Functional rehabilitation represents a revolution in our industry. Transcending traditional boundaries in physical therapy and occupational therapy, it is a comprehensive approach to recovery. With its focus on restoring daily activities and independence, functional rehab engages the body as well as the mind.

That’s where functional rehabilitation has an edge over other philosophies – its psychological impact. In a world where mental health is gaining increasing recognition, understanding the psychological aspect of recovery is more important than ever.

In this article, we’ll discuss the psychological impact of functional rehabilitation. You’ll learn why I consider the patient’s first failure a major milestone, how your relationships influence clinical outcomes, and the impact of visualization. We’ll also cover why and how to document progress objectively with innovative tools to help you do so. Finally, an exploration of functional rehabilitation in three important clinical settings: workers’ compensation, neurologic conditions, and geriatric care. Let’s dive in!

History of Functional Rehabilitation

The rudimentary beginnings of rehabilitation appear in texts from Greek, Roman, and ancient Chinese cultures.¹ The first inkling of functional rehabilitation comes from the 18th-century text Medical and Surgical Gymnastics.¹ This text describes the benefit of movement for patients recovering from neurological incidents such as strokes.

R. Tait McKenzie developed rehabilitation practices further. He was a physical educator, Physician, Physical Therapist, and author of Reclaiming the Maimed: A Handbook of Physical Therapy.² This handbook describes specific ways to improve function and was the official reference for hospital rehabilitation for Americans, Canadians, and the British during WWI.²

Functional rehabilitation became more distinct during the occupational therapy movement in the early 1900s.³ Stemming from the mental health sector, early OTs assisted sanitorium patients with industrial work tasks throughout the day. This structure provided a sense of worth  for their patients.

In WWII, functional rehabilitation practices used by therapists were further recognized by the U.S. Military.² Wounded soldiers had such a marked increase in productivity after working with OTs that Canadian and British militaries both allowed therapists on the front lines.³ The value of functional rehabilitation in the healthcare space has only compounded from here.

What Makes Rehabilitation Functional?

Functional rehabilitation focuses on exercises and movements that directly translate to a functional skill. Instead of addressing specific muscle groups involved in the skill, the skill itself is the intervention.

Since WWII, functional rehab has gained popularity across the healthcare sector and is used almost daily by us therapists. Regardless of discipline, the functional component to these interventions allows rehabilitation progress to hold more weight, meaning, and purpose for patients.

Psychological Considerations During Treatment

As we all know, the road to recovery takes time, patience, and trust. Rehabilitation encompasses much more than just the physical restoration of muscles, joints, or neurological systems. In fact, physical rehabilitation is only half of the rehab journey. The psychological aspect carries just as much weight in the process of recovery.

A good level of self-efficacy is imperative to a successful rehab journey.⁴ Low self-efficacy can too easily lead to learned helplessness and lower motivation to do things independently. For many patients, psychological hurdles include the fear of pain, anxiety about reinjury, lack of trust in their body, fear of falling, and more. Even a temporary loss of an activity due to injury can lead to disappointment, anger, social isolation, and even .⁵

Once treatment begins, we can expect to see some patients regain their optimism. Their emotional state will likely fluctuate as they experience victories and setbacks during the course of treatment. In my experience, one milestone stands out as a significant learning experience for patients.

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The First Failure

As an OT on an inpatient rehabilitation spinal cord unit, I have witnessed firsthand the emotional rollercoaster of recovery. Recovering from life-altering injuries and relearning daily functions is nothing short of daunting. For the patient, every little action feels different. Body parts operate differently, and even sitting up in bed can feel like an out-of-body experience much of the time.

Relearning a skill that once came naturally is something you can’t comprehend until you’ve experienced it. The first time a patient fails at a skill can feel like a setback, but is actually a major milestone in my eyes. Most people don’t understand what it takes to relearn a skill until that first failure. This first failure essentially alters how they perceive their body and performance ability, which has huge emotional meaning.

That first failure often opens the floodgates to the grieving process, if it hasn’t started already. Grieving the decisions leading up to an activity that caused an injury, grieving the familiarity of a body that no longer exists in the same way, being in a body that is completely different functionally than what you once knew. It alters the perception and experience of the world and triggers a psychological process of patients redefining their role as a person in society again and taking back that autonomy with confidence and support.

While grieving isn’t a pleasant process, it’s necessary for patient success. Once this process starts flowing, the real work can happen and motivation kicks in. Joining patients in the journey of redefining how they want their life to be (with some new considerations like paralysis) is an emotional but invigorating process.

Therapeutic Alliance and Patient Perception

One of the most influential psychological aspects of treatment is your relationship with the patient. This relationship influences the patient’s belief in the efficacy of treatment, which has a real impact on their clinical outcomes.

Successful rehabilitation is defined by how the patient perceives the relevance of therapeutic outcomes.⁶ These outcomes are often concerning their everyday life or goals and are as unique as patients themselves.⁶ We learn while earning our degrees that our genuine interactions with patients are a huge influence on this perception.

Therapeutic alliance is a term that encompasses how we, as therapists, build rapport and a positive relationship with patients.⁷ This relationship has been found to directly correlate to patient engagement, satisfaction, and overall outcomes in a rehab setting.

We’ve seen it firsthand; good rapport is established between us and a patient which leads to the patient engaging more in interventions and sessions. This leads to that patient having more positive functional outcomes and in turn, being more satisfied with their program as a whole.

For example, let’s say a professional chef receives services to recover from a tendon repair surgery after a kitchen accident. Their OT establishes great rapport with the patient and pays attention to the importance of regaining those cooking tasks.

At a certain point in recovery, the OT creates a functional intervention plan, using a set of cooking pans of various weights and grip handles. Over time, working with these tools increases the patient’s grip strength, endurance, functional abilities, and confidence. The patient understands how their performance compares to before their injury. This helps them develop a strong sense of progress and belief in the treatment plan.

The positive physical and psychological results tend to carry over and augment each other. On the flipside, you’ve probably noticed that patients with the best mindset for recovery tend to see better results than those who are reluctant, disengaged, or non-compliant. This underlines the importance of your relationship with the client.

Visualization

One of the major tools of functional rehabilitation is visualization. When used in rehab, visualization is imagining a movement or combination of movements while practicing them. Physical and Occupational Therapists use visualization, especially in neurorehabilitation, to encourage patients attempting to restore a particular motor pattern.

The goal of visualization may include normalizing a functional reach pattern or balance skills such as weight shifting. It can also extend to orthopedic recoveries, such as restoring a more typical gait pattern after a hip replacement.

Other visualization techniques are a little more concrete and simulated, which can help with more niche-type tasks. This can also be helpful for us as therapists in seeing what may be firing and misfiring when a patient visualizes and attempts a task in order to address it better.

Measuring Outcomes in Functional Rehab

The psychological benefits of functional rehab aren’t limited to what you do in treatment sessions. You can also make a positive impact by providing concrete feedback on their progress. It’s not always easy to document patient progress, but doing so can provide strong motivation for your patients.

I’m constantly asked by patients “how am I doing?”, and I usually lead with “I don’t sugar coat this…” I’ve found that even if I give a plain-as-day answer, pointing out the progress, it can be hard for a patient to truly believe they’re making progress. Instead of my verbal affirmation, they respond best when I can provide some form of a visual measurement, like a score.

Providing numerical, objective measures is particularly helpful with clinician and patient perceptions of overall success.⁸ Concrete data shows that the hard work is paying off, helps with documentation, and can fine-tune future goals for each patient. It helps reinforce the connection between treatment exercises and the real-life payoff.

Objective reporting can help even the most difficult patients turn a corner. I’ve found that the patients that struggle most with believing they’re making progress are those that hope to get back to everything they used to do in under a month. These are the ones that benefit the most from objectively measuring functional rehab outcomes. Seeing their score or progress bars grow week by week provides much needed encouragement to keep going.

