FOTO Rehab Outcomes

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Selena Horner

I believe outcomes data is the new frontier - so many things to learn from this type of data: professionally, clinically and businessly!
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Aug 21, 2017 | Selena Horner

Low Dose Radiation Therapy for Musculoskeletal Problems

After I read the abstract I was cringing. Believe me, I think it is great to dream and have ideas. 

When it comes to a potentially new treatment, I would prefer if there is a control group. How do we know if radiation therapy is better? This abstract doesn't mention any complications or side effects.  With what was reported as the results, it seems we could toss a coin with regard to whether long term pain relief will occur. 

Below you will find a quick view of the abstract.

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Aug 17, 2017 | Selena Horner

Safety of Exercise for Patients who Have Advanced Cancer

This topic brings many memories to the forefront and is difficult for me. Years ago, I found a study by Andrea Cheville, MD highlighting the importance of exercise for these individuals. The study included a home exercise program. As I analyzed the program, it was quite apparent that the exercises were not strenuous.

Over the course of the last 2 years, I have had more and more patients who have cancer. For me is difficult to use FOTO with these individuals because they typically do not meet the predicted goals. The reason they do not meet the prediction is because they are outliers. They are outliers because the likelihood of attaining full, predicted function is not realistic. (Okay, I have nothing to substantiate this except what I have reflected on as I treat these individuals.) They are undergoing chemotherapy and infusions... they have bouts of hospitalization... they are experiencing side effects of their treatments...  they have periods where they are not able to physically attend. FOTO can track their change in function nicely - it tends to take longer for change to happen. Often their function reaches a plateau. 

Now, FOTO does have something of high value to help capture something that is really, really important for these individuals: fatigue level. Most of my patients are seeking an increase in strength so they can go up and down stairs normally and enough endurance so they can walk in the grocery store to get their groceries. They complain of severe fatigue. What I tend to use in FOTO as an optional survey is the Facit Fatigue Scale Version 4.  Often times, within 4-6 weeks of initiating services with me, the Facit Fatigue Scale has a substantial change.

I agree with the below study that we really do need more studies to assist us in designing exercise programs that are of the appropriate intensity for these individuals. For now, if you are lucky enough to use FOTO, you can track how they are changing.

Below you will find a quick view of the abstract.

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Aug 14, 2017 | Selena Horner

Does Treadmill Training Improve Gait in Individuals Post-Stroke?

My thoughts are very different than what you'll see in the abstract. What kind of treadmill was used for the experimental arm?

The reason that I ask is because I have a treadmill with GaitSens 2000.  (I am not being paid to mention this product. I truly do use it in the clinic with a variety of patients.) The really cool thing about combining force platform technology with a treadmill is the capability for me to really track changes. The other aspect that is awesome is the immediate feedback a patient receives when reaching goals that I set to improve their quality of gait. The immediate feedback is far faster than I can speak. (And if you know me, that is a feat in and of itself.)  The other neat thing is that with goals, the auditory cues when goals are met and with repetition, the patient's gait actually changes when walking in the clinic. With patients who have a neurological condition, the gait characteristics may not be perfect, but I can readily prove the changes via session reports. 

The other aspect to consider... typically, when a patient is walking on the treadmill, the person is holding onto the side rails. Well, from what I have seen, the gait characteristics on the floor don't tend to change as much until I begin having the patient let go of the side rails and walk. Yes, it is quite stumbly and unsteady and scary for the patient. The timing of movement patterns is not conducive to smooth, coordinated movement. For that reason, I have the patient in a harness which is connected via a rope block and tackle to an eyelet in the ceiling. 

Anyways, I thought I'd bring in another perspective to provoke thinking. I tend to disagree that including sessions on a treadmill do not lead to better outcomes. What matters is immediate feedback and increasing the challenge while keeping the patient safe.

Below you will find a quick view of the abstract.

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Aug 13, 2017 | Selena Horner

When is Chest Pain a Fractured Rib?

Since many physical therapists have some level of direct access (or what physiotherapists refer to as self-referral), I tend to keep my eyes open for research that helps me with differential diagnosis.

Chest pain... now that could have a scary complication, right? Is there a way to come to a conclusion that the person has a rib fracture? I find it interesting that history of recent trauma and age greater than 40 years were predictive factors. I wonder if pain with inhalation or coughing were considered?

Below you will find a quick view of the abstract.

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Aug 10, 2017 | Selena Horner

Retear of Rotator Cuff Repairs

Clinicians are not in full control of final results after a rotator cuff repair. We all know that there is always the complication of a failed repair. Failure can occur for a variety of reasons. The one that we need to definitely keep in the back of our mind, because it relates to using the shoulder: retear rates.

