Mohamed Abdelrahman, MS, DPT, MBA Health Strategist and Doctor Of Physical Therapy, Visiting Nurse Service of New York
Current Physical Therapy practice relies on visual observation coupled with hands-on practices for diagnosis, assessment, and follow-up treatment. Resistance to change and slow clinical acceptance of a largerrole oftechnology in the rehabilitation industry is still the status quo. This article is not intended as an exhaustive list ofwhat is needed to empowertechnology in the Physical Therapy profession,but is rather a thoughtframework to guide a dynamic discussion on more meaningful use of technology in the rehabilitation field. Toinitiate wider adoption of advanced technology in the rehabilitation industry we need to introduce four technologies which,if used as one system, would lead to a better automation model toimprove outcomes. These four technologies are outlined below.
Motion capture and tracking interfaces
Motion capture and tracking interfaces record movements of objects or people and translates the recording into actionable data. The technology thus providesquantitative physiological measures to support physical evaluations andtreatments, and to improve the personalization of Physical therapy interventions. Motion capture and tracking interfaces would play a pivotal role in any Physical Therapy automation model by analyzing functional movements, measuringranges of motion, and allowing follow-up on objective measurements of function.
Virtual Reality (VR) is the use of computer technology to create a simulated environment. Instead of viewing a screen in front of them, patients are immersed in 3D worlds with which they interact. By simulating as many senses as possible, such as vision, hearing, touch, even smell, the computer is transformed into a gatekeeper to this artificial world. Motion tracking systems are commonly used in virtual reality-based interventions to detect movements in the real world and transfer them to the virtual environment.
Oxford’s telemedicine definition is “the remote diagnosis and treatment of patients by means of telecommunications technology.” Using Tele-health in the rehabilitation industry encompasses the delivery and facilitation of rehabilitation-related services, including physical exam, patient education, physical treatments, and self-care via telecommunications and digital communication technologies. Live videoconferencing andmobile health appsare examples of technologies used in Tele-Rehabilitation.
Artificial intelligence (AI) is an area of computer science that emphasizes the creation of intelligent machines that work and react like humans. In the rehabilitation industry AI could be used to analyze data sets for patterns and arrive at recommendations for therapists. AI would thussupport decision making in evaluation and treatment processes.
Where are we now?
Generally, there is small-scale adoption of the aforementioned technologies for rehabilitation in large health systems, teaching hospitals, and research laboratories; and no adoption yet in smaller hospitals, small practices, or community health centers. There is limited use of virtual reality and/or motion capture interfaces in research centers and teaching hospitals. We can find Tele-health capabilities coupled with virtual reality in some assisted living facilities, home health agencies, and skilled nursing facilities. A fully integrated automation model including the four technologies as one solution, has not yet been launched.
What are the obstacles against large-scale adoption?
There are safety concerns regarding technologies,for instance for motion capture systems that have wires likely to cause falls and subsequent injuries among elderly and cognitively impaired patients. There is also the concern withinprofessional communities thatembracing technologies and,consequently, automation, may result in cuttingback on services and reducing the “personal touch,"thus compromisingpatient care. Major payers including Medicare, Medicaid, and private insurance do notprovide a comprehensive payment model to reimburse care provided through these technological means.
How could partial automation create value?
According to the American Physical Therapy Association, an attrition rate of 3.5% projects a shortage of 26,560 physical therapists by 2025. The automation plan would bridge this gap and compensate for the shortage of physical therapists. Partial automation would improve accessibility to high-quality services and highly trained physical therapists, especially for health systems that face difficultyoperatinglarger numbers ofcenters or hiringqualified therapists.
An Integrated Partial Automation Model (IPAM) for rehabilitation
We can imagine a health system with two or three main campuses and some satellite locations serving a large geographical footprint.About 50% of the population servedwould be in rural areas and remote communities. These patients would have difficulty accessing rehabilitation services, especially highly specialized ones. Due to scarce human and financial resources, this health system would be challenged in deploying more satellite locations for rehabilitation services to cover the whole region. This is where the proposed Integrated Partial Automation Model (IPAM) for rehabilitation comes into play. This model’s structure would include a main central rehabilitation office that employs highly trained and specialized Therapists. The Therapists would see patients face-to-face on intaketo conduct a comprehensive evaluation and set up a plan of care. After the initial visit, the Physical Therapist would follow up with the patients remotely using motion capture and tracking technology on movement patterns. Subsequently, the Therapist could create a customized virtual treatment environment and deliver feedback and instructions through Tele-health.
"The assessment and treatment processes can partially be automated to improve patients’ engagement andcare accessibility, and to improve quality of care."
The patient would receive the follow-up treatments and reassessments at home or in some cases at small offices within his or her proximity. These small follow-up offices would be low-cost operations deployed throughout communities that employ only one Physical Therapist Assistant (PTA) responsible for monitoring the system andfollowing up on the instructions of the central office’s Physical Therapist. After widespread adoption of this system, AI technology would be integrated to analyze the data and provide the therapist with precise and cost-effective recommendationsfor intervention.
Of course, a pilot program is needed to examine this model for better understanding and any needed enhancements. In preparing the field for innovation in the rehabilitation industry, messages are intended for different stakeholders. For the American Physical Therapy Association (APTA),establishing a separate section for Clinical Innovation would allow for a more proactive role in the innovation of the Physical Therapy profession. For physical therapy education Leaders, dual degrees combining DPT/MS in Information Technology and other computer sciences, would supply the job market with a generation of PT professionals equippedto lead the innovation revolution. For Health System leaders, large-scale investment in Physical Therapy Innovation would be beneficial. Collaboration with, and investment in,start-ups with new ideas is instrumental to reaping the benefits of the technology for more effective care delivery. Lastly, for CMS and health insurance leaders, there is an opportunity to work with professional associations and health systems to pilot reimbursement models designed for embracing technologies to save costs and improve quality.