The Innovation of PrimusRS

The PrimusRS is an innovative piece of equipment that not only provides functional rehabilitation exercises, but documents and reports patient progress with objective data.

This device has a variety of attachments and features, from steering wheels to various handles and an entire database of functional activities programmed to accurately mimic the force, weight, resistance, and lines of pull for nearly any task. By simulating real-life functional activity, patients immediately understand how this device helps them get better, they quickly gain confidence in their tasks, and can improve their technique or mechanics to avoid future injury.

Progress With Objective Data

Value-based therapeutic service is a concept of healthcare that has waxed and waned since the days of Florence Nightingale. Often, therapists are caught between a rock and a hard place by providing accurately simulated and measurable tasks while maintaining productivity standards.

The PrimusRS system efficiently tracks incremental changes and produces graphic reports for each patient. The automated measurement provides concise method to document and report a patient’s progression, plateau, or regression in any particular exercise or task.

The PrimusRS helps bridge the gaps between producing measurable results, practical task function, and patient perception of benefit while being efficient for clinicians to set up and adjust during a session.

The Psychological Benefits of Functional Rehabilitation Across a Spectrum

The functional rehabilitation approach applies to work conditioning and hardening settings, such as with athletes, workers’ compensation claims, and those with neurological injuries.⁸ By definition, functional rehabilitation is the process of returning a patient to a performance level acceptable for a particular job or task after an injury.

Regardless of what task it’s concerning, simple or complex, functional rehabilitation is integrated into every rehabilitation journey to a degree. It helps motivate individuals to push through difficult humps in the road and serves as a concrete product of a patient’s hard work. Next, we’ll explore the psychological impact of functional rehabilitation in three common settings: work hardening / work conditioning, neurological rehabilitation, and geriatric care.

Work Hardening and Conditioning

Workers’ compensation claims are some of the most finicky that we deal with as clinicians. Often, these are overuse injuries, back injuries, shoulder injuries, etc., that affect a patient’s ability to satisfy a job demand. To return to work, the patient needs documentation that they can perform their duties effectively and safely.

Work hardening varies from work conditioning in subtle ways. Work hardening is a regimented process focused on returning an individual to work successfully. In contrast, work conditioning focuses on a worker’s longevity throughout their career.

Work hardening often includes directly simulated tasks and weights, especially for those in physical professions like construction, firefighters, and factory lines. Specific items such as boxes, lumber, ladders, poles, and tools are commonly integrated into sessions as real-life simulations. This simulation serves as a basis for objective documentation for the company to determine if the employee is fit to return to work.

Navigating rehabilitation in workers’ compensation is difficult enough. It can be even more difficult when battling with the potential of losing a job that’s considered part of your identity. Being able to have concrete, visible progress with familiar tasks can bring the process back down to earth. It gives patients something to hold on to and celebrate.

Neurological Injuries

Neurorehabilitation and neuroplasticity are some of the best representations of functional rehabilitation. One of the core principles of neuroplasticity is that salience matters, meaning the higher the meaning of activity or skill to the patient, the greater the incidence of skill mastery.⁸

Pair functional rehabilitation tasks with visualization techniques, and soon the gears start turning, motor patterns start to emerge in a more organized way, and the patient directly sees their hard work paying off.

With those experiencing lower motor neuron injury, the brain often remembers the motor pattern, but the body can’t execute it the way the brain is signaling. That’s when visualization can help.

For example, I’ll often have my spinal cord injury patients visualize a functional movement pattern, such as self-feeding, while providing hand-over-hand assistance to execute the pattern as accurately as possible. I’ll tend to pick a favorite food to visualize along with everything; you’d be amazed at how much more effort is put in to eat an imaginary chicken nugget than a piece of therapeutic putty.

For those with injuries to the brain that impact the signal generation itself, I often break down functional steps to a task and then attempt to combine them. I find that the full execution is where the most error and frustration can happen if the individual parts aren’t addressed first. I find this additionally helps with visualizing the complete movement. Sometimes the full motor pattern is too complex for a healing brain at first.

Geriatric Conditions, Including Dementia

Functional rehabilitation has a stark benefit for older adults, especially those experiencing dementia. Aside from working in a hospital, I’ve worked as the primary OT in a skilled nursing facility with memory care, long-term stay, and short-term rehab. Especially with my memory care and long-term rehab, patient refusal was high unless they perceived the task as functional and important.

I’ve found that older adults generally performs better with more concrete tasks than abstract visualization, so the closer the task can be simulated to the real thing, the better. This can extend further into tasks that have been most likely repeated throughout their life. That may look like wiping down the table, folding clothes, raking leaves, sweeping the floor, or tinkering.

In this setting, I had many patients that knew they weren’t leaving the facility, which is an adjustment in and of itself. In light of this, sometimes it was difficult for them to put in real effort in their sessions. I found that using objective measurements significantly helps give concrete meaning to our therapy time.

Make It Functional and Make It Matter

Functional rehabilitation matters to us as clinicians, it matters to the patient, and helps ground the rehabilitation process. Simulating real-life tasks leads to greater patient engagement and better patient outcomes as a whole. It gives a tangible answer to the question I’ve heard many times, “why are we doing this?”

The more a patient feels they are making progress, the more they’ll generally follow our recommendations. In difficult cases, objective data can help tremendously with providing proof of improvement, showing that the patient’s hard work isn’t for nothing.

It’s often time-consuming to simulate every task, job, or hobby from scratch that a patient might have to accomplish. But focusing on the most important tasks is very valuable and is easier with the help of technology. Equipment like the PrimusRS can simulate any real-life task, measure and report objective data, and keep patients motivated to continue treatment.

The psychological impact of functional rehabilitation reaches patients at a different level. Functional rehabilitation bridges a complex process to grounded outcomes and answers the “why” question with concrete results.  Paired with great therapists, patients are more engaged and see the benefits of therapy a little more clearly.

 

Mary Vieregge, OTR/L is an Occupational Therapist and freelance writer based in Eastern North Carolina. She has experience in a range of settings, from inpatient rehabilitation to long-term care, with a concentration in neurorehabilitation and spinal cord injury populations. Mary is passionate about patient education and innovative practices, is constantly searching for the latest and greatest to add to her clinical toolbox, and enjoys connecting over LinkedIn or UpWork.

The post The Psychological Impact of Functional Rehabilitation appeared first on BTE.

Managing a clinic requires a diverse skillset. Your clinical degree program prepared you well for a career as a practitioner, but learning to manage a clinic is another field entirely. Here we will cover seven pillars of success for clinic management in physical therapy and occupational therapy:

1. Staff management
   • Hiring new staff
   • Preventing burnout
2. Clinic management software
   • How to choose the right one for your clinic
   • Telehealth platforms
3. Evidence-based clinical technology
   • Expectations of today’s patients
   • Data-driven rehab: measuring, reporting, and tracking progress
   • Elevate your evaluations and treatment with objective tools
4. Clinic marketing
   • Building a marketing strategy that works
5. Patient engagement
   • Improving patient engagement in five steps
6. Billing and reimbursement
   • Overview of reimbursement process
   • Documentation
   • CPT codes and reimbursement
   • Challenges and denied claims
7. Regulatory and compliance
   • HIPAA and privacy
   • Medicare and Medicaid compliance
   • Private insurance regulations
   • State licensing

1. Staff Management

Your staff are your clinic’s backbone. Having a motivated, cohesive team helps your clinic succeed. From hiring the right clinicians to promoting workplace wellness and preventing burnout, a well-developed staff management strategy is essential to your clinic management overall.

Hiring New Staff

For both Occupational Therapists and Physical Therapists, the average clinician stays at their job for just one to two years (43% of OTs, and 31% of PTs). The second largest tenure category is less than one year, for 19% of OTs and 28% of PTs.¹ With this relatively high turnover rate, you must be ready to hire new clinical staff with minimal downtime.

