Trying wrapping your head around this one. On twitter, I see tweets from across the globe that indicate researchers in the rehabilitation world are promoting muscle overload to be included in interventions. I’m sure we all agree that muscle overload has value. When you read “optimal load orientation concept” in the below abstract, you are not to be thinking about rehabilitation professionals. This term is derived from shoulder models and mathematical equations. The biomedical engineering goal is to use human models and mathematics to define the optimal length for each shoulder muscle in order to provide targeted overload. Because the shoulder has a wide range of possible positions, equations were used to determine the best angle or placement of an external load to more precisely achieve high muscle activation in each shoulder muscle. The simulations compare the calculated optimal load orientation with a typical resistive exercise performed in the clinic.  

What I am not able to readily comprehend in the full text is how the optimal load orientation concept looked in the simulation. It would be interesting to have seen a video of the simulated muscle overload. 

Engineers are truly focused on creating a robot to provide strengthening activities for the shoulder musculature for individuals with a shoulder problem. The article mentioned being used for individuals after having a stroke. I’m not sure how the robot will overcome the often concurrent problem of lack of coordination. I’m also not sure how a robot would be helpful when someone is experiencing pain. Then again, the robot may have artificial intelligence built into its programming. Are we indispensable? 

The abstract is included below for you to review.

A Muscle-Specific Rehabilitation Training Method Based on Muscle Activation and the Optimal Load Orientation Concept.

The post Will Robots Replace Clinicians? appeared first on FOTO Patient Outcomes.

A couple of years ago, I had a patient who reduced his cost for health insurance by participating in a program offered by his employer. The patient reduced his costs by always having an annual physical and staying at a particular activity level. The smart watch was responsible for tracking his amount of activity.

Fitbit Care sounds interesting. Technology has really changed to not only allow activity tracking and social competitions, but to also have coaching built into the app. For the large employers, I can visualize a dashboard of sorts in which every employee has an account within the platform. If the technology is smart enough, the platform can provide alerts as to when an individual’s behavior is changing outside of desired parameters.

What I am curious about are the coaches. As we begin to see more and more telehealth options on the market, it seems that we now need to wonder about the coaches. What credentials are required for health coaches? Do the coaches just follow scripts and find scripts to match the situation reflected in the data? Will coaches have a medical background to be able to provide excellent coaching advice?

As I sit here writing this, my mind wanders to some of my patients. All I can say is that life happens. When life happens and a loved one is hospitalized or the employee is ill or the employee is going through a divorce or the employee is a caregiver? As their physical activity is being tracked and monitored, what is in place to take into account life circumstances? There are times in our lives when all we can do is get up in the morning and focus on getting through our day – and truly not have time for ourselves. How accommodating will an employer be to provide assistance for these individuals? I’m thinking like continuing to pay wages, but allow the person to leave and go to the gym or leave and go home an hour earlier to be able to truly eat a healthy meal. For an employer to really be able to help and provide not only coaching, but the support for healthy behaviors may actually mean providing non-traditional support to give time for healthy habits to be maintained when life happens.

The next thing I wonder about: do physical therapists have a role in this coaching care? I mean, so many people are told: exercise. Exercise is just a single word. Exercise prescription is what is needed. Another component involves progression of exercise activities. Quite a few of my patients are a bit fearful when it comes to exercise. We really do have the knowledge and skill to prescribe exercises for sedentary individuals and help progress them to active individuals without incurring injuries.

Until next time,

~Selena

The post Wearable Technology Harnessed to Improve Health appeared first on FOTO Patient Outcomes.

I am sure that many of us provide care to people who have had a joint replacement. I wish that our brains could accurately recall each of our patients.

I believe that the apps have a bit more importance than just pre and post-operative education and tracking. Research is pointing to the importance of being active far sooner than when osteoarthritis is seen. And then, even when someone has osteoarthritis, it is still important to be active. It seems research is indicating that the lack of physical activity may be playing a large role in occurrence rates. It seems to me there could be a way to somehow harness that research to pull into an app to help track, motivate and increase efforts to change behaviors before the situation reaches a need for a joint replacement.

