FOTO Rehab Outcomes

Apr 28, 2017 | Selena Horner

Increase Self-efficacy and Increase Rehabilitation Participation


More and more has been published on self-efficacy. This factor will impact rehabilitation outcomes. It's important enough that clinicians may need to figure out ways to know a patient's level of self-efficacy.  Once you know a person's level of self-efficacy, how can you interact to change that patient's beliefs?

As I researched this, I came upon Bandura who defined self-efficacy. You may find this blog post helpful in how you can interact with patients who have low self-efficacy. 

When you use FOTO, there are optional surveys that can be used to individualize the information you learn about your patients. The Self-Efficacy Scale is included as an optional survey within FOTO.

Below you will find a quick view of the abstract. 

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Apr 26, 2017 | Selena Horner

New Approach: Real World Clinical Research

Don't let the title of the abstract divert your attention. 

Value based purchasing will require some of the exact components mentioned in the abstract:

  1.  A Data Registry: this allows for national benchmarks. Registry means that organization that holds and maintains the registry has met certain requirements to be qualified as a registry. 
  2. Integration with EMR: this allows for immediate knowledge of cost of services if the EMR has a built in reporting system to capture cost of episodes of care.
  3. Integration with EMR: this could allow for immediate knowledge of generalized services provided if EMR has built-in reporting features to indicate CPT codes performed. In the rehabilitation world, this may not prove to be really helpful because the codes used in rehabilitation are quite generic. "Therapeutic exercise" has no meaning when trying to learn what kind of exercise provided the outcome. Was the exercise isometric... was it isotonic... was it eccentric... was it endurance type exercise. What could happen though, there could be a generic comparison of clinicians in their outcomes and what their episodes of care looked like via generic services billed. There may be differences noted which may help in discussions or in clinical education.
  4. A Data Registry: thinking forward with Merit-Based Incentive Payment System (MIPS), a registry will be extremely helpful for reporting quality measures and outcomes. 

It seems for future success you'll need both an EMR and a data registry. FOTO is a qualified data registry for MIPS and for the Canadian Physiotherapy Association

Below you will find a quick view of the abstract. 

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Apr 24, 2017 | Selena Horner

Remote Monitoring System after Total Knee Arthroplasty

New ideas are intriguing to me. My lil brain immediately has questions. I highly doubt patients will be able to consistently velcro something on themselves in the same location. Will this matter when monitoring range of motion. Then, is the device mentioned in the abstract really measuring range of motion or the distance between 2 points? Obviously, if it is the distance between 2 points, then the closer they get to each other the more motion achieved. What is the cost associated with the system and the modem? Are there situations where the technology will fail? Are there situations where transmissions are either delayed or fail? 

The article makes valid points about a few pitfalls that occur after an arthroplasty. I do believe it is great to think of solutions. One huge missing component: a comparison between using the device and transmitting information versus status quo. It's intriguing, yet I honestly don't know if it really mattered. (And then if it did matter, was it more of the idea that patients knew that they were being monitored, so they were more exuberant in doing their stretches?)

Below you will find a quick view of the abstract. 

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Apr 21, 2017 | Selena Horner

Step Length & Step Frequency: Effect on Lower Limb Function

Last year I finally splurged and purchased a treadmill that has force platforms within it. Somehow the treadmill talks to a tablet and I can immediately see gait biomechanics. 

The below abstract grabs my attention. For many older adults with balance deficits, I observe very short step lengths. After surgical procedures, I observe an odd mixture of short step lengths with high percentages of asymmetry. The focus I've been taking is to normalize step length. 

Increasing step length takes a lot of concentration and work. It's nice to see a bit of what I tell patients substantiated in the abstract. In order to change their gait, I mention they need to use their powerhouse muscles: their buttocks and thighs. When they focus and change their gait pattern, the exact muscles that are mentioned in the abstract are reported to be sore.

My thought: it isn't the reduced strength that created the gait pattern we see. I have a feeling the gait pattern is due to fear of falling. The fear of falling alters the gait pattern such that the individual's gait has reduced step length. And over the years of walking with shorter step lengths, the muscles become weaker. 

Below you will find a quick view of the abstract. 

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Apr 19, 2017 | Selena Horner

Effectiveness of Telehealth-based Interventions for Individuals with Low Back Pain



Although technology can be exciting to use, we need to know the impact technology may have on our patients. What changes if telemedicine is brought into the picture as the intervention of choice for individuals who have non-specific low back pain?

