As the unexpected derails many of our plans, how do practicing therapists and clinics adapt their approaches to better serve those in need?
Across physical therapy clinics, outpatient clinics have seen some of the most drastic declines in patient flow. With the unknown still looming over the remainder of 2020, outpatient clinics and physical therapy as a practice will have to brace for big changes and a shift in providing a much needed resource.
As the San Francisco Bay Area rounds the corner past 80 days since the start of the shelter in place, people are anticipating a strategic re-opening across businesses and public spaces alike. Not only has the population grown more restless, but maintaining the motivation to continue any kind of exercise routine proves to be more challenging as each day passes.
Ida, the owner of an outpatient clinic in Pleasanton, voices her concerns as "eighty-percent of the patients chose not to come to PT, even some who will need surgical revisions because of waiting." Though those numbers and alternatives lend an inauspicious tone, she continues on an encouraging note, "The patients that needed to come have been very expressive of their gratitude. It’s been really nice to still be able to make a difference."
Her clinic, Physical Therapy Specialties, has seen a very diverse population of patients come and go over these past decades. Tall and lean, Ida has a light, nurturing presence that is hard to ignore especially in conversation when she gives you her full attention. She recounts her path to physical therapy as a career as "not a glamorous" story. She describes the practice as a way of using "natural simple things" to make a large difference, which is in-line with her humble disposition.
Surveys from last year indicate that the top few patient populations seen in outpatient PT/OT clinics include adult orthopedics, geriatrics (wellness and fall prevention), geriatrics (dementia and neurocognitive decline), and adult/adolescent sports medicine. This breakdown lends insight to the eighty-percent decline that Ida highlights in our conversation--individuals are canceling or postponing visits due to evaluated risks or necessity.
It would be undermining to say that physical (and occupational) therapy is non-essential. Restoring and improving movement and mobility allow people to lead dynamic, independent, empowered lives.
Clinics like Physical Therapy Specialties continue to operate during this global pandemic as they recognize that helping those with debilitating pain, or need help with balancing and mobility, has benefits that outweigh the risks. The APTA sent notice with safety measures to be taken immediately by practicing therapists as early as March. Preventative and cautionary measures can be diligently implemented, given the resources and adherence by staff, and can create a comforting safe place for individuals.
Still, even a clinic that can offer quality care and a more eclectic range of treatment and modalities, like Physical Therapy Specialties’ aquatherapy using an indoor pool, will not be able to smooth the drastic decline in scheduled visits. The report last year highlights that eighty-percent of outpatient visits were scheduled by referral from physicians, and a whopping third from hospital referrals. The majority of patient visits are not special cases, but orthopedic and geriatric, and require restoring function to the musculoskeletal system. Simply put, many of these cases that don't require fancy equipment aim to teach people to move in a way that promotes long term health.
The "natural simple things" Ida mentions includes exercises and teaching proper or better ways to move--which is something that can be done remotely now, too. The future of healthcare and physical health may look drastically different and take place outside a gym or clinic. The shift for some practices is to utilize telehealth. Insurance policies such as that of Aetna, United Health, Humana, and Cigna Health are quickly noticing the need to shift accessibility by including telehealth in some benefit packages.
Telehealth implies taking over the digital space, utilizing apps, visual tools, and other modalities to provide continued care towards better health. A program that allows a therapist to virtually meet, speak with, and grant analytical tools to assess function and mobility, might just be the progress needed to keep those on-track with their healing processes and keep outpatient clinics afloat.
The CDC remains that the populations at highest risk include "older adults and people of any age who have serious underlying medical conditions", which are likely those included in the greater half of outpatient populations. Reaching these individuals, more readily assessing and treating by means of telehealth can keep businesses afloat while simultaneously improving lives in the safest way possible.
With over seventy-percent of patient attrition rates explained by insurance limits and denial, new insurance policies that include telehealth can also provide relief in more affordable options even when storefronts reopen and life begins to look more like the recognizable former "normal".
This shift will likely face some resistance from both therapists and patients. As Ida points out, "manual therapy is such a large portion of what we provide as physical therapists and there is really no substitute". (She's right.) Her passion for helping people live more empowered, pain free, lives is apparent. Using telehealth, patients eager to be properly assessed and communicate their needs and expectations will face a seemingly less intimate, elaborate interaction. Some may find it an added challenge to learn the systems of an app/program in addition to establishing a schedule, and receiving information and instruction from their therapist regarding their treatment plan. Programs such as Total Motion Release will continue delivering a broad range of content to present a solution to mitigate concerns with user-friendly material as well as support for therapists from different practices alike, but the resistance to a shift in treatment methods can prove to be a high hurdle. Until then, we can look to continue to provide a safe treatment environment and do our best in bringing education and accessible means for people to keep moving and prioritize their overall health.
There will certainly need to be accessible, inventive, and effective tools to bring physical therapy practices into people's homes safely. It will rest on those behind the practice to show the benefits of these new tools, and those being treated to be open-minded to an evolution in the delivery of movement-based health. Other factors to evaluate may be the ability to schedule more frequent virtual visits, enabling greater levels of accountability, and possibly achieving better results with lower attrition rates.
Being able to deliver results implementing a plan of care through an easy-to-use digital program may not be the solution for every case, but it might bridge the gap between these unexpected trying times.
Some helpful online resources:
I am not paid to endorse any online site.
Please be advised to seek medical advice from your doctor/practitioner if you are experiencing pain or discomfort, and proceed in self guided practices with caution.
Sources:
Office of Public Affairs, "State Officials Announce Latest COVID-19 Facts," May 22, 2020.
Ida Hirst, Interview, May 23, 2020.
"Groups at Higher Risk for Severe Illness", Coronavirus Disease 2019 (COVID-19), CDC, last reviewed May 14, 2020.
Rafael E. Salazar II, "2019 Survey Results: Outpatient PT & OT Clinicians & Clinic Owners", Nov. 5, 2019.
Written by:
Judith Wang
Founder, Project Green Beard
UCSC Banana Slug