(Part 2: Adherence to physical therapy keeps the painkillers away)
By: Roni Mansur and Hollan Oliver, DPT, OCS, SCS
Over 18,000 Americans die every year due to opioid addiction1.
In Part 1: Coordinated Care Delivered by Clinicians and Physical Therapists, we discussed the factors that have contributed to this crisis and the first step in a multi-pronged approach to address the issue. In particular, we proposed establishing closer ties between clinicians and PTs to deliver coordinated care to patients who could be treated for their condition (e.g. lower back pain, hip or knee osteoarthritis, and fibromyalgia) by physical therapy instead of painkillers.
In this blog, we discuss two additional components of the solution – adherence and data visibility.
Roland Lavallee is incredibly dedicated and committed to his health. He’s a professionally sponsored elite runner, but even a 4:11 minute mile couldn’t save him from a physical therapy office. Roland has been in and out of physical therapy for right knee pain dating back to his micro-fracture surgery in 2012. In 2015, he learned of an osteochondral defect that threatened to keep him out of running, even in a recreational capacity. Roland went through a SFMA movement assessment with sports and orthopedic specialist Hollan Oliver, DPT, OCS, SCS and has been diligent about addressing mobility, strength, and motor control deficits throughout his entire body. Months later, he ran 10 miles for the first time without pain.
Hollan had the opportunity to sit down with Roland and ask him about this experience in physical therapy. What she heard loud and clear, “physical therapy is hard.” As a high school science teacher and track coach, Roland admitted that life often gets in the way of accomplishing your goals. “If you want to be successful in physical therapy, you have to treat it like it’s a second job. You have to take a step back and realize that the small steps, the little progress that you make every week, translates into long strides – but until you take a step back, you can feel incredibly discouraged day after day. Sometimes the progress is slow and it’s hard to stay motivated.”
Adherence is the key to breaking the cycle
A large portion of behavioral change is recognizing vicious cycles. Opioid addiction and over-prescription of painkillers are two elements of the same vicious cycle that is receiving national media attention. Recent guidelines from the Centers for Disease Control and Prevention (CDC) indicate that physical therapy can provide an effective solution for treating many chronic pain conditions2.
However, patients have to adhere to the treatment plan to achieve the benefits of physical therapy. If not, their condition will likely regress, which leads them down the dark path of painkillers and opioids.
Adherence is not easy, as described by Roland Lavallee in our case study. Research estimates that physical therapy adherence rates are as low as 35%3 and that 90% of the information you give patients to educate them on their condition is forgotten. The combination of home exercise programs given on outdated paper printouts yields low adherence rates, slow progress toward patient goals, declining motivation to continue with therapy, missed appointments, and in far too many cases premature discharge and poor outcomes. Consequently, physical therapy clinics lose thousands of dollars in annual revenue.
Using technology to promote adherence
Used correctly, technology can strengthen the relationship between clinicians and their patients to produce better outcomes.
The vast majority of physical therapy patients are not engaged with or accountable for their recovery. Despite being 2016, physical therapists continue to prescribe home exercise programs on archaic paper printouts. Patients forget how to perform the exercises, misplace or lose these printouts, and ultimately waste the days between their follow up appointments, which leads to slow recovery times and poor adherence.
The structure of our current healthcare system leaves patients vulnerable for failure. Physical therapy in particular is lacking in technology that can assist patients with the rehabilitation process. With significant healthcare reform, it’s never been more important for patients to be empowered, accountable, and engaged in their plan of care. The alternative to curing a patient’s injury with interventions such as skilled manual therapy, dry needling, spinal manipulation, aquatic therapy, and therapeutic exercise is to resort to painkillers.
Smart phone technology is ubiquitous and the level of consumer engagement that has been achieved in the past few years is nothing short of phenomenal. The combination of technological advancement with continued healthcare reform has created an inception point where physical therapists can implement software necessary to promote patient engagement and program adherence. Jumping on this bandwagon as a profession is a no-brainer as new data emerges on the efficacy of such technology. In fact, 100% of patients participating in a university-sponsored focus group reported that they preferred using the patient engagement mobile app compared to paper printouts.
Technology enables data visibility – the final piece of the puzzle
Physicians and physical therapists can best treat their patients when they have access to patient reported data.
This data visibility can easily be achieved through the use of the right types of technology that can engage patients, easily collect the most critical pieces of information that are important to track and provide real-time reporting capabilities to physicians and physical therapists. This allows them to monitor progress and adjust the treatment plan as appropriate.
It further promotes engagement between the patient and their healthcare providers and fosters a level of trust that is needed to help patients get healthier without resorting to painkillers or more acute treatments.
At Healigo, we believe we have the solution to help physicians and physical therapists break the cycle of dependence on opioids. Healigo is a technology platform that promotes patient adherence by providing 24/7 access to their mobile are plan, friendly exercise reminders and simple progress tracking to drive patient engagement. Healigo allows physical therapists and physicians to monitor clinically-meaningful data from their patients, and modify a patient’s plan of care if necessary, to promote success. The platform also boosts communication between patients and their physical therapists.
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About The Author
Roni Mansur is a health care executive focused on health care strategy, operations, technology, business development and product / program implementation, with interest and experience in disruptive business models and complex enterprise transformations.
- Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA
- Center for Disease Control and Prevention. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016.
- Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy. 2010;15(3-2):220-228. doi:10.1016/j.math.2009.12.004.