FOTO Rehab Outcomes

Aug 24, 2017 | Selena Horner

Association of Practice-Level Social and Medical Risk With Performance

Do you believe most of your patients are simple with little to no factors affecting the outcome of the care you provide? 

In a previous post I brought up the concept of social determinants of health.  A recent study looked at whether social determinants of health, medical factors or a combination of both would have an effect on incentive payments and penalties for practices.

After reading the abstract, I have an even better appreciation for what FOTO is able to do for clinicians and organizations with its risk adjustment process.  If risk is not accounted for in a value based payment model, then truly earned bonuses may not be earned OR undeserved penalties may occur.  Most of the current alternative payment models aren't really including a provision acknowledging risk adjustment or the importance of risk adjustment. Risk adjusted outcomes are key for a successful alternative payment model.

A favorable component within FOTO is a strong risk adjustment process coupled with predictive analytics. It's almost like having artificial intelligence onboard immediately at the start of an episode of care.  The next level of power within the system is analyzing data. The data revolves around the initial assessment, the predicted outcome and the final outcome. The final analysis using aggregated data determines the effectiveness and efficiency of the care provided.

If you take a look at the abstract, you'll see what can happen when a  payment model is based on raw data. The authors make a valid point that patients aren't all the same and that the payment models do not adequately address the patient risk factors.

Below you will find a quick view of the abstract.

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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 09, 2017 | FOTO Team

Researchers in Need of 14-17 Year Olds: Please Help

A research team is interested in learning if patient reported outcome measures connect with teens.  Rehabilitation professionals work with teenagers to assist them with returning to the highest level of function possible. This research team wants to ensure that the tools  accurately assess a teen's self-reported functional ability. If you work with teens or know of any teens who have recently had physical therapy OR are currently receiving physical therapy services, please share this research study with them.  The details are below. For your convenience you can download the flyer to share with your colleagues, email  or post for others to see. Thank you so much for helping!

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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 06, 2017 | Nikki Rasmussen

Take Your Data and Run for the Green

I am a runner. I don’t look like what many people visualize a runner to be. I am not fast, and I am not very likely to place in my age group, nor in anyone else’s for that matter. My spot is typically toward the back of the pack. And even though I’m not a fast runner, many a weekend morning, the girl who feigned illness to avoid running in gym in junior high now pays money to run several miles with a bunch of strangers.

Being the statistics nerd that I am, after crossing the finish line of a race, I eagerly check my phone for a text from the timing company, compare it to my running watch, and analyze my overall time and splits for this race. Once I get home, I assess my historical race data, and compare it to see how my performance at this event stacks up with previous endeavors for me.

After a recent race, while I was looking at my sports watch app and analyzing my data, I suddenly realized how similar running participation is to outcomes participation and analyzing outcomes data. And then, my statistics brain wondered what my data would look like on a FOTO Scorecard.

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