As I read the news about the current study between Apple and Zimmer Biomet, I found it interesting that surgeons may play the main role with regard to who the patient will be able to communicate. As a physical therapist, as I think about the patients who don’t quite do as well, most may not have been zealous with stretching their joint and getting themselves back to life. I am not able to see the full app design via the link, so I hope there has been thought on how to capture that the patient is actually spending time focused on gaining full range of motion. The patients who don’t begin to walk distances or go up and down stairs in a normal manner are also at risk of not regaining full use of their new knee or hip. And for some individuals, targeted education, demonstration, exercises need to be provided to help the person get rid of their limp. I’m not quite sure how an app might be able to provide the individualized feedback to help the person perform quality movement patterns. Technically it isn’t unless it merges with a video platform that can see a patient move and qualify the movement pattern.

It seems that combining this wearable technology with the app being designed by Apple and Zimmer Biomet might have a bit more value. The ability to combine the majority of the patient needs into one package seems more helpful and ties everything together for the patient. Again, the biggest question: which patients need the technology to help them be successful.

I’m not sure the surgeon will really be the professional who truly cares or even wants to spend time thinking about the patient’s day to day activity level. It seems that a physical therapist would have more stake in not only analyzing the date, but also advising on activities. I am finding it more and more interesting to learn a patient’s perspective of doing a lot of walking. Some patients think “a lot” of walking is 1,000 steps.  When I look at research to help me define activity levels based on steps: <5,000 steps is sedentary. So, yes, I can see a disconnect between “a lot of steps” and what is really necessary to have a person be considered physically active. I also think that as wearables become more commonly used with the majority of our patients, we have the opportunity to help educate on acceptable, healthy targets so the patient really is exceeding sedentary status.

Until next time,

~Selena

The post Can a Smart Watch Help with Faster Recovery after a Joint Replacement appeared first on FOTO Patient Outcomes.

It seems we are all scrambling to meet the various needs of those we interact. Our first responsibility is to the patient. Each patient is a bit different and has slightly different needs. I believe we always need to determine the best way we can fulfill the patient’s needs.

For example, with the pressure to provide value and cheaper care, we need to stay aware of new options as they become available to us. As new options become available to us, we aren’t going to have evidence be a guide for our care delivery – we will need to design our own screening processes to determine which patients a new option is appropriate. We will also have to have strategies in place to evaluate whether implementing a new option in care delivery is not only feasible but also whether it really changes anything. The biggest factor, if you place the patient in the center and forefront of care, is whether the new option was truly beneficial for the patient.

I recently came upon a company called Claris Reflex.  My attention was perked. Right now I have a “smart” treadmill that interfaces with a tablet. I am able to have all sorts of data at my fingertips about how my patient performed during the session. The patient is able to have immediate feedback on performance. I am able to provide functional goals and the patient is far more easily able to learn the movement pattern working with the devices than I have ever been able to do with verbal feedback or manual cues. There is also an opportunity to save a session and print it or add it to the patient’s medical record.

The focus of Claris Reflex is knee joint replacement care. There are already some bundled care initiatives and if joint replacement care becomes bundled across the board, everyone caring for these individuals may be looking at ways to improve outcomes. If most physical therapists are like me, then you all worry about the progression of gaining motion after the replacement. Patients are definitely able to do their home exercise program to increase their motion. The biggest problem is that some patients are a bit fearful and really aren’t willing to move their knee into a bit of discomfort for fear of damaging the knee. Another problem is that for some patients as they gain more and more motion, yet are not quite at the 120 degrees of flexion, they don’t have an accurate way to know they still have more motion that needs to be acquired. The same thing happens for some patients who have not felt their knee go straight in forever and their ability to determine their knee is straight is not accurate. I liked what Claris Reflex had to offer for those patients. 

So the question then becomes, how do we adapt our care to the opportunities that technology allows us to take? I mean, I know that every patient I treat does not need remote monitoring. How much time is acceptable to allow a patient to independently manage their care? When is the best time to introduce patient remote monitoring? What does it do to patients mentally and their pride of achieving if remote monitoring becomes a standard of care? I guess what I mean by this is that there are a lot of patients who do take pride in independently doing the work to achieve. I wonder if introducing technology for everyone without considering the individual will have negative ramifications. 

