The Future of Hand Therapy Lies Within Quantifying Patient Progress

In the field of hand therapy, a patient's ability and progress has to be communicated to a variety of involved parties: the physician needs the information to design and complete a therapy regimen; properly educating the patient ensures that they come to and fully participate in the therapy; and the payer needs to be convinced that the care was necessary and effective. Objective data serves as the backbone of the clinical assessment, impacting each of these areas. Mike Cricchio, MBA, OTR/L, CHT, and founder of the Teton Hand and Upper Extremity Conference, says that therapists are always trying to make data as objective as possible.

"When data is objective and repeatable it can be accurately and easily compared," says Cricchio. "From one visit to the next, we are able to compare the data side-by-side and show exactly how much change has or has not taken place. The tests also become repeatable from person to person, allowing for comparison between multiple testers and multiple patients.

Cricchio stresses the ability to objectively quantify change from visit to visit and being able to communicate this change through visuals as a key to patient retention and therefore better care.

"It's a challenge to communicate to a patient their own ability, and any positive or negative changes to that ability, because they are living with it every day" says Cricchio. "If we can show the patient objective data that allows them to visualize their progress from one visit to the next, we instill in that patient a confidence in us as a provider, the treatment plan, and the need for further therapy."

Communicating a patient's ability and treatment plan using objective data can be used from day one. Cricchio says that they ideally collect objective data for every patient during the initial visit, and then set intervals for further objective testing, depending on the patient's diagnoses.

"Patients who are educated about their ability and treatment plan at the first visit are more likely to return and successfully complete a therapy program. Patients who have limited education are likely to cancel or no-show for their appointments—and those patients with limited education who do come to therapy are not likely to do as well as patients with a good understanding of their ability, therapy program, and progress."

As an example, Cricchio describes a patient who needs rotator cuff strengthening. The patient has received a diagnosis they think they can live with, so rehab is not high on their priorities.

"If we perform objective functional tests on the patient, print out a report, and show them the difference in strength between their left and right side, they are able to appreciate their deficit, and are more likely to participate in and benefit from rehab."

When it comes to strength tests, real-time force curves are a critical component of the therapist's objective data toolkit. By measuring the patient's ability over time, the therapist can gain insight into any cognitive overload, and gain a greater view of the patient's overall functional ability.

"The ability to view a patient's peak performance over an extended period of time opens up a window into pain," says Cricchio. "The force curve provides a more detailed view of the patient's functional basis versus a single static value. For instance, a patient may be able to peak at 80 lbs. for one second, but if they attempt to sustain the action, their ability drops to 30 lbs. This information gives great insight into a patient's endurance and fatigue, and is particularly important when determining impairments or maximum medical improvement."

Cricchio believes any clinic could benefit from adding objective functional technology by saving time, increasing reimbursements, and providing solid evidence for further care.

"The first benefit comes from getting objective data on a printable report," says Cricchio. "It saves the therapist the time it takes to write up each report by hand, and you can bill directly with this report. Management likes it because it is highly reimbursable, and therapists like it because it is meaningful data. If I say I need five more visits, the report provides a compelling argument to back that up."

But there are barriers to incorporating this technology. Older clinics may be reluctant to change the way they practice, or it may be daunting or difficult to incorporate new software into existing Electronic Medical Record (EMR) systems, a barrier that Cricchio says may more frequently arise with larger organizations.

"The younger generation of therapists is tech savvy, but they aren't being introduced to this type of equipment," says Cricchio. "The students that come through my clinic are all trained how to use objective functional equipment, and they ask why they haven't ever seen this technology before, and why it isn't in any other clinics."

As he looks to the future, Cricchio sees hand therapists being required to do more with less. The demands will increase, while the level of care will be expected to remain at peak levels.

"We will be working in environments that expect more out of hand therapists with more efficiency," says Cricchio. "We'll be expected to treat more patients, over a shorter amount of time, with better or the same results. The way that we measure objective data will help us to increase and justify each visit. Without objective data, we ensure a decrease in the quantity and quality of those visits."

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