How hard do we push and progress a patient? Are some patients better candidates for a more aggressive program than others?

In my practice the majority of my patients are older adults. This study is nice in the sense that it reported the complication of retears across age groups. Based on the findings, I think it does a nice job in highlighting which patients are not candidates for an aggressive program.

Below you will find a quick view of the abstract.

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Aug 07, 2017 | Selena Horner

Stem Cells in the Management of Rheumatic Diseases

As technology changes and provides new treatment options, are we ready to evaluate the changes that may occur with the care we provide? Meaning... is there a difference in the rehabilitation outcomes of someone who has received stem cell treatments versus someone who hasn't? 

I know that typically this my questions would typically be answered via a randomized controlled trial. Yet... shouldn't we also know the answer with real life patients using practice based evidence?

FOTO has a way, built into its system, for you to create your own special groups of patients. You can definitely create a category of patients who have had stem cell treatment and a category for patients who have not. You can easily compare. The capability to do this could definitely set you apart with physicians in the community who are truly interested in being able to compare results. Granted, many colleagues will be thinking there is a bias... there isn't any randomization.... the clinician knows what treatments the patient has received in the past. Reality: real clinical life is messy and in the real world, clinicians have to treat patients on their schedules. Practice based evidence looks at retrospective data to help clinicians learn.

Below you will find a quick view of the abstract.

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Aug 03, 2017 | Selena Horner

Patient Reported Outcome Measures are a Stethoscope for Patient History

Patient reported outcome measures are being used more and more frequently. In rehabilitation, I have a feeling the main reason the majority initially begin using a measure is to be compliant with regulations. I mean, we need to report functional limitations, so the easy button is to incorporate patient reported outcome measures.

I took time to read the below perspective published in Annals of Surgery.  Although I don't agree with a stethoscope analogy, I definitely agree that patient reported outcome measures can be used to drive clinical decision making. FOTO has really led in the outcome world by tackling two things: 1) making each patient's report easily understood by the clinician so that clinical decisions may be more easily determined and 2) immediately sharing results with the patient who just completed the patient reported outcome measure. 

 What are patient seeking when they enter the rehabilitation world? I have a feeling, most want to improve either in function or in reducing pain level. Patient reported outcome measures are far more than a score. The score translates into a picture of  their functional life. I can be immediately transported into a glimpse of what it is like to live in their shoes. I can see that when they begin services how much different they are from individuals who are similar. And, due to a large database, I can even learn how much improvement is typical and what that means in how function will change.

I use the functional limitation portion of the report only for patients who have insurance requirements to report functional limitation. I really don't see value in the functional limitation codes and modifiers. If I only used that portion of the report, I know that I would be missing a great opportunity to converse with the the patient about what matters to them most.

Below you will find a quick view of the abstract.

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Aug 01, 2017 | Selena Horner

What are Considered Social Determinants of Health?

Recently National Quality Forum released findings from a two-year trial to determine if social risk factors should be risk adjusted when determining outcomes. It appears that it may not be easy to obtain social factors.

A recent article highlights not only the social determinants of health, but also the ways in which these factors can be captured within electronic health records.

The risk adjustment process is a fairly new concept when it comes to predicting health outcomes. Although the social risk factors may seem to intuitively impact outcomes, the fact is, until various statistics are performed on a very large dataset, no one will really know the amount of impact each factor may or may not have on outcomes.  Health care providers want as many variables as possible considered and included in a risk adjustment process to help level the playing field in upcoming alternative payment models focused on value.

FOTO recently analyzed an enormous amount of data to assess its risk adjustment process. The analysis led to improvement in its risk adjustment process. You can see how FOTO uses its risk adjustment process to compare and predict outcomes of care.

Below you will find a quick view of the abstract.

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Jul 31, 2017 | Selena Horner

Can Aquatic Exercises Effectively Strengthen Lower Extremities?

Short answer, "No."

If we apply what we know about specific adaptation to imposed demands, it is doubtful that the lower extremities will be challenged enough in the aquatic environment. The buoyancy of the water reduces weightbearing through the joints. Specialized pools with jets and aquatic equipment that attaches to extremities to increase resistance will provide a bit more challenge if the goal is to increase strength.

To increase strength, it is important to know the patient's one repetition maximum. After knowing that, you can then calculate the appropriate intensity the patient needs to be challenged to increase strength.

The aquatic environment can be an excellent choice for exercise. It just may not be the best environment for increasing lower extremity strength.

Below you will find a quick view of the abstract.

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