I definitely appreciate technology. It seems we will need to take some time to do some thinking before automatically bringing technology into the care.

• Which patients are the ones that need remote monitoring – which patients are at risk of failing to achieve results?
• Does the benefit outweigh the cost of the technology?
• Could there be detrimental effects using the new technology?
• How does the clinician’s role change?
• Are processes in place to help the clinician succeed as the new technology is implemented into practice?

We are going to see more and more options for remote monitoring. I think we need to have conversations in our heads and also within our organizations to help determine the best patients to incorporate this kind of intervention.

Until next time,

~Selena

The post Are You Contemplating Remote Monitoring? appeared first on FOTO Patient Outcomes.

The FOTO Team recently released the availability of a Net Promoter Score (NPS) Dashboard.  The NPS consists of one simple question, “How likely are you to recommend us to a friend or colleague?” The FOTO Team included the NPS Dashboard as a bonus twist turning it into a management tool. Your patients will be able to add comments after responding to the question and receive real-time alerts of detractors. 

There are quite a few articles online focused on scoring and the interpretation of scores. If a patient indicates 0-6, then that patient is considered a detractor. If a patient responds 7-8, then that patient is considered a passive. Finally if a patient responds 9-10, then that patient is considered a promoter. The score is actually calculated by the percent of promoters minus the percent of detractors multiplied by 100.  I’m choosing not to spend a lot of time on the scoring because most of what you find online goes into substantial detail. What I’d like to do is instead take time to provide you with hurdles and strategies that you will need to think about so you may be effective if you choose to use NPS.

The biggest hurdle for your organization is to determine what to do with NPS scores. Should the scores be something you track? Should the scores be something  you share with everyone in your organization? Should the scores have an action plan? Do the scores really matter?

---

Is my Net Promoter Score acceptable?

---

Will your organization have a targeted goal for your NPS results? I’ve been researching NPS and what you may find helpful is benchmark data from CustomerGauge. Their 2018 benchmark report may provide you insight as to what would be considered a reasonable result when capturing NPS. Within the benchmarked data, the industry actually matters with regard to Net Promoter Scores. As you can see, healthcare and professional services tend to have higher scores. If you decide to implement NPS into your business model, you might want to set a score goal. The score represents the accumulation of touch points within your organization for every person who interacts with patients. This score is not specific to clinicians; this score captures the patient’s perception of the whole experience from the first contact with your organization (either website, email, phone or walking in) to that last day of graduation.

Your next hurdle has to do with an action plan for detractors. If you choose to have the NPS within each patient functional status report, anyone within your organization will be able to easily identify if the patient is a detractor. Then what? What action plan will your organization implement? Should a detractor be addressed? Who should address detractors? As you think about this, keep in mind that organizations that have an action plan in place reaching out to detractors seem to demonstrate improved revenue. Revenue may improve because the detractor might flip to a promoter: choosing services in the future and referring others. I’m assuming this happens if the customer truly believed the organization cared and really worked toward addressing the detractor’s needs.

Should a promoter be seen as a hurdle in your organization’s strategy? Okay, a promoter probably isn’t a hurdle, yet you do need to think about promoters. Can you harness your promoter’s exuberance toward your organization and help make it easy for increased referrals? To me, referral marketing feels like it cheapens the kindness extended by the promoter. Although there may be some in this world who expect something for doing something, there are many others who truly appreciate helping others just because. I tend to send a quick thank you note to previous patients who refer others. To me, that just seems special – to receive something handwritten in the mail with a heartfelt thank you.

Speaking of which… do you track how your patients choose your organization? To me, the NPS is just one piece of the equation. The other piece of the equation are behaviors. What I mean is that anyone can say that they would refer… but who actually takes action and does refer? If you add that bit of information into your organization, you have both the NPS and behavioral information. If you believe that it costs less to retain your patients and make them lifelong customers, then it would probably be wise to know if you really are retaining them. It’s important to know when scheduling an initial evaluation if the patient is a previous patient, referred by a previous patient, specifically referred by another healthcare professional or choosing based on location or marketing efforts. 

