The Benefits and Risks of Technology-Aided Physical Therapy
By Elizabeth Carrollton
Technology has made a big impact on the physical therapy profession. Evaluating muscle and joint function in patients rehabilitating from procedures like hip replacement is done more easily with today's technology, as is monitoring patient progress. High-tech therapy tools are allowing therapists to help patients for whom rehabilitation might have proven difficult or impossible 20 years ago. However, like any treatment, new therapy tools and procedures do have some potential risks.
Body-Supported Treadmill Training
Body-supported treadmill training is a relatively new technology that has fast become the primary form of technology-aided physical therapy for hip replacement rehabilitation, helping patients who aren't ready to place much weight on the joints begin therapy sooner. Starting therapy as quickly as possible after a replacement procedure is important to both short-term and long-term results. Patients who get up and moving within 24 to 36 hours after surgery have less risk of common post-surgery complications, such as blood clots. In the long-term. prolonged periods of immobilization can inhibit healing and recovery. Patients who begin therapy directly after surgery have shorter recovery times, regain more range of motion and higher levels of mobility, and have less pain and stiffness than those in whom rehabilitation is delayed.
By supporting as much as 80 percent of a patient's body weight, these machines allow exercise without joint stress, allowing therapy to begin earlier and progress faster than would otherwise be possible. Computerized sensors used with many of these high-tech treadmills monitor muscle and joint function, strength and stress levels to allow therapists to determine how much progress is being made, making it easy to increase or decrease exercise intensity according to each patient's changing needs.
These easy-on-the-joints treadmills can be a great help to patients who have undergone revision surgeries, which are often more complex than the original hip replacement and involve longer, more intensive rehabilitation. Patients who have had revisions due to replace faulty implants, such as the recently recalled Stryker Rejuvenate hip implant, might have joint damage due to complications, reducing their tolerance for the weight-bearing exercise that is so crucial to successful recovery.
Many of these patients have been affected by serious joint conditions and damage related to implant debris, such as metallosis and osteolysis. Metallosis is caused by particles of metallic debris shed from the implant that accumulate in the soft tissues, which can cause symptoms such as severe inflammation and pain in the hip and tissue or bone death, Osteolysis occurs when the body's immune system attacks the joint in an effort to clean up implant debris, causing bone loss. Both conditions can cause implant loosening or failure. Patients who have had these types of complication may emerge from revision surgery with restrictions on weight-bearing activity. Supported treadmill training can accommodate those restrictions, allowing patients to begin rehabilitation therapy and recovery sooner.
However, use of body supported treadmill training requires close supervision and capable professional assistance. Patients have reported feeling faint and dizzy during their use more often than in traditional therapy, and falls have been more frequent.
Author Bio: Elizabeth Carrollton writes about medication safety and defective medical devices for Drugwatch.com.
FORCE Therapeutics Introduces New App to Extend Patient Care Beyond the Walls of the Physical Therapy Clinic
FORCE Therapeutics is introducing a new web and mobile application today for physical therapy practices, providing therapists with a tool that allows them to extend clinical patient care beyond the clinic. The new product, called FORCE TherEx, is a clinically tested, browser-based software product that provides both therapists and patients an easy way to view exercise videos, track progress and securely communicate with one another.
FORCE TherEx contains a video library containing hundreds of clinically tested exercise demonstration videos that were created by a team of prominent physical therapists. These videos can be used to demonstrate clinically correct exercises to patients, whether they are at the clinic, or in the comfort of their own homes. They show patients precisely how each prescribed exercise is to be completed and they can be viewed on any browser-enabled device, whether that be a computer, a phone or even an Apple iPad.
“The product was designed to address the specific clinical challenges that face physical therapists,” said Bronwyn Spira, a veteran physical therapist and a co- founder of FORCE Therapeutics. Chief among those challenges is that “the average first time patient leaves a clinic with between 4 – 10 prescribed exercises as a part of their physical therapy program.” Those patients are then expected to return home and remember precisely how each of those exercises should be performed.
Using FORCE TheEX, a therapist can prescribe any number of exercises and provide the patient with access to those professionally produced, clinically correct videos that can be used as a reference by the patient between visits.
According to Ms. Spira, FORCE TherEx was designed as “clinical tool for therapists that enables them to be more effective, to be more current with their technology and to run their practices in a cooler, more time efficient way. I believe it really achieves that and is a huge time saver for Physical Therapists. I know, I use it myself in my own practice.” She continued by saying that “Patients love the technology as well because they are looking to manage their own healthcare using their mobile devices or home computers.”