Whether you’re replacing due to turnover or expanding your clinic, bringing on new staff is an exciting time. To help you find the right fit, check out this article: Five Interview Questions for New Candidates. Once you’ve hired the new member of your team, help them get acquainted with your current staff and feel welcome in your clinic. Holding regular one-on-ones with them will help you track their progress and gives them the opportunity to ask for help when needed. Plus, you may find a newcomer’s perspective very helpful in identifying areas of improvement for your clinic.

Preventing Burnout

On the other end of the spectrum is preventing employee burnout. Burnout is a major concern for staff Occupational Therapists and Physical Therapists, as the bar for today’s productivity demands is generally set high. This can be dangerous, as often, burnout results in decreased productivity, low job satisfaction, and turnover. Here are four ways to mitigate burnout by promoting a healthy work environment in your clinic:

• Manage workloads – Ensure that workloads are reasonable. To maximize productivity, it can be tempting to load up your staff with as many patients as possible. But chronic overscheduling leads to overburdened staff who will seek a more manageable work environment elsewhere.
• Time off and breaks – Encourage staff to use their time off and vacation time. Time away from work is essential for mental and physical health.
• Mental health support – Be attentive to signs of stress or disengagement and provide a safe space for discussing these issues and finding solutions.
• Recognition – Regularly recognize and reward your staff’s hard work. Simple verbal appreciation, bonus programs, or professional development opportunities can go a long way in boosting morale.

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2. Clinic Management Software

Clinic management software helps your practice run smoothly and efficiently. The right software will streamline your appointment scheduling, billing, patient records, and much more. With so many clinic management software options on the market, it can be hard to evaluate all the options. Here we’ll cover a few key criteria to guide your decision process and find the right clinic management software for you:

• Your clinic’s needs, including patient volume, specialty services, staff size, and integration with existing EHR or billing systems.
• User-friendliness
• Features and applications
• Customization and scalability
• Support and training
• Cost and ROI

How To Choose the Right Clinic Management Software

It’s smart to start by identifying the needs of your clinic. Do you serve a high volume of patients daily, or is your practice more boutique? Do you offer any specialized services that would require specific features in the software? How many employees will use it? Does it need to integrate with existing systems like your EHR, or billing software? Integration with your existing systems can help streamline processes and reduce data entry redundancy.

Most modern clinic management software will have a well-designed user interface. Still, it’s worth signing up for a demo so your staff can see if it works for them. A user-friendly experience is vital. Intuitive operations will reduce the learning curve, save time, and minimize errors.

In order to meet the needs you identified, your clinic management software should include a range of features and applications. These include appointment scheduling, billing and invoicing, patient records, reporting and analytics, and data security (including HIPAA compliance). Each of these features is important to ensuring smooth management of your clinic’s essential functions.

Customization and scalability are how you build for the future. Flexibility is key. Do you plan to add new services or expand your clinic? Choose software that can be tailored to your workflow and can be changed as your clinic develops. This ensures that the software can adapt to your needs, not the other way around.

As with any new tool, a new clinic management software will require some training. Look for an option that includes robust training videos, live sessions, or on-demand courses. In addition to learning the new system, you’ll want to ensure continued support.  The level of support may vary between software companies and the packages they offer. Look for support options including phone, email, live chat, help articles, and a user community forum. Quick customer support can save you time and frustration when issues arise.

Finally, consider the cost of the software and how it contributes to the success of your clinic. While cost is a significant factor, keep in mind that investing in efficiency can save time and money in the long run. By considering these factors, you can be confident in choosing a clinic management software that enhances your operations, simplifies your workflow, and contributes to a high standard of care.

How To Choose a Telehealth Platform

The COVID-19 pandemic pushed many rehabilitation clinics to explore telehealth. While it may sound counter-productive for occupational therapy or physical therapy services, many providers are finding creative, new ways to help their patients remotely.

Choosing a telehealth platform requires careful consideration. The best one for your clinic depends on the needs of your clinic and severable variable features of the software itself. When choosing a telehealth platform, start with a quick needs assessment of your clinic. Use the following points to evaluate your clinic’s needs:

• Monthly patient volume
• Clinical users
  • How many clinicians need access?
  • What are their clinical disciplines? Only PTs or OTs, or both or more?
• Specialty services offered at your clinic, such as hand therapy, workers’ comp, and more
• Existing EHR and other software

Next, you’ll want to compare features and benefits of the telehealth platforms you’re considering. That includes HIPAA and reimbursement requirements, user-friendliness, training, and tech support. For more help on finding the right fit for your clinic, read How To Choose a Telehealth Platform.

3. Evidence-Based Clinical Technology

Staying up-to-date with the latest clinical technology is not just an option, but a necessity. Integrating technology into your treatment and evaluation significantly elevates your standard of care. However, it’s important to strike a balance between investing in new technology and resisting the temptation to buy each new gadget and gizmo that hits the market. Let’s discuss the ways you can harness technology to provide a higher level of care, boost patient engagement, and drive better outcomes.

Expectations of Today’s Patients

As healthcare costs rise, patients increasingly expect more from their clinic visits. In other words, if you want to prevent attrition, you have to provide a valuable experience at every session. Simple rubber band exercises may be effective in the short-term, but how long until the patient becomes disengaged and decides they can do these same activities without you?

Your clinic needs to offer valuable treatment that patients not only appreciate, but eagerly return to. Utilizing technology is a strategic way to meet these expectations and demonstrate your commitment to high-level care. Look for treatment technology that is engaging or gamified to keep patients interested and motivates them to continue with their sessions.

Data-Driven Rehab: Measuring, Reporting, and Tracking Progress

Objective measurement is a game-changer in clinical evaluations and treatment. Technology that allows you to measure, track, and report progress over time will demonstrate the difference your treatment makes. Rather than relying on the subjective nature of MMT or self-reporting, objective data shows patients exactly how they are progressing.

Objective progress reports make a strong impression to everyone involved in care, including patients, referrers, and case managers. When referring doctors see charts and graphs detailing improvement in strength and range of motion, they immediately understand the value of your treatment.

“The objective data clearly shows patient progress and evidence for our recommendations. It’s a terrific marketing tool that helps us get more referrals,” says Rich Douglas, Center Manager of NovaCare Rehabilitation. He uses objective data as a motivational tool for patients and referrers. See how NovaCare keeps clients engaged and shows real proof of progress with objective reporting in this case study.

Elevate Your Evaluations and Treatment with Objective Tools

BTE provides the world’s leading clinical technology for both evaluations and treatment. Our systems are highly engaging and evidence-based to bring better outcomes for your patients and your business. With BTE systems in your clinic, you’ll provide a higher standard of care that meets and exceeds expectations. Explore our product lines for both Functional Rehabilitation and Evaluation and Testing.

4. Clinic Marketing

Marketing is one of the many skills that clinic managers usually have to learn through experience. That’s why we created this guide: Everything You Need To Build a Clinic Marketing Strategy. In it, we cover everything from how to identify your audience (hint: it’s not just people in the area with certain injuries) to navigating the ever-changing world of Search Engine Optimization (SEO) and Search Engine Marketing (SEM).

Marketing campaigns that resonate in a genuine way will strengthen your patient relationships and help grow your clinic. Whether you’re opening a new practice or looking to breathe new life into a longstanding clinic, these marketing activities will get you to your goals. Learn how to create a clinic marketing strategy including content marketing, website development, digital ads, online reviews, trackable performance metrics, and more.

Read our complete guide to clinic marketing: Everything You Need To Build a Clinic Marketing Strategy.

