"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, September 20, 2011

Physical Therapist Innovators Can Impact Population Health

My post yesterday had a fascinating video from TED about the origin of new ideas.

Ideas are often thought of as "Eureka!" moments but Steven Johnson describes a "network" of ideas that are resident within a group of like minded-individuals that "fade into view" over time until the value of the idea becomes evident to everyone paying attention. This "bubbling up" process is described as innovation but the innovative process depends on the network, not just the brilliance or the insight of one person.

One innovative approach to health that is becoming more and more obvious is the wellness approach to population health. Population health will be important to anyone trying to understand what the future of outpatient physical therapy practice will look like.

Engaging Populations Through Total Health Management from Healthways, Inc. describes some of the biggest cost drivers in treating chronic conditions, like painful musculoskeletal conditions. These drivers are patient self-reported measures like...
  • "Am I thriving in my current situation?"
  • "Am I struggling in my life to just get by?"
  • "Am I suffering in my life?"
People who were suffering spent 50% more on medical services than people who were thriving.

If physical therapists could identify "sufferers" early in the course of rehabilitation perhaps we could help direct appropriate care to alleviate their suffering.

Physical therapists are currently challenged to remain relevant in the changing US healthcare system and understanding how to impact population health seems important for our future.


  1. The last two clinical guidelines I read by the orthopedic section (neck and low back) indicated risk factors for chronic pain with these conditions was psychological distress and depression.
    After attending the Future of PT Symposium in Atlanta, I believe identification of "sufferers" early in the course of treatment is critical to reduce readmissions, save the system money, and keep PTs relevant in the changing US healthcare system.

  2. Thanks for your comment, Craig.

    I wish I'd been at the Future of PT Symposium in Atlanta.

    What else did the presenters discuss at the symposium?


  3. The presentation I enjoyed the most was by Anthony Delitto. He described the use of clinical decision rules with low back pain, how it demonstrated savings, and led to improved intereactions with by third party payers (less paperwork). The main point I took from him was that the relevancy of PTs in the changing healthcare system will be determined by our ability to save money for the system. If we can do that, we can make more money, even if the 'pie' is smaller.
    The other presenters, like Steven Wolf, talked about the necessity to grow our profession by teaching and incorporating new technologies and collaborations with other 'non-healthcare' professionals (engineers, computer scientists, ect.).
    As a student, it was a great experience. When I presented some work at the ASB conference, one of the speakers spoke about using light and gene therapy to control spasticity. It just made me think the better we incorporate the developing technology and demonstrate value for the system, the more PTs will be asked to come to the table for important legislation discussion.

  4. I saw Dr. Delitto's presentation online - he used the graduate thesis by JC McGee who studied adherence to therapy protocols.

    Therapists who went "off protocol" ended up costing the patient and the payer more money.

    Protocols threaten physical therapists by "taking away my autonomy".

    I believe that physical therapists will need strong, validated protocols to impact population health.

    I still believe that outcomes, not just costs, will improve if physical therapists get involved in a wellness model.


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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

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Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

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