While the videos are a big part of the product, it can also serve as a practice portal allowing therapists to view and update their daily schedules, securely communicate with patients and track patient progress. The fact that the product is browser based allows the therapist to use it on a desktop computer while updating schedules or communicating with patients, or at the point of patient care with a mobile device.
“Using the FORCE App in our practice has resulted in a significant improvement in patient outcomes,” says Claude Hillel, PT. “It saves us so much time and the patients love it. FORCE TherEx has transformed my practice by providing an easy-to-use tool that greatly enhances a patient’s rehab experience.”
In the coming months FORCE Therapeutics will also be adding electronic medical record (EMR) functionality to the product which will allow physical therapy clinics to more easily communicate and exchange medical records with the EMR savvy physicians that refer patients to them. This product will be called FORCE TherEx Plus and the company hopes to introduce it during the first quarter of 2012.
Physical Therapists interested in trying FORCE TherEX can sign up for a free trial of the service at www.forcetherex.com. The company will also offer individual exercise videos to consumers who may not be visiting a clinic that uses FORCE TherEX.
New Physical Therapy Tool Empowers Patients and Your Practice
Bronwyn Spira, President and Co-founder of Force Therapeutics speaks to the physical therapy community through a podcast interview with Jeff Worrell.
Taken from PTtalker.com:
Poor patient compliance is one of the leading factors behind unsatisfactory patient outcomes. To help improve patient outcomes and compliance tracking, this week’s expert developed an online solution for physical therapists. Brownwyn Spira, PT is a practicing physical therapist and owner of FORCE Physical Therapy. She’s also the president of FORCE Therapeutics which provides digital health applications for the physical therapy industry.
The inspiration behind FORCE Therapeutics was Spira’s frustration with the way physical therapists deliver exercise instruction to patients. Instead of handing a paper with written instructions on ways to do a specific exercise, she turned to technology to provide patients with videos that provide clear visual and verbal instructions to patients. The collection of videos and patient management tools are combined together in a subscription based online application, FORCE TherEx. This intuitive online solution allows physical therapists to provide professional home exercise video programs to their patients from their own website. The videos are easily accessed online from any computer or mobile device.
After years of testing, FORCE TherEx is slated to launch on September 12, 2011. Physical therapists can give the program a try for free by signing up for their free 14-day trial. Click here to listen to the full podcast now.
The Power of Connecting: How social media is changing healthcare
Co-authored by Bronwyn Spira, PT, and Mark Fields, PhD, MPH
As consumers we are using social networks to manage just about every aspect of our daily lives. From the way we rate and purchase items to the way we plan our next vacation, we depend on our networks to help us make decisions. We share our lives with others. We seek connection and access. We find value in our networks; they enrich us, expand our knowledge and extend our relationships. So how are we using these same networks to guide our health and our most important health decisions?
Today patients are participating actively in all aspects of personal health information. Patients are searching for the best knowledge and recommendations to empower themselves for a healthier life. Many turn to social network groups for support, reassurance and specific health news. A recent article entitled, Healthcare Performance Management in the Era of “Twitter” discusses how social networks improve patient care by connecting healthcare providers and consumers [1]. According to the article, 61% of Americans are turning to the Internet for health information, particularly for consumer reviews and comments. “Internet-enabled communities of patients and providers are coming together to communicate and collaborate,” explains Brian Klepper, Ph.D., Healthcare Analyst and Consultant, Health 2.0 Advisors. “In so doing, these virtual communities are reshaping the way healthcare is delivered and consumed,” he says. Further, a recent Pew Internet Study suggests, “The Internet has changed people’s relationship with information. Our data consistently show that doctors, nurses and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S” [2].
So how are healthcare providers using social media networks to engage and empower patients? Medical professionals are experimenting with many types of electronic tools to help manage health costs and improve the quality of care. Online social networks offer a unique platform allowing healthcare providers to connect with patients as a larger population. Providers can make recommendations for treatment, comment on the latest medical findings and respond instantly to patient inquiries. At Sarasota Memorial Hospital in Florida patients “tweet” their doctor when they have questions about their care. At Chicago’s Rush University Medical Center physicians keep connected with patients through Facebook so that they are notified of their recovery [3]. During a real-time brain surgery in March 2009, doctors at Detroit's Henry Ford Hospital answered questions via “tweets,” broadcasting to more than 1,900 followers [3].
Other healthcare connector sites include PatientsLikeMe.com where patients can compare care options and outcomes with specialized groups [4]. Sermo and Doximity are web and mobile based social networking platforms where physicians can share insights about medicine and specific cases.