Since apps and telemedicine are fairly new and could definitely be an option to substantially reduce the cost of care, time needs to be spent determining if this care option is beneficial. It doesn't appear that rehabilitation professionals will be replaced by an app, based on the abstract below. I'd be curious if the app falls along the same lines as an educational booklet. 

Below you will find a quick view of the abstract. 

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Apr 17, 2017 | Selena Horner

Three Ways Rehabilitation Professionals Can Prepare for Merit-Based Incentive Payment System

Just because rehabilitation professionals are not currently included in the merit-based incentive payment system (MIPS) as eligible providers does not mean that rehabilitation professionals should not be thinking about this type of payment model.

Right now eligible providers have somewhat of a grace period. The eligible providers will experience MIPS where quality reporting is the highest weighted category and by 2020 quality becomes less weighted as cost is included in the MIPS performance metric. Rehabilitation providers may not be granted the same "Pick Your Pace" option that currently happened for 2017. 

Below are the three ways that you can prepare for Medicare quality payment programs.

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Apr 14, 2017 | Selena Horner

Is There a Relationship between Generalized Osteoarthritis and Physical Activity?

 This study blows my mind. It just seems intuitive that physical activity would reduce disability.

Although I say that, I can easily think of a dozen patients who were and are consistently active in their lives. I don't mean "active" to mean serious exercisers. I mean active to mean, traveling on trips and walking touring the scenes, heavy gardening, farming chores - feeding animals, dancing, and lifting 40-50 pound bags of concrete mix. 

Maybe more work will be done to better understand the relationship between osteoarthritis and disability.

Below you will find a quick view of the abstract. 

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Apr 13, 2017 | Selena Horner

5 Ways to Maximize Conference Apps

Once upon a time when I attended a conference, I felt like a lone attendee. I registered ahead of time. There was no way to know who was attending. It wasn't easy to prepare for the conference to get the most out of it. A huge book of presentations was provided. It was a burden to carry along all day. Scraps of paper held various scribbled notes. Being able to connect with attendees was left to serendipity and swapping business cards.

Speed forward to 2017. Have conference planners come a long way in creating a participatory experience for attendees! Conference planners are now harnessing the power of technology by using apps that are used on mobile devices. The app design not only has details about the conference, but also immediately connects with your social media accounts, your photos, and your email accounts. The apps also have neat, built-in ways to immediately communicate with attendees about any changes in the conference OR information about the conference.

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Apr 12, 2017 | Selena Horner

Hospital Engagement in Value Based Reforms and Readmission Reduction


Although I know this particular article is not about rehabilitation, I really was curious if the various programs Medicare has implemented has created the desired change.

The reforms focused on in this article focused on meaningful use of electronic medical records, bundled payment for care and accountable care organizations. The growth of these initiatives is amazing. If this article is correct, in 2010 no hospital was participating in any initiative and by 2015 only 56 hospitals were not participating in at least one of the programs. 

If I understand the statistics correctly, the meaningful use program provided poorer results than not participating in any program. In some areas, the stats are actually worse. Participation in ACO alone really didn't seem to be a huge difference compared to not participating at all. Participating in all 3 programs did result in a change.

Now, the question I have, if the change was in the 1-1.5% range for reducing readmissions, was that the desired outcome? Did that level of reduction outweigh the costs associated with each program? (Costs for hospitals and costs associated with building the infrastructure and the meetings involved with designing and monitoring the programs?)

Maybe I am misinterpreting what I've read. If you have thoughts, definitely enlighten me.

Below you will find a quick view of the abstract. 

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Apr 10, 2017 | Selena Horner

Designing Incentive Programs

 If you've read Daniel Pink's work, you know that monetary incentives can backfire. Incentives will not consistently lead to desired outcomes. If a task is a simple type of an activity then financial incentives may be successful. When a task requires thinking and a financial incentive is included, the size of the incentive matters. Too much of an incentive leads to a breakdown in the ability to think and perform effectively and efficiently.

Incentivizing quality... I have mixed feelings about this. In the Selena "world," everyone does their best. Everyone cares. At times, reality is hard for me to accept. How can organizations and teams be motivated to provide top-notch quality of care? Although some payment models define quality and are focused on paying for higher quality, I wonder what organizational processes will ensure long term success. To set the record straight, I'm truly speaking about models that really look at quality versus reporting quality metrics. I'm speaking about the real change that happens through the course of a continuum of care or at least over an episode of care. 

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