5. Patient Engagement

As a clinic manager, you already know that high levels of patient engagement can decrease dropouts, drive better clinical outcomes, generate referrals, and contribute to your clinic’s overall success. Studies show that patients who are more actively involved tend to have better outcomes.² In addition to the patient benefits, high engagement also supports your business by encouraging positive word-of-mouth and reviews. As 92% of people trust recommendations from people they know, it’s vital to provide the best patient experience possible.³

Improve Patient Engagement in Five Steps

So how do you improve patient engagement at your clinic? These five steps are the perfect place to start:

1. Define your clinic’s vision for patient engagement
2. Create a culture of engagement
3. Employ the right technology and services
4. Empower patients to become collaborators in their care
5. Chart progress and modify as necessary⁴

Supporting patient engagement takes input from every role in your clinic, not just the clinical staff. Many of the tactics you’ll use to drive engagement will benefit your patients, staff, and business in more ways than one.

First, you should seek input from your staff. Hold feedback sessions to learn what helps, what gets in the way, and how you can make improvements. Set your goals as a team to encourage collaboration and buy-in from everyone. Creating a culture of engagement means making every touchpoint patient-centered. Your clinical staff should know how to actively listen, educate patients, personalize each session, and involve family / caregivers when necessary.

The right technology can help make the patient experience better than ever. From booking to billing and even session progress, your clinic should take advantage of software that saves you time and keeps patients engaged.

In another article, we dive into each of these five steps and show you how to apply this process at your clinic. You’ll learn simple tactics you can start today plus long-term strategies for success. Read it now: 5 Steps to Better Patient Engagement.

6. Billing and Reimbursement

Now let’s dive into one of the trickier aspects of clinic management: billing and reimbursement. This process ensures you get paid for the services you provide. But like many things in healthcare, the landscape is complex and evolving. Here’s a quick overview of the billing and reimbursement process in a typical rehab clinic.

Overview of the Billing and Reimbursement Process

First, the clinician provides documentation on the patient visit. This will include details of the treatments, exercises, patient progress, and any changes to the plan of care. These services are associated with a specific CPT (Current Procedural Terminology) code which determines how it is billed.

Second, the clinic creates a bill and submits to the payer for review. The bill includes the diagnosis, a breakdown of all services provided, the corresponding CPT codes, and other relevant information. The bill is submitted to a payer, usually an insurance company or Medicare / Medicaid.

Third, the payer will evaluate the bill and determine whether the documentation justifies payment. If it is approved, the bill we be paid. If it’s denied, the clinic will receive notice. Most of the time, a denial can be resolved by correcting the documentation or providing further information required by the payer. More on each of these three parts next.

Documentation

Detailed documentation is paramount to billing and reimbursement. Typically, documentation should start with the patient information and medical history. From there, the treatment plan should present a logical and relevant approach to each activity or intervention used. Throughout the sessions, it’s best to use objective measurements to show progress over time. This could include range of motion, strength assessments, pain scales, and any other quantifiable data.

When documenting a specific treatment exercise, the notes should include the following:

• Timing
• Supervision
• Exercise volume (exact sets, reps, weight, etc.)
• Progress with this exercise over time

CPT Codes and Reimbursement

Whether you’re documenting an evaluation, exercise, manual intervention, or other treatment procedure, there’s a CPT code for that. Payers will evaluate the documentation against the set criteria for each code. It’s important to understand the requirements for CPT codes to maximize reimbursement while remaining compliant. More on that here: The 3 Most Common CPTs in Rehab.

Challenges and Denied Claims

With thorough documentation and compliant practices, you should have no issues with reimbursement. However, you may get a denial every once in a while. Claims can be denied for various reasons. When a claim is denied, you must investigate the reason and appeal the denial.

Most of the time, it’s a documentation issue. Your clinical staff may rarely deal with billing, but it’s important that they understand the requirements of their documentation. If a claim has been denied, take a look at the documentation and check for the following:

• Exactly what exercises the patient performed and why
• How long the exercise lasted (and how many billable units)
• Who supervised the exercise (PT, PTA, etc.)
• How the patient has improved over time in terms of volume or intensity

Overall, the more detail you provide, the better. Claims reviewers will be checking off their list of requirements while they read your documentation. Provide as much information as possible to ensure your claims get approval.

7. Regulatory and Compliance

As a clinic manager, you don’t just oversee patient care and business operations. You’re also responsible for navigating the complexities of regulatory and compliance requirements of the practice. Understanding and managing these issues can be challenging, but is essential to running your practice. This topic deserves its own series of articles to cover everything a clinic manager needs. But for now, we will cover four core regulatory and compliance concerns that clinic managers must prioritize: HIPAA, Medicare and Medicaid, state licensing, and insurance regulations.

HIPAA Compliance and Patient Privacy

First, one we’re all familiar with: HIPAA compliance. The Health Insurance Portability and Accountability Act is a cornerstone of healthcare regulation. HIPAA regulations protect patients’ health information and ensure confidentiality.⁵ Clinics handle sensitive health information regularly, so adherence to HIPAA is non-negotiable. In order to stay compliant, clinics should:

• Secure patient information – Keep records and data safe from unauthorized access or breaches. This includes securing physical records, electronic records, and communication channels. Any software or platform that you use to handle patient information should have built-in security measures.
• Train your staff – Ensure your staff is educated on HIPAA compliance, data security, and the importance of confidentiality. New hire training is the perfect opportunity to provide this information.
• Implement proactive policies – Establish and enforce HIPAA-compliant policies that govern how patient information is handled, stored, and shared.

For more information, visit the US Department of Health and Human Services’ website specifically for HIPAA compliance.

Medicare and Medicaid Compliance

If your clinic works with Medicare and Medicaid beneficiaries, you must comply with an additional set of regulations. The Centers for Medicare and Medicaid Services (CMS) enforces certain requirements on clinics billing for reimbursement. Key requirements include:

• Eligibility and enrollment – In order to treat Medicare or Medicaid patients, your clinic must be enrolled in CMS’ program. This is a multi-step process that involves meeting certain eligibility requirements and submission for acceptance. Medicare and Medicaid have separate but similar requirements. For more information on Medicare eligibility, visit the Medicare Enrollment Guide for Providers.⁶ Visit your state’s Medicaid site for more information on provider eligibility requirements.
• Billing Accuracy – This is not only a financial responsibility, but a legal requirement. Mistakes or inaccuracies can lead to improper payments, claims denials, or even investigations for fraud.
• Documentation – This one almost goes without saying, but it is absolutely essential to running your practice. Medicare and Medicaid require detailed documentation and record keeping, including patient records and services provided.
• Beneficiary rights – Medicare and Medicaid patients (beneficiaries) have specific rights defined by the respective agencies. These rights include informed consent and the right to choose their provider.⁶ More information on Medicare beneficiary rights can be found here, and you can find more information on Medicaid rights on your state’s site.
• Ongoing education – Ensure compliance by continually educating your staff on the matter. Regular training and education will help keep your providers up to date. You may also want to occasionally audit your billing and documentation practices to preemptively address any potential issues.
• Adapt to changes – These regulations are subject to change. Clinic managers must stay informed of these updates and adapt your practices accordingly. One way to stay informed is to subscribe to email updates from the CMS blog or other helpful resources, like us here at TherapySpark.

Private Insurance Regulations

Like Medicare and Medicaid, private insurance companies issue their own requirements. In order to become an in-network provider for a particular insurance company, your clinic must undergo credentialing and adhere to contract terms and the payer’s regulations. These include prior authorization requirements, medical necessity criteria, benefit verification, claims documentation stipulations, and other compliance considerations.

As you may have noticed, many of these regulations overlap. Often, what is required for Medicare and Medicaid also meets the criteria for other payers and vice versa.

7. State Licensing

Last but not least, state licensing. Each state has its own regulatory board responsible for regulating providers’ licenses. Your clinical staff are responsible for maintaining their licenses and continuing education requirements. However, some clinic managers offer continuing education opportunities in-house.