Social media has created new possibilities for patient and provider communication. These tools allow healthcare communities to connect and form support networks that were unimaginable a short time ago. Such networks, in turn, create new platforms for healthcare providers to listen to their patients and provide them with resources to be more accountable. Networks empower recovery and increase the potential for better health outcomes. The power of a network depends on its activity and participation. Historically, healthcare professionals have been slow to adopt. In 2011, that rate of adoption has accelerated; we may finally be at a tipping point.
Resources
1. Cooper, L.F. and S. Aluise (2010) Healthcare Performance Management in the Era of "Twitter": Harnessing the Social Networking Phenomenon, www.hpminstitute.org/Era_of_Twitter.
2. Fox, S. (2011) The Social Life of Health Information, 2011 Pew Internet, www.pewinternet.org/Reports/2011/Social-Life-of-Health-Info.aspx.
3. Hanluain, D. (2011) Doctors Embrace Facebook, Twitter. Mobiledia, www.mobiledia.com/news/82375.html.
4. Hawn, C., Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care. Health Aff (Millwood), 2009. 28(2): p. 361-8.
Demystifying HIT (EHR/EMR/PHR – what does it all mean?)
Co-authored by Bronwyn Spira, PT, and Mark Fields, PhD, MPH
As health care professionals adopt information technology within their organizations, a new language has emerged around these activities. For physical therapists, these terms can be confusing- for example what is the difference between an EHR, an EMR and a PHR? How do provisions for “meaningful use” outlined within The American Recovery and Reinvestment Act of 2009 impact us? Lets start by describing the various types of electronic documentation and their differences.
An Electronic Medical Record (EMR) is an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.
A Personal Health Record (PHR) is an electronic record of health-related information that can be drawn from multiple sources, where the information it contains is under the management and control of the individual (patient).
An Electronic Health Record (EHR) is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be managed by authorized clinicians and staff across multiple health care organizations. It allows integration across multiple settings, provides tools that support clinical decision-making and provides access to electronic data by multiple authorized users.
The EHR is the primary focus of our government as it attempts to leverage technology to reduce health care costs and business inefficiencies. According to the Committee on Data Standards for Patient Safety, technology based efficiencies will enhance quality, safety and expediency in health care delivery processes. The core functions of an EHR, according to this Committee, include electronic communication and connectivity, longitudinal collection of personal health information and patient support. Further, the Institute of Medicine (IOM) stipulates that EHR systems must support the delivery of personal health care services, including care delivery, care management, care support processes, and administrative processes (e.g., billing or scheduling). The IOM suggests “as individuals engage more actively in management of their own health, they too become important users of electronic health information.”
EMRs and EHRs are tools for providers while PHRs are the means to engage patients in their personal health and well-being. The key difference between an EMR and an EHR is interoperability -- an EHR is used to exchange information across multiple users, an EMR does not.
Although the federally mandated “Meaningful Use” reimbursement plan is not applicable to physical therapists, multiple benefits can be extrapolated from adopting an EHR including improvements in:
● Documentation efficiency and accuracy
● Overall operational efficiency
● Communication (amongst health care professionals as well as between patient and therapist)
● Data accuracy and analysis
● Clinical decision-making
● Research and outcomes management
● Coordination of care
● Reimbursement efficiency
Accordingly, changes are being made in HIPAA regulations to accommodate the use of technology in health care. As a response, the APTA has recently launched a multi-phase initiative to assist physical therapists with the implementation process -- from decision-making to training and preparation, through the final stages of incorporating electronic systems into clinics (they do not endorse products, just provide guidance on selecting the right solution for your clinic).
When implemented properly, the adoption of electronic documentation has the potential to transform clinical practice for both therapists and patients. The question remains- have therapists begun to adopt health IT into their practices? The APTA along with the Health Policy and Administrative Technology SIG recently conducted a survey measuring EHR/EMR adoption among physical therapists. The results indicate that 28% of those surveyed have fully adopted an EHR/EMR in their practice. Of these respondents, 13% reported they were extremely satisfied and 50.8% were somewhat satisfied. 22.6% of physical therapists surveyed are in the implementation phase of introducing an electronic system.
Given the vast investment by the HHS, CMS, IOM, and APTA to provide guidelines for health care professionals to embrace EHRs, the signficance of technology adoption is clear. The goal is to continually provide clear and concise information that will hopefully make it easier for the clinician to transition to the world of HIT.