One last thought about what the FOTO Team has rolled out that is different. The FOTO Team has provided an option for patients to comment after responding to NPS. By providing the opportunity for a patient to comment allows for two things. If the patient is a detractor, the patient may actually share what is bothersome. Your organization will have concrete information from that patient and a more efficient process to address the negative comment. For the promoters who share a comment, you now have an opportunity to use the comment as a testimonial. Depending on the comment, you may even have a way to reach out to that patient expressing gratitude.

The NPS is just a score. The score should drive action to help you improve the interactions your organization has with patients. Although NPS seems to be a loyalty gauge, the real power, growth and advantage is truly based on what your organization does with the score. FOTO now provides an NPS dashboard as a customer experience management tool. 

{{cta(’40ad9577-bf23-4c17-a3d6-0c0a124073f3′,’justifycenter’)}}

Until next time,

~Selena

The post Net Promoter Score and Loyalty appeared first on FOTO Patient Outcomes.

At times it seems we play the game, “how low will you go?” I’m referring to “can more be done for patients in less visits?” The traditional frequency of three times a week for service delivery has been phased out for the majority of our patients. Typically patients may be seen 1-2 times/week.

When I see research comparing 5 sessions to 12 sessions, I begin to get a little bit curious. Reducing in office visits by over half will have a huge impact on cost for the episode of care IF results are truly delivered.

I found a video that helped explain eExercise and how technology was used in the provision of services. I’m not sure that this is the best solution for all patients – yet it seems there are some pearls as to which types of patients this type of model may be appropriate within the article.  

 Hopefully this study is somewhat helpful as you think of the cost of your services, your outcomes and ways to deliver services more cost effectively.

You’ll find the abstract to the recent study below.

Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial.

The post Reducing Face-to-Face Visits with Online Exercise App appeared first on FOTO Patient Outcomes.

My cell phone and iPad are readily available for my use during my clinic days. Amazing applications have influenced my practice: from wellness apps that motivate patients to be physically active to apps that provide safe and challenging balance activities for patients. I also have apps that help me immediately know lab values and their meaning and apps that help me know the sensitivity, specificity and likelihood ratios of clinical tests. Smart phones are quite the amazing resource.

Truth be told, I am wrestling with virtual reality. I have played with a system and I can see opportunity for clinical value. I’m a bit of a germaphobe – well, not really a strong germaphobe – but on a practical, reasonable side of it. Wearing devices means that I need to ensure that I’m not cross contaminating patients. I’m really not sure the best way to ensure cleanliness between patients when it comes to virtual reality.

What excites me is that there are fun and cheap ways to challenge patients through the use of virtual reality. Maybe we’ll all need to have a cheap supply of ski caps in the clinic in the future as a way to ensure cleanliness between patients? 

You’ll find the abstract to the recent study below.

Smartphone virtual reality to increase clinical balance assessment responsiveness.

The post Smart Phone Virtual Reality and Postural Stability Challenge appeared first on FOTO Patient Outcomes.

The most recent experience I can recall about a patient’s perception about physical activity happened a few months ago. I had an older adult who was noting an increase in her normal amount of strength and also was feeling deconditioned. She had been ill multiple times over the past year with pneumonia.

As we were talking about her typical activity level, she insinuated that she walked with her granddaughter, walked at the senior center and spent time walking in her home. I should have picked up on her daughter’s nonverbal body language. The following week, the patient had a pedometer. The daughter got her a pedometer and wanted her to use it to show me her activity level. I asked my patient how her day had been and about her walking. The patient mentioned a significant amount of walking prior to attending her visit. I told her I was curious about how many steps that would be and had her show me her pedometer recordings.

Let’s just say that 500 steps was far, far less than the patient described. From the experience with that particular patient, I learned that a patient’s perceptions may not necessarily reflect true judgment of activity level. This particular patient would definitely be considered frail and really wasn’t achieving the required amount of physical activity to begin to change her status to pre-frail.

I do believe that wearable sensors may definitely help in providing information to help us guide patients through their rehabilitation. The sensors can provide both more accurate information for us while at the same time motivating patients.

You’ll find the abstract to the recent study below.

Wearable Sensors and the Assessment of Frailty among Vulnerable Older Adults: An Observational Cohort Study.

The post Wearable Sensors and the Assessment of Frailty appeared first on FOTO Patient Outcomes.