While physical therapy and occupational therapy license requirements are state-specific, some states are working together to allow individuals to practice in multiple states (*APTA, OT Compact). Known as a compact, this agreement would give practitioners greater flexibility and reach. For more information and updates as states join the compact, visit OT Compact and APTA Licensure Compact.^7,8

Conclusion

As we’ve seen, clinic management encompasses many different areas of business and clinical expertise. Depending on the size and structure of your clinic, you may be able to delegate some of these responsibilities or hire an external resource for help. Mastering these skills and developing effective clinic management practices takes a blend of skill, innovation, and continuous learning. The insights discussed here can guide you towards operational excellence and enhanced patient care. Expanding your clinic management skillset helps you create an environment where excellence, adaptability, and commitment to health are at the forefront, bringing a brighter future for your patients and your practice.

Colleen Isaiah
Editor, TherapySpark
BTE

The post 7 Pillars of Clinic Management for OT and PT appeared first on BTE.

Despite this alarming connection, aerobic exercise is widely underutilized in neurological rehabilitation. After initial treatment, patients with neurological conditions usually begin a personalized rehab program. In general, the prescribed exercises focus on balance, strength, and motor skills. Aerobic exercise is a critical component of comprehensive recovery, but it is frequently undervalued and omitted.

Aerobic exercise offers the potential to not just mend but revitalize. It’s time to elevate this unsung hero of recovery so that it becomes a cornerstone, rather than an afterthought, in neurological rehab.

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Why Aerobic Exercise Is Underutilized in Neurological Rehabilitation

Increasing aerobic exercise is the foundation for many other rehabilitation programs. This includes cardiac rehab and pulmonary rehab, as well as general health and wellness guidelines. So why should neurological rehab be any different? Reduced cardiac health only compounds the obstacles that survivors face following a neurological injury.

Perhaps one reason cardio is underutilized is that therapists tend to prioritize immediate functional needs. As we know, neurological injury can be accompanied by many different physical and cognitive deficits. This includes hemiparesis, hemiplegia, spasticity, muscle tone, and poor coordination. With these pressing concerns, therapists may find their attention and time fully consumed. Therefore, most exercise programs prioritize range of motion, strength, balance, motor skills, etc. However, while heel raises and bridges are undoubtedly beneficial, neglecting aerobic exercise leaves out a crucial aspect of rehabilitation.

There are additional reasons for the underutilization of aerobic exercise in neuro populations. For example, limited information or guidance on aerobic exercise prescription likely plays a large role.³ Combined with time constraints and pressure to maximize billing, this can discourage rehab professionals and lead to underutilization of aerobic exercise. Furthermore, many individuals affected by neurological injury have decreased exercise tolerance.³ This can limit participation in cardio activities.

Individuals affected by a traumatic brain injury (TBI) have been found to have an aerobic capacity that is 25-30% reduced when compared to healthy sedentary individuals.⁴ This can lead to reduced endurance for daily activities and a greater risk of additional neurological injuries. For someone recovering from a TBI, this further increases the likelihood of developing additional complications, including reductions in lung function, pituitary function, and hormone production.⁴

How Aerobic Exercise Improves Neurological Rehabilitation Outcomes

The list of health benefits of aerobic exercise after neurological injury is extensive. By implementing healthy lifestyle changes, such as increasing physical activity, the risk of cardiovascular mortality in stroke survivors can reduce by as much as 92%.⁵ Additionally, aerobic exercise may facilitate improvement in cognitive function and information processing.⁶

The advantages of aerobic exercise aren’t just seen in late-stage rehab. On the contrary, aerobics can be a useful tool in the acute phase of recovery. Aerobic exercise has been shown to reduce stroke-induced brain lesions within the first 28 days after stroke.⁶ Furthermore, researchers have explored the impact of aerobic activity on neuroplasticity. In animal studies, aerobic exercise was found to consistently regulate neurotrophic factor synthesis.⁶ This can allow survivors to capitalize on neuroplasticity in the early stages when it is most active.

After an injury like a stroke or TBI, the resulting damage to brain tissue can impact automatic processes. For example, stroke survivors who are deconditioned often experience metabolic disturbances as a result. These changes in metabolic activity increase the risk of both heart attack and recurrent stroke.² In truth, cardiovascular comorbidities constitute the leading cause of death in the post stroke-population.²

Evidence for Aerobic Exercise After Stroke

The rate of impaired glucose metabolism is as high as 80% in post-stroke populations.² However, evidence suggests that regular aerobic exercise can positively impact insulin resistance and glucose tolerance.² This, combined with improved cardiac health, can significantly improve a survivor’s health and well-being.

The pros of a cardio-inclusive rehab program don’t just stop at the chemical level. Treadmill aerobic training was found to be more effective than conventional rehab at improving ambulatory function for those affected by chronic stroke.⁷ Furthermore, there is evidence for improved upper limb function and general muscle fiber changes due to aerobic training.^8,9

Stroke survivors commonly have low tolerance for aerobic exercise. Research shows that exercise with BTE’s eccentric-only resistance system, Eccentron, is safe and effective for post-stroke patients. Because this system uses eccentric resistance, rather than concentric, it facilitates efficient aerobic exercise while requiring less energy consumption.¹⁰ Post-stroke, post-operative, and deconditioned patients can gradually build strength and aerobic endurance by performing eccentric-only resistance training. Increasing aerobic activity and lower extremity strength are key to improve overall health for stroke survivors.

Cardio as an Intervention for Parkinson’s Disease

Parkinson’s disease is progressive, and affected individuals experience a gradual decline in function. However, new evidence suggests aerobic exercise can help slow the progression of Parkinson’s disease.¹¹ A recent clinical review found high-intensity aerobic exercise to have the greatest disease-modifying potential. In this review, individuals who participated in regular exercise experienced a slower decline in gait and the activities of daily living.¹¹

Furthermore, aerobic exercise was shown in other studies to improve gait, balance, and overall quality of life.¹² By making cardiovascular exercise a priority, individuals can take charge of their rehabilitation after a Parkinson’s diagnosis. While this condition is progressive, improving functional mobility can boost autonomy, independence, and even mental health.

Aerobic Exercise and Mood Disorders

The benefits of aerobic exercise after neurological injury extend beyond just physical improvements. There is substantial evidence to support the use of aerobic exercise as an intervention for mood and behavioral disorders.

Depending on the injury, survivors often experience changes in mood, behavior, and emotions. This can include conditions such as anxiety and depression, which are compounded by the loss of independence many individuals experience.

While medication is beneficial for many to reduce the severity of mood and behavioral changes, this is not the only available treatment. By enhancing neuroplasticity and preventing atrophy of the hippocampus, aerobic activity can improve symptoms of depression.¹³ Additionally, this is an effective intervention for chronic pain conditions after neurological injury.¹³

In one study of aerobic exercise for individuals with TBI, both acute and long-term improvements in mood were recorded.¹⁴ While improvements were noted as early as 4 weeks, the greatest impact on overall mood was at the 12-week mark.¹⁴

Barriers to Aerobic Exercise

Understanding the importance of aerobic exercise after neurological injury is vitally important. However, putting this knowledge into practice comes with its own challenges. Even when survivors are aware of the need for aerobic exercise, the barriers can seem overwhelming. These barriers can include limited social support, poor motivation, reduced physical function, and emotional condition.⁵

Among individuals with a traumatic brain injury, knowing how and where to exercise is a major concern.¹⁵ When combined with motor impairments like weakness, paralysis, or ataxia, this can feel impossible. Therefore, providers need to work closely with patients to provide guidance for continued exercise after discharge from therapy. By enabling survivors of neurological injury to be active in their rehabilitation, we can maximize therapeutic outcomes.

Research suggests that 20-40 minutes of light aerobic exercise performed 3-5 days per week is optimal.⁴ However, every program should be tailored to meet the individual needs of the survivor. Finding ways that your patient can be successful at aerobic activity is vital for encouraging independence and self-efficacy. This can include walking, arm or leg cycling, swimming, or an aerobic circuit workout. Additionally, community exercise programs can be a great place to start. Exercise can always be adapted to meet an individual’s needs.