Resources
1. The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms, April 28, 2008
2. Key Capabilities of an Electronic Health Record System: Letter Report Committee on Data Standards for Patient Safety ISBN: 0-309-55877-8, 35 pages, 8 1/2 x 11, 2003
3. APTA: Electronic Health Record Adoption Toolkit and Education Plan, April 15th, 2011
The Value of a Patient Portal: Increasing compliance while reducing cost
by Bronwyn Spira, PT and Mark Fields PhD and MPH
As patients become more and more interested in engaging and communicating with their healthcare providers online, the demand for portal applications will only increase. Patients are looking for innovative ways to access their health information and care providers – what better way than online patient portals?
Portals are healthcare related online applications that allow patients to interact with their healthcare providers through secure websites or integrated electronic medical records (EMRs). These applications can give patients the ability to request prescription refills, make appointments, receive medical reminders, view billing statements, and ask providers questions about ongoing treatment regimens (2). The key is engagement and it’s a growing trend among individuals who expect the most out of their provider-patient relationships.
While portals empower patients to take control of their treatment and recovery, they hold even greater potential for healthcare providers. In particular, these platforms can substantially enhance the quality of physical therapy care. Compliance is an overarching issue for ensuring proper recovery during the physical rehabilitative process. Think home exercise regimens, post-surgical contraindications, body mechanics… physical therapists always have so much to communicate and monitor. As we discussed in past blogs, compliance plays a direct role in patient outcomes. Portals provide a secure platform for sending important messages directly to patients and monitoring their compliance at the clinic and outside of it. The downstream effects are increased efficiency and productivity, reduction in administrative overhead costs and improved patient outcomes. These applications also allow therapists to expand their practices’ reach by providing innovative solutions for patients that are geographically inaccessible.
So, you may well ask: is now really the time to integrate this type of technology in my practice? In a recent survey conducted by Intuit Health, 73% of respondents said that they would use an online communication application to pay medical bills, communicate with their physician or physician office, make appointments and view lab results (1). More than 40% said they would consider switching physicians in order to obtain such access. Research such as this makes it clear that patients are eager to adopt such applications and now is the time for providers to get on board.
The use of portal technology is inevitable as patients take control of their health and demand two-way communication platforms from their providers. As we innovate around ways to increase the quality of care provided to patients, the integration of secure portals should become a mainstay for effective clinical practice.
Resources
1. Shinkman, R. 2011. Americans want more online access to physicians, FierceHealthIT, http://www.fiercehealthit.com/story/americans-want-more-online-access-physicians/2011-03-07.
2. Terry, K. 2011. Patient portal use becoming an inevitability, ForceHealthIT, http://www.fiercehealthit.com/story/patient-portal-use-becoming-inevitability/2011-04-23.
iPad: PT’s New Best Friend?
Co-authored by Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS
The iPad is quickly transforming the way business is conducted in the media, entertainment and education sectors. But what about health care? What are the specific benefits of the iPad for physical therapists and what should you be cautious about? As a clinic that has actively been using the iPad for about 6 months now, we have found a number of tangible benefits. Documentation is much faster and happens in real time with each visit. We can track and log the time of each modality, which is especially useful for insurance billing. The small, flat screen is less obtrusive than a laptop - I always felt the screen created a physical and potentially emotional barrier between my patients and myself. I also like that the ipad can be easily handed to the patient for demonstration of a video exercise or other visual aids.
A couple of notes of caution - the iPad doesn’t have a USB port or printer connection so document management is challenging. Current battery life is shorter than the 12-hour workday and common flash based applications don’t work.
The other issues we face when evaluating the iPad as a medical tool are fragility (it will break if dropped) and hygiene since it cannot be sterilized. The latter is probably less of an issue for physical therapists than other medical professionals, but certainly bears mentioning.
The true future of iPad use within physical therapy clinics will depend on the availability of medical apps for clinicians. It seems inevitable that as our world becomes more and more technology focused we will have to start thinking about how to maneuver our own clinical landscape.
Recent Posts
- Are patients tracking their own health?
- FORCE Packs deliver mobile flights of care for iPhone, iPad & iPod Touch
- Digital Patient Management and Tracking System for Physical Therapists
- Regulation of Medical Apps by the FDA: What qualifies as a “medical app”
- What is the Role of Movement Assessment in Athletics? Is it Prevention or Performance Enhancement?
Categories
- ACA
- android
- Apps
- Electronic Alerts
- EMR
- Evidence-based practice
- Fitness
- government
- healthcare
- HIPAA
- iphone
- mhealth
- News
- Patient Compliance
- Patient portal
- Physical Therapy
- Podcasts
- Politics
- Social Media
- Technology
- Video Exercise
Calendar
Tags
Meta
Stay Connected
