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PHYSIOOUTCOMES IS A TECHNOLOGY PLATFORM THAT ENGAGES YOU IN PREVENTING MUSCULOSKELETAL INJURIES, AND IF YOU SUSTAIN AN INJURY, FACILITATES YOUR ACTIVE INVOLVEMENT IN THE RECOVERY PROCESS.

THIS STRATEGY INCLUDES ACCESS TO OUR eREHAB PLATFORM TO HELP ENGAGE YOU DAILY FROM INJURY TO YOUR RECOVERY. WE HAVE PHYSIOOUTCOMES PATHWAYS FOR ALMOST EVERY ORTHOPEDIC PROBLEM.

BY OFFERING RESOURCES FOR BOTH PREVENTING AND RECOVERING FROM INJURIES, PHYSIOOUTCOMES ALLOWS YOU TO PARTICIPATE IN YOUR CARE WHICH HELPS YOU RETURN TO WORK, SPORTS AND NORMAL LIFE SOONER.

Prospective multiple case study analysis

Presented at The 2014 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in New Orleans, Louisiana

Internet Enhanced, Patient-Centered Orthopedic Care:

A Prospective, Randomized, Controlled Pilot Trial‍ ‍

Jonathan Paul, MD ,Kasey Rolfes, DHA, MS, ATC-L,Bryan Herron, MD

Charlotte Sports Medicine Institute, Charlotte, NC and Advanced Orthopaedic Specialists, Prince Frederick, MD

Presented at The 2015 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in Nevada, Las Vegas

Abstract

Objective: We have developed a patient-centered web portal that utilizes streaming, clinician prescribed video instruction to motivate and inform patients in self-care of their orthopedic condition, focusing on the importance of a home exercise program. The objective of this study is to compare this web portal (eRehab) to formal outpatient physical therapy (PT) in terms of patient costs and outcomes. Our hypothesis is that in certain patient populations, eRehab will yield similar clinical outcomes to PT and provide significant financial savings to the healthcare system.

Study Design: This is a multicenter, prospective, randomized controlled pilot trial.

Setting: Private practice orthopedic surgery clinics.

Patients: Twenty patients with an initial pain score less than 6 who were diagnosed by a board certified orthopedic sports medicine surgeon who were candidates for a knee or shoulder orthopedic outpatient physical therapy referral. Seventeen patients completed the study.

Interventions: Patients were randomized to a six-week treatment course of either standard PT or eRehab.

Main Outcome Measures:Patients were evaluated for outcome scores (Dash or Reverse KOOS), pain NRS-11 scores, patient subjective outcomes, and cost of treatment for the current episode of care.

Results: At the six-week follow-up evaluation, only the eRehab group achieved a statistically significant improvement in both pain scores (2.9 v .9, p = .02)

and outcome scores (25.1 v 12.6, p <. 02).

Patients who were candidates for an outpatient physical therapy referral who instead were treated with an eRehab treatment plan had a significant reduction in total cost of care per episode ($214 v $705, p < .001)

and patient cost per episode ($65 v $172, p < .04).

Conclusions: The outcomes of this pilot study suggest that Internet-based home exercise programs may be a viable option to standard physical therapy for knee and shoulder patients with a pain score less than 6.

A Prospective multiple case study analysis

Jonathan Paul, MD ,Kasey Rolfes, DHA, MS, ATC-L,Bryan Herron, MD

Charlotte Sports Medicine Institute, Charlotte, NC and Advanced Orthopaedic Specialists, Prince Frederick, MD

Presented at The 2014 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in New Orleans, Louisiana

Initially, to evaluate patient interaction with WebHSR rather than to make comparisons with clinical physical therapy, we reviewed the first 10 cases randomized to the eRehab intervention. Cases were examined individually through program views, exercise logs, survey and questionnaire results, and outcomes based on patient reports and physician evaluation notes. The results of the individual analyses were collectively summarized and reviewed for trends. Results of qualitative data interpretation were verified by a separate review and analysis by an academic medical professional not affiliated with the study

Each individual patients utilization of the platform is listed below followed by Table 1 which lists demographics, web portal utilization and outcome scores for the first 10 patients randomized to the eRehab group.

Individual Patient Data:

Patient A

Patient A had a history of having an active lifestyle throughout her life, from previously playing collegiate volleyball to currently running for a duration of forty-five minutes three to five times a week. She logged on 3 times to her WebHSR eRehab prescription and reported performing a HEP 21 times over the 6-week study period At the 6-week follow-up this patient commented “It was very convenient to be able to perform the prescribed exercises from home”.