Low-tolerance Aerobic Exercise

Patients struggling with low exercise tolerance or deconditioning can still benefit from light aerobic exercise. Combined with the minimal energy requirements of eccentric-only resistance, the Eccentron provides gentle and gradual exercise for patients with low tolerance. Learn more about facilitating gentle aerobic exercise for deconditioned patients with the Eccentron here.

Emphasizing Well-rounded Rehab

Aerobic exercise is not a replacement for strength training for populations with neurological injury. However, it is a valuable adjunct to maximize recovery and decrease mortality. This is because of the impact aerobic exercise can have on so many aspects of health after neurological injury.

Improving cardiac function and endurance should be a consideration for all neurological rehabilitation programs. After injury and hospitalization, muscle atrophy and decreased endurance are limiting factors for a survivor’s daily function. However, intentional aerobic training can help overcome this reduction in function and increase independence.

Treating more than just strength-related impairments can better meet the needs of survivors of neurological injury. Addressing cardiac disease, mood disorders, endurance, and aerobic capacity are overlooked pieces of neurological rehabilitation. By making aerobic exercise a priority, survivors can take charge of their recovery and optimize functional outcomes.

Mariah Kellogg, PT, DPT is a Physical Therapist and health writer. Her career focuses on rehabilitation for neurological and orthopedic populations and she is passionate about patient advocacy. Mariah began her career in Alaska and uses writing as a tool to inspire patients to pursue their health goals as well as to engage with other clinicians about rehab topics.

References

1. Stoller O, de Bruin ED, Knols RH. et al.Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol 12, 45 (2012). https://doi.org/10.1186/1471-2377-12-45
   
2. Ivey FM, Hafer-Macko CE, Macko RF. Exercise training for cardiometabolic adaptation after stroke. J Cardiopulm Rehabil Prev. 2008 Jan-Feb;28(1):2-11. doi: 10.1097/01.HCR.0000311501.57022.a8. PMID: 18277823.
3. Billinger SA, Boyne P, Coughenour E, Dunning K, Mattlage A. Does aerobic exercise and the FITT principle fit into stroke recovery? Curr Neurol Neurosci Rep. 2015;15(2):519. doi: 10.1007/s11910-014-0519-8. PMID: 25475494; PMCID: PMC4560458.
4. Mossberg KA, Amonette WE, Masel BE. Endurance training and cardiorespiratory conditioning after traumatic brain injury. J Head Trauma Rehabil. 2010 May-Jun;25(3):173-83. doi: 10.1097/HTR.0b013e3181dc98ff. PMID: 20473091; PMCID: PMC2885899.
5. Bailey RR. Lifestyle Modification for Secondary Stroke Prevention. Am J Lifestyle Med. 2016 Feb 21;12(2):140-147. doi: 10.1177/1559827616633683. PMID: 30202386; PMCID: PMC6124986.
6. Zhang D, Lu Y, Zhao X, Zhang Q, Li L. Aerobic exercise attenuates neurodegeneration and promotes functional recovery – Why it matters for neurorehabilitation & neural repair. Neurochem Int. 2020 Dec;141:104862. doi: 10.1016/j.neuint.2020.104862. Epub 2020 Oct 6. PMID: 33031857.
7. Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke. 2005 Oct;36(10):2206-11. doi: 10.1161/01.STR.0000181076.91805.89. Epub 2005 Sep 8. PMID: 16151035.
8. Kato A, Hayashi H. Aerobic Exercise for Upper Limb Function in a Patient With Severe Paralysis With Subacute Stroke: A Case Report. Cureus. 2023 May 25;15(5):e39502. doi: 10.7759/cureus.39502. PMID: 37378161; PMCID: PMC10291986.
9. Potempa K, Braun LT, Tinknell T, Popovich J. Benefits of aerobic exercise after stroke. Sports Med. 1996 May;21(5):337-46. doi: 10.2165/00007256-199621050-00003. PMID: 8724202.
10. Lim S, Lee W. Effect of two types of muscle contraction training on muscle thickness, strength, and delayed onset of muscle soreness in persons with chronic stroke. Physical Therapy Rehabilitation Science. Korean Academy of Physical Therapy Rehabilitation Science; 2018. Available from: https://www.jptrs.org/journal/view.html?doi=10.14474%2Fptrs.2018.7.4.154
11. Schootemeijer S, Darweesh SKL, de Vries NM. Clinical Trial Highlights – Aerobic Exercise for Parkinson’s Disease. J Parkinsons Dis. 2022;12(8):2297-2306. doi: 10.3233/JPD-229006. PMID: 36336942; PMCID: PMC9837678.
12. Shu HF, Yang T, Yu SX, Huang HD, Jiang LL, Gu JW, Kuang YQ. Aerobic exercise for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Jul 1;9(7):e100503. doi: 10.1371/journal.pone.0100503. PMID: 24983753; PMCID: PMC4077570.
13. Jia Y, Yao Y, Zhuo L, Chen X, Yan C, Ji Y, Tao J, Zhu Y. Aerobic Physical Exercise as a Non-medical Intervention for Brain Dysfunction: State of the Art and Beyond. Front Neurol. 2022 May 13;13:862078. doi: 10.3389/fneur.2022.862078. PMID: 35645958; PMCID: PMC9136296.
14. Weinstein AA, Chin LMK, Collins J, Goel D, Keyser RE, Chan L. Effect of Aerobic Exercise Training on Mood in People With Traumatic Brain Injury: A Pilot Study. J Head Trauma Rehabil. 2017 May/Jun;32(3):E49-E56. doi: 10.1097/HTR.0000000000000253. PMID: 27603762; PMCID: PMC5339064.
15. Pinto SM, Newman MA, Hirsch MA. Perceived Barriers to Exercise in Adults with Traumatic Brain Injury Vary by Age. J Funct Morphol Kinesiol. 2018 Sep 14;3(3):47. doi: 10.3390/jfmk3030047. PMID: 33466976; PMCID: PMC7739410.
16. Petrofsky J, Donatelli R, McKivigan J, Laymon M. Can eccentric exercise of the lower limb be made more efficiently, a pilot study.  Sunkrist Public Health and Research Journal.   Vol1:1: 1-8 https://www.researchgate.net/publication/337062603_Can_eccentric_exercise_of_the_lower_limb_be_made_more_efficiently_a_pilot_stud

The post How Aerobic Exercise Can Revolutionize Neurological Rehab appeared first on BTE.

Namely, we’ll provide you with the following pertaining to this CPT code:

• The definition of Therapeutic Activities
• When to use CPT 97530 as opposed to other similar codes
• Other important considerations surrounding code 97530

If you’re new to learning about CPT codes for occupational therapy or physical therapy, start with this article: The 3 Most Common CPTs in Rehab and How To Document Them for Reimbursement.

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Therapeutic Activities in Brief

The APTA defines procedure code 97530 as “the use of dynamic activities to improve functional performance.” Within this definition, “functional” and “dynamic activities” do a lot of heavy lifting. If you think about it long enough, you could fit essentially any treatment into this category.

However, payers are generally looking for something more specific when they reimburse Therapeutic Activities. CPT 97530 generally refers to movement patterns that are used to accomplish specific tasks throughout the day. Think about functional activities like getting out of bed, opening a jar, using a steering wheel, and more. Simulating these and other functional tasks in the clinic would qualify as Therapeutic Activities.

Difference Between Therapeutic Activities and Therapeutic Exercise

It’s easy to get Therapeutic Activities and Therapeutic Exercise mixed up. The interventions that fall under these two CPT codes are quite similar. Here’s an example that shows the difference:

For instance, ascending and descending stairs usually fall under Therapeutic Activities. These tasks require coordination, strength, and timing from many different areas of the body. The key element that pushes stair negotiation toward Ther Act instead of Ther Ex is the functionality of the movement. Plus, a person who is climbing the stairs integrates many different skills all at once.

