater transparency and accountability on price and quality
– Allow providers to transition to wider-scale payment reforms (1)
The 4 Models of Bundled Payments:
Model 1: Hospital services provided to a beneficiary during an acute inpatient stay, where physicians are partners in improving care
Model 2: Hospital, physician, post-acute provider, and other Medicare-covered services provided during the inpatient stay as well as during recovery after discharge to the home or another care setting
Model 3: Hospital, physician, post-acute provider, and other Medicare-covered services beginning with the initiation of post-acute care services after discharge from an acute inpatient stay
Model 4: CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit “no-pay” claims to Medicare and would be paid by the hospital out of the bundled payment (2)
Under the current fee-for-service model patients choose the doctor, hospital or clinic and providers are reimbursed for each service they provide (such as tests or manual therapy).
Fee-for-service payments drive up health care costs and potentially lower the value of care for two main reasons. First, they encourage wasteful use, especially of high-cost items and services. Second, they do nothing to align financial incentives between different providers. As a result, patients receive care that they do not need and may not want, and health care providers may not be on the same page about what type of care the patient should receive. It is not just insurers who bear these unnecessary costs: These costs raise premiums, deductibles, and cost-sharing for all health care consumers. (1)
According to an article by the Center for American Progress:
Defining what’s included in an episode-of-care bundle is one of the most challenging aspects of implementing bundled payments. For in- stance, a bundled payment for total knee replacement surgery could begin after diagnosis of a joint problem, and before hospitalization for the surgery. The episode would include payment for the services of the orthopedic surgeon, as well as operating room fees (including anesthesiology), and post-acute care for 30 days following discharge. This bundle could also be expanded to include physical therapy services and post-acute care services for 90 days after discharge. Thus, the bundled payment could include reimbursement for several different providers: the hospital, anesthesiologist, surgeon, and rehabilitation facility. (1)
Patient Choice and Access
A vexing issue for physical therapists is the matter of patient choice and access. In most of its forms, bundling means limiting patient choice to providers who are represented in the bundle, but patient choice is already limited. Edelman of the Center for Medicare Advocacy argues that “patient choice in [today’s] postacute care is often illusory” and that “patients and family often, if not usually, follow physician or discharge planner’s recommendation.” (3)
Postacute choices are often made under duress and short lengths of stay in acute care give patients and family members very little time to make informed choices. In short, bundling will limit patient choice but patient choice is already quite limited except in cases of elective procedures where postacute services can be selected in advance of the acute stay (3).
Both Medicare and private health care providers have shown that bundling payments improves care for patients, and leads to better health, better care, and lower costs.
Instead of basing payment solely on the volume and price of the items and services provided to patients, these alternative methods of payment create incentives to encourage preventive care and better care coordination, especially for patients with chronic illnesses (1).
Providers of all kinds will be strongly motivated to figure out what works and does not work and weed out interventions and care processes with little or no benefit; they will focus on resources that provide the highest probability of improving outcomes (3).
This information was gathered from the following websites:
(1) Calsyn, Maura, and Emily Oshima Lee. "Alternatives to Fee-for-Service Payments in Health Care." Center for American Progress. Center for American Progress, 18 Sep 2012. Web. 14 Jan 2013. <http://www.americanprogress.org/issues/healthcare/report/2012/09/18/38320/alternatives-to-fee-for-service-payments-in-health-care/>.
(2) "Improving Care Coordination and Lowering Costs by Bundling Payments ." HealthCare.gov. HealthCare.gov, 23 Aug 2011. Web. 15 Jan 2013. <http://www.healthcare.gov/news/factsheets/2011/08/bundling08232011a.html>.
(3) DeJong, Gerben. "Bundling Acute and Postacute Payment: From a Culture of Compliance to a Culture of Innovation and Best Practice." Journal of the American Physical Therapy Association. American Physical Therapy Association, May 2010. Web. 14 Jan 2013. <http://ptjournal.apta.org/content/90/5/658.full>.
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