Patient B

Patient B was a 39 yo Morbidly Obese Female 5 months post meniscectomy with medial OA. Her sharp pain had improved post op but she still experienced OA pain and was “Somewhat Satisfied” with her care at her orthopedist’s office using a Likert type scale questionnaire. This patient did not view the videos in the office and logged on 3 times at home and reported doing a HEP 16 times:. At 6-week follow-up, when asked the same question: Overall, please describe your satisfaction in your evaluation and treatment of your condition at your orthopedist’s office. (Likert scale) Her response was “Satisfied” (improved from “Somewhat Satisfied” at baseline) and she reported “90% improvement, seeing a lot of improvement with exercises “

Patient C

Patient C was a 19 yo F with patellar malalignment who viewed the videos in the office and although on the inclusion questionnaire reported having Internet access at home, she actually did not and was unable to view the videos at home. She returned to the office at the 3-week post initial evaluation for a cortisone shot and to watch the videos a second time. She worsened and because of limited access to formal physical therapy secondary to Medicaid insurance, elected to proceed with knee arthroscopy.

Patient D

Patient D was a 66 F with Rotator Cuff Disease with Pain level 5 and DASH 13.3 who did not watch the videos in office. She never filled out her emailed exercise log but logged on the view her videos 9 times so it was assumed she was doing a HEP. Her 6-week f/u DASH improved to 5.5 but did not record a follow-up pain score.

Patient E

Patient E was a 57 yo male with bilateral glenohumeral arthritis, Sjogren’s disease and rotator cuff disease with no prior physical therapy for his longstanding condition. He watched the videos in the office at the start of the study period, never logged on at home but did his HEP daily (36 times). It was confirmed with the patient’s wife (who also was a patient in the office) that the patient was doing his HEP daily. This patient never came in for his 6-week follow-up visit and when asked why he chose to not to return for follow-up care, he answered: “as long as I do my exercises, I have no pain”. When asked why he never logged on at home, he attributed viewing the videos in the office and leaving the office with a printed list of exercises with sets, reps and hold time to be sufficient to motivate and instruct him to do a HEP.

Patient F

Patient F was a 22 yo male college student and avid runner with ITB Syndrome. He watched the videos in the office at the start of the study period, never logged on at home but did his HEP “regularly”. This patient also never followed-up for his 6-week visit. Using a telephone follow-up, the patient stated he did not follow-up because of his improved outcome and reported a pain score of 1.5 (improved from 3.5).

Patient G

Patient G was a 58 yo female with a rotator cuff tear and baseline pain level of 8. She reported having Internet access at home but never logged on to view her videos. On a follow-up visit, the patient’s daughter reported that the patient actually did not currently have access to the Internet at home. She returned with increased pain at 6-week follow-up, was sent to formal physical therapy where her condition also worsened and she elected to proceed with surgery.

Patient H

Patient H is a 37 yo female who entered the study with level 3 pain who logged onto the website 11 times and reported doing a HEP at least 17 times over the 6-week study period. At 6-week follow-up, her pain score improved to level 1.

Patient I

Patient I withdrew within the first week and was not considered for analysis, citing that she felt she was “not a candidate.” This patient never viewed any of the videos at any time either in the office or at home.

Patient J

Patient J withdrew from the study at four weeks elected to begin formal PT. Reasons cited for this decision included she does “not regularly exercise” “not suddenly running to do these exercises without supervision and changing (her) life pattern” and the “the emails were too easy to ignore” and she wanted to use “cool equipment”. This patient , like patient I, never viewed any of the videos at any time either in the office or at home

dATA FROM Physiooutcomes -rETROSPECTIVE sTUDY

To get an initial assessment of patient utilization of PhysioOutcomes, we performed a retrospective review of 289 consecutive eRehab prescriptions from a single orthopedic clinic. Most patients viewed the patient education videos in the office and all were prescribed an eRehab prescription allowing them the opportunity to log on at home for free to watch the videos as many times as they needed to gain an understanding of their condition and how to do their exercises properly. All major orthopedic conditions and body parts were included in this retrospective review. ANOVA and independent Student’s t-test were applied to the data to compare patient demographics with the number of eRehab logons and website utilization.

One hundred and seventy-one patients viewed their prescription at home at least once for an overall patient home view rate of 60%. There were 1.31 home views per patient (range 0 - 26). For the 171 patients who viewed their prescription at home at least once, the average number of home views was 2.22. There was no correlation between patient age (Figure 1), sex or type of health insurance with utilization of the web portal.

Figure 2

A similar trend (Figure 3) was seen for the number of outpatient PT visits for the current diagnosis.

A statistically significant reduction in mean number of orthopedic follow-up visits for the current patient’s current diagnosis (Figure 2) was seen between patients who viewed the videos three or more times at home (1.8 follow-up visits) compared to patients that never viewed the videos at home (4.2 follow-up visits) (p<. 05, Student t-test).

Figure 3

pilot study at Group Health Cooperative

Seattle, WA

We performed a pilot study at Group Health Cooperative in Seattle, WA.

Seven primary care, sports medicine fellowship trained MDs and 1 sports medicine fellowship trained orthopedic surgeon prescribed PhysioOutcomes eRehab to 178 non-operative, patients.

An 80% patient view rate of the exercise and patient education videos was achieved with no adverse encounters.