On the other hand, if you are working with your patient on the individual component portions of stair negotiation (such as controlled knee flexion and extension), it might be more appropriate to bill for Ther Ex.

While these terms certainly have a lot of gray within them, it’s crucial to remember that Therapeutic Activities are related to function. If the exercise or activity is not directly functional, you may be better off using another CPT code in order to avoid fraudulent claims.

Performing and Documenting CPT 97530

Simulating functional tasks is the best way to prepare your clients to get back to those activities. Functional rehabilitation equipment like PrimusRS helps you evaluate and perform virtually any activity in your clinic. Practice ADLs, sports, job tasks, and isolated movements with the many tools, attachments, resistance modes, and exercise modalities. With PrimusRS, you can perform Therapeutic Activities that exactly match the real-life activity.

As for documenting CPT 97530, your notes must include certain criteria in order to qualify for reimbursement. One of the most important is showing progress over time. Without documenting patient progress, your reimbursement claims may get denied. Using quantified measurements of strength, ROM, and functional performance ensures that your documentation is indisputable. With the PrimusRS’ progress reports, you get detailed charts and graphs showing your patients’ progress in each activity they perform. These progress reports show concrete evidence that payers and referrers want to see. Plus, the charts and graphs keep patients motivated to come back and see their progress continue.

In addition to progress over time, we’ll discuss the other requirements for documentation of CPT 97530: the eight-minute rule, modifier 59, qualifying specialties, reasons for denial, and future legislation that affects reimbursement.

The Eight-minute Rule Applies to Therapeutic Activities

Like many other codes, CPT 97530 is subject to the eight-minute rule. Briefly, the eight-minute rule states that you must perform the activity for a minimum of eight, and a maximum of 22 minutes in order to bill for one unit of that code. If the treatment extends beyond 22 minutes, the therapist may bill for multiple units. If the treatment lasts less than eight minutes, the therapist may be able to combine the time spent on this activity with another treatment. Combining treatment times from separate timed codes is a process known as “mixed remainders.”

Unfortunately, not all payers will accept mixed remainders, and it is important to review individual insurance company policies for clarity on these billing nuances.

Modifier 59 For Therapeutic Activities

One applicable modifier for CPT code 97530 is modifier 59. Modifier 59 is fairly common in the rehab setting. Essentially, this modifier indicates that multiple distinct procedures were performed during separate 15-minute increments.

For example, if an Occupational Therapist had a patient practice transferring from a chair to a bed for 15 minutes, and then performed 15 minutes of manual therapy, they may need to use modifier 59.

Specialties Who Commonly Bill for CPT 97530

Therapeutic activities are a mainstay for Occupational Therapists. OTs use CPT 97530 nearly every day. Physical Therapists, on the other hand, will more often utilize Therapeutic Exercise in order to work on specific parameters of exercise.

For instance, the OT might be more inclined to work on the pattern and component parts of a car transfer while the PT might work to strengthen the muscles associated with said transfer. However, these are by no means hard and fast rules. PTs can and do have their patients perform both Therapeutic Exercise and Therapeutic Activities, and OTs do the same.

In addition to PTs and OTs, you may not have known that Certified Athletic Trainers (ATCs) can also bill for reimbursement of certain CPT codes. Learn more about how Athletic Trainers can use CPT codes here: Reimbursement for Athletic Trainers ­– What You Need To Know.

Reasons for CPT 97530 Denial

Denial by a payer is almost always due to a lack of demonstration of medical necessity, in one way or another. You are unlikely to face many denials if you can show that what you have done for your patient meets the following criteria:

• Medically necessary – Does the plan of care clearly document why the treatments are needed? This should provide a clear, logical rationale for your treatment approach where a payer can see what the patient’s deficits are and how the proposed treatments will help them.
• Helps them progress over time ­– Progressive overload, and progress in general, is critical for helping patients to improve. If the patient is doing the same things over and over each session, with no progress or increased difficulty, the payer may not reimburse you.
• Proper supervision – Clinical supervision is an important part of reimbursement. There are clear guidelines for who can perform which treatments under various levels of supervision. For Therapeutic Activities, patients must be supervised in a direct, one-on-one setting.

As is always the case, the more information you can provide about the treatment and the necessity of it for the patient’s health, the less likely you are to face issues related to reimbursement. For more tips on avoiding claims denials, check out this article: Skilled Service Documentation Tips for Reimbursement.

Therapeutic Activities in 2024

As we move closer to 2024, rehab professionals can expect to see some reimbursement changes. Medicare announced a cut of 3.4% which could drastically affect many different rehab professionals.

However, while this news is certainly not encouraging, the APTA was not altogether unhappy with CMS’s decisions for the coming year. In fact, certain services provided by rehab therapists, such as Therapeutic Exercise, Gait Training, and Therapeutic Activities may actually increase in value.

The APTA has long argued that these services have been undervalued and, to the surprise of many, CMS seems to have tentatively agreed. So, we will all keep our eyes open for these changes  in 2024.

Conclusion

If you take nothing else from this post, remember that CPT 97530 Therapeutic Activity can only be billed for functional activities. Again, this code is often confused with CPT 97110 Therapeutic Exercise, which is used for more specific exercises geared toward improving an area of fitness or wellness. But as long as your documentation is thorough and sound, payers should reimburse this code without much ado.

Bennett Richardson, PT, DPT, CSCS is a Physical Therapist and writer. He is the owner of Richardson PT LLC, a mobile, cash-based physical therapy service out of Pittsburgh, PA. Ben is passionate about many health-related topics including weight loss and athletic performance. To get in touch with Ben, visit www.richardsonpt.com

References

1. 1. American Physical Therapy Association (APTA). (2018). Guide to Physical Therapist Practice. 3rd ed.
   2. Centers for Medicare & Medicaid Services (CMS). (2019). Medicare Claims Processing Manual. Chapter 5 – Part B Outpatient Rehabilitation and CORF/OPT Services. Section 20.2 – Components of a Therapy Service. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912
   3. American Physical Therapy Association. Final 2024 Physician Fee Schedule Reflects Some Flaws; Includes Some Wins. Accessed on: December 3rd, 2023.

The post CPT 97530: How To Document Therapeutic Activities for Reimbursement appeared first on BTE.

To navigate these complex relationships, we must first understand why difficult patients behave the way they do, and then work on our approach. In this article, I’ll share 10 actionable tips for dealing with difficult patients that you can use in your practice. These tips will help you understand their perspective, get yourselves on the “same side,” and stay on track for better patient engagement.

Defining “Difficult” Patients

Let’s first define what we mean by a “difficult” patient. This can include those who demonstrate non-compliance, aggression, manipulation, passive-aggressiveness, and attention-seeking behaviors.¹ These behaviors can include resisting treatment, unwillingness to follow recommendations, or even verbal confrontation.

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Why Patients Can Be “Difficult”

To effectively deal with difficult patients, we need to understand where they are coming from. Patients can act out for a variety of reasons, most of which are rooted in fear, pain, or lack of understanding. Patients may be worried about their condition or their future. They are likely in some physical pain, which can understandably cause irritability. They may have had negative experiences in therapy in the past or came in with unrealistic expectations. While you can’t control all of these variables, we will focus on the issues you can influence in a positive way. Recognizing the underlying source of their behavior is the first step in addressing the issue effectively.

As therapists, we must approach the situation with empathy, compassion, and patience.

Remember that non-compliance or challenging behavior is not a reflection of your personal competence. It is a manifestation of the patient’s own struggles and concerns. In other words, have patience with yourself too! With the following tips, you can turn difficult patient relationships into opportunities for growth, ultimately benefitting you and your patients.

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How To Deal with Difficult Patients

1. Active listening

We can start by actively listening without judgment. This will allow us to understand our patient’s point of view more accurately. Be aware that active listening without judgment can be challenging. Without realizing it, we’re normally listening through our own filters, making judgements and assumptions that are unintentional and innate.

