History

The field of physical therapy has changed considerably since its inception post World War I. With thousands of injured soldiers returning home from the war, the necessity for qualified, knowledgeable rehabilitation specialists propelled the field from a small contingency of specialists to a professional organization (1).
Since the early 1900s, much has improved in terms of rehab practices; however, compared to other professional organizations, it has been comparatively sluggish advancing as it prepares to tackle the future of large-scale rehabilitation.

This rapidly developing situation illustrates two immediate necessities: a need for more P.T.’s working in the field and a general commitment toward new, innovative practices to maximize patient care and improve the patient experience. It will be the latter of the two – developing and managing new practices – that will ultimately be the savior when scaling rehabilitation to match the demands in an abruptly aging society. One-on-one care and human touch will never be replaced, nor should it be, nevertheless, if technology can expedite the rehab process, create efficiencies, and provide new ways to engage with patients, it will advance recovery – the ultimate purpose of rehabilitation.

21 First Century Obstacles

Medicine, in general, is facing a crisis, as currently, chronic diseases are among the most prevalent and costly health conditions in the U.S., with nearly half of all Americans suffering from at least one chronic disease; and the number is growing (2). Additionally, one out of every five Americans suffers from chronic pain (3).

What makes treating chronic conditions (particularly on a large scale) expressly challenging is that chronic conditions often do not exist in isolation. For example, one in four U.S. adults have two or more chronic conditions, and more than half of older adults have three or more chronic conditions. Moreover, the likelihood of these types of comorbidities occurring increases as we age (2).

Given America’s current demographics, where 10,000 Americans turn 65 each day from now through the end of 2029, it is reasonable to expect that the overall number of patients with comorbidities and chronic pain will increase significantly and swiftly over the next few decades (2).

Further complicating the situation, the average outpatient course of care is only seven to ten sessions in total, with reimbursement rates (as well as the number of payer-approved visits for P.T. services) remaining mostly stagnant over the last decade and, in some cases, decreasing (10,11). Additionally, only 30% of patients who receive outpatient rehab services attend all the visits their insurance company authorizes (10). In fact, a CDC study found that more than 700,000 people receive knee replacements each year, with almost 70% of those patients not completing their post-surgery physical therapy, leading to complications (4).

only 30% of patients who receive outpatient rehab services attend all the visits their insurance company authorizes

ref (10)

New Practices Emerging:

Listed below are some of the innovative and emerging practices developing within the field of physical therapy and similar medical science communities.

Gamification of Rehab Practices.

Often using a Wii or similar system, these virtual games, movements, and exercises provide a fun and competitive therapy option to rather mundane treatment. The competition through games improves patient engagement and enjoyment of rehab, found researchers from Johns Hopkins. This gamification of rehab drives patients to perform better as they enjoyed the challenge of the games and the change of pace in their exercises (4,9).

Virtual Reality

V.R. blends the engagement of the environment with gaming aspects to help encourage and challenge patients to develop qualities such as balance, coordination, mobility, and memory. Therapists and clinicians are still experimenting with new ways to use virtual reality for rehab; however, V.R. is currently testing the treatment of patients recovering from a stroke, surgery, walking disorders, orthopedic, and neurological issues (4,9). While the research is raw, there are some highly promising results, and the field will continue to reveal new practices as the technology improves and accessibility is advanced (4,5,6).

Active-assistive Robotic Therapy

Often used in conjunction with stroke treatment, Cerebral Palsy, and orthopedic interventions, rehabilitation robots are intelligent devices that use sensors to monitor human movement and positioning, processing this information to provide feedback to interact with the environment and the patient (7,8). These robotic technologies are not only useful as clinical interventions but can also help with assessments, data tracking, and guidance on progress (possibly removing some human error along the way). Moreover, the American Physical Therapy Association referred to the pairing of robotics and P.T. as “The New Age of Function, Movement, and Recovery” (9).

e-Rehabilitation and telerehabilitation

This process describes the communications and treatments with patients through digital platforms while encouraging patients to complete their exercises from the comfort of their homes. The ability to access care on demand has some immediate advantages resulting in patients more likely to see a specialist and a higher likelihood of patients completing their treatment programs (4).

E-Rehab reduces or removes the patient’s need to commute to the clinic while providing the rehab specialist the ability to have a greater scope of patient outreach. Through the telemedicine platform, P.T.’s can walk patients through the rehab process, showing them how to complete exercises, watch to make sure the patient is doing the exercises correctly, and prescribe a home exercise program. While this innovative system is still developing, it does offer some unique benefits for both the practitioner and patient (12).

Scheduling/Patient Experience

Scheduling inefficiencies are an all too common problem in healthcare that has not improved much, despite the demand of people looking to schedule appointments online. 70% of consumers prefer to book appointments online, yet 50% end up calling to book appointments because of the lack of resources and other barriers preventing online booking (15). Furthermore, 34% of new patients try to schedule appointments outside of standard business hours (16).

Nearly 60% of individuals surveyed are frustrated with waiting on hold and the inconvenient office hours related to scheduling appointments by phone. It is no coincidence that healthcare systems that evaluated their outpatient performance found that 10% to 30% of their clinicians’ capacity is unused or under-used; yet, long patient wait times persist at many clinics (13,14). These inefficiencies are costly to medical offices and cause more than half of patients to switch healthcare providers to ones that offered good ‘basic’ access (short or no wait times) and more advanced amenities (convenient online booking) (14).

In fact, by the end of 2019, more than a third of all appointments will be self-scheduled through web forms, apps, or some other digital interface with estimates of these self-scheduled appointments valued at $3.2 billion (13).

Outcome:

The changing societal health problems brought on by an aging population and commonality of diseases will present challenges to the healthcare system yet to be seen on the massive scale developing. These challenges must be met with innovative and swift technology advancements to ensure patients are receiving the therapy they deserve. Nothing can replace the care of human touch, and technological progress should do everything possible to maximize this priceless time.

References:

http://www.amhsjournal.org/article.asp?issn=2321-4848;year=2014;volume=2;issue=2;spage=257;epage=260;aulast=Shaik;type=3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876976/

https://www.medpagetoday.com/neurology/painmanagement/75078

https://www.concentra.com/resource-center/articles/three-ways-technology-has-improved-physical-therapy-treatment/

https://www.sciencedirect.com/science/article/pii/S0003687018300176

https://n.neurology.org/content/90/22/1017

https://web.stanford.edu/class/engr110/2012/04b-Okamura.pdf

https://otpotential.com/blog/active-assistive-robotic-therapy

https://www.aaos.org/AAOSNow/2011/Jul/managing/managing3/?ssopc=1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544892/

https://blog.pokitdok.com/patient-booking/

https://healthcare.mckinsey.com/access-imperative

Colin Reno

Colin Reno

Board-Certified Exercise Physiologist; Sports Science & Technology Consultant. Follow on Instagram: @colin_reno

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