Listening without judgement takes awareness and practice. Each conversation with a patient is an opportunity and a privilege to be allowed into the world of someone who trusts you in a vulnerable state. We must give them our undivided attention and avoid making assumptions. This allows us to gain insight into the patient’s perspective and experiences influencing their behaviors.

2. Stay solution-focused

Once we understand the root causes behind a difficult patient’s behavior, we can collaborate to find solutions and overcome obstacles in their care. For example, suppose a patient is non-compliant with home exercises due to discomfort and pain. In that case, we can focus on modifications like lower-impact activities, modifying the exercise volume, or trying a different time of day when pain is lower.

Another common issue is a lack of focus during sessions. In this case, we can implement solutions like limiting distractions in the treatment space or incorporating more engaging modalities. The key is identifying the root cause and then co-creating an actionable plan to address it. With a solution-focused, collaborative approach, we can turn difficulties into opportunities for growth.

3. Create shared goals

Collaborating with patients on goal-setting and care decisions can give them a sense of control. It also instills confidence that you truly care about their input and wishes. As therapists, we want our patients to feel empowered and invested in their rehabilitation process.

However, some difficult patients may try to direct their care in ways that are unrealistic or inappropriate. While collaboration is ideal, we need to set clear expectations and limits based on our clinical expertise. Difficult patients may require more education on why certain exercises or modalities are prescribed over others. With open communication and empathy, collaboration can still occur within the appropriate boundaries we set.

4. Manage expectations and set boundaries

Set clear expectations and professional boundaries. From the start, you should set clear expectations about your role and theirs. For example, explain during the initial evaluation that patients are expected to arrive on time, participate actively, and complete home exercises. You may need to establish what behaviors will result in termination of services due to non-compliance or abuse. Professional boundaries create the structure patients often need to be successful in therapy.

Ever wondered what patients really expect from you? This research study asked just that. See the results in our recent patient engagement article: The 4 Things Patients Expect from You ­– Manage Patient Expectations for Better Retention.

5. Educate patients

 Educate patients on how your treatment techniques and home exercise programs connect. Explain how they work together to facilitate progress and reach their treatment goals. Identify possible barriers to learning, like language barriers, limited attention span, learning disabilities, or difficulty in understanding new concepts. Some factors, such as limitations in literacy, may be more subtle and harder to recognize.

You may want to use the teach-back method (also called the show-me method or closing the loop) to confirm that you have explained the information in a way that the patient understands clearly. This builds buy-in and investment and lets you know they understand your directions.

6. Reinforce positive behaviors

As therapists, we use our observational skills to read all the big and small nuances in behaviors a patient continuously provides during treatment. These observational skills start from the moment you first lay your eyes on them to the last glimpse of them leaving. This is where we can identify positive behaviors and attitudes and call attention to them by validating and encouraging those behaviors.

For example, when the patient demonstrates desirable actions like arriving early, completing home exercises, or having friendly interactions with other staff, verbal praise will help motivate continued progress. You can say things like, “I’ve noticed how dedicated you’ve been to your recovery, and I wanted to let you know I appreciate your commitment to the process.” Verbal praise and positive feedback will help motivate the patient’s continued progress.

We can also consider using tools like rewards systems or goal charts that allow patients to track achievements visually. By reinforcing positive behaviors, we shape productive patterns.

7. Diffuse attention-seeking behaviors

 Complaining loudly, displaying inappropriate boundaries, exaggerating symptoms, being overly dramatic, or confronting staff are all examples of attention-seeking behavior. Patients engage in attention-seeking behaviors due to low self-esteem, loneliness, feeling unheard. It is their way of attempting to seek help and support. It’s best to avoid reinforcing these behaviors by responding with immediate, excessive attention.

To diffuse attention-seeking behaviors, you can set clear expectations for appropriate conduct. Remind patients calmly and respectfully about those standards if inappropriate behavior occurs. We can say, “I know you’re frustrated, but I cannot allow that language here. Let’s take a minute to collect ourselves and then try discussing this calmly.”

If disruptive behavior escalates, set firmer limits. However, ignoring harmless bids for attention can also diffuse the situation. The key is finding a measured response that maintains professionalism and progress.

8. Open and honest communication

When conflict arises, address issues directly yet impartially, and keep communication professional, direct, and free of emotion. For example, “I understand this exercise causes discomfort. Let’s explore some alternative modalities that may better suit your needs.” Present rational options for finding mutually agreeable solutions.

If patients become hostile or oppositional, refrain from defensiveness. Instead, pause the interaction briefly to allow tensions to diffuse. Then, revisit the discussion, maintaining composure and objectivity. For example, you can say, “Let’s table this conversation for now and constructively reapproach these concerns later once we’ve both had time to reflect.” Language like this will model the respectful discourse expected from patients.

9. Know your limits

What is your limit as a therapist? Knowing the exact answer to this can be challenging. We are hard-wired to help, support, and see the patient’s goals come to fruition. We are invested in their recovery. However, in rare cases of severe noncompliance, abuse, misconduct, or safety threats, discontinuing services may become necessary as a final recourse once all other options are thoroughly exhausted.

If a patient persists in violating conduct policies despite repeated redirection or presents an escalating physical threat, formal termination may be warranted. It is a difficult decision that we, as therapists, can rest securely in the making after extensive efforts over a reasonable timeframe to implement solutions, enforce boundaries, and protect staff and patient welfare.

When all clinically and ethically indicated options have been attempted, terminate formally in writing, providing alternative care resources. Though difficult, setting these necessary boundaries ultimately preserves wellness and safety.

10. Practice self-care and stress management

Managing difficult patients mandates prioritizing your mental and emotional health through self-care. Difficult patients are draining, so make time for exercise, hobbies, vacations, or counseling. Ask colleagues for support.

Monitor yourself for early burnout signs like irritability, lack of motivation, or fatigue. If needed, take a brief hiatus or make caseload adjustments. You cannot sustainably care for others without first caring for yourself.

Conclusion

With empathy, consistency, and boundaries, many difficult patients can become more cooperative over time. While we can’t prevent every challenging case, these strategies can ease the friction when difficult situations do arise. We all want the best for our patients – meeting them where they are is the first step.

Hannah le Roux OTR/L, CHT, is an Occupational Therapist/Hand Therapist with more than 20 years of experience working in South Africa, the United Kingdom, and the United States. She is now using her knowledge and skills as a consultant to other therapists and writing articles related to hand therapy, managing therapy groups, and patient care.

References:

1. Potter, M., Gordon, S., & Hamer, P. (2003). The difficult patient in private practice physiotherapy: A qualitative study. Australian Journal of Physiotherapy, 49(1), 53-61.
2. Bassett, H., & Lloyd, C. (2001). Occupational therapy in mental health: Managing stress and burnout. British Journal of Occupational Therapy, 64(8), 406-411.

The post 10 Tips for Dealing with Difficult Patients appeared first on BTE.

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Overview of DeQuervain’s Tenosynovitis

Of the many tendons that work together for hand and wrist movement, DeQuervain’s involves two that work in tandem. The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons attach forearm muscles to the base of the thumb.² These tendons share a sheath that binds them. Usually, these tendons extend and abduct the thumb with no problem. However, repeated or overly forceful movements of the thumb and wrist can aggravate them.

As the amount of friction increases, the tendon sheath becomes inflamed. Repeated motions add to the swelling, and movement becomes constricted. As a result, there is pain during motion and even at rest.

Could you recall those hand and wrist anatomy terms? Try your hand at this fun Upper Extremity Anatomy Quiz!

Causes, Signs, Symptoms

DeQuervain’s is caused by overuse or aggravation of wrist structures. This can result from swelling, such as the kind caused by arthritis or other inflammatory conditions.3 It also may be caused by trauma or injury to the thumb or wrist. Overuse is another likely cause, possibly from hobbies, daily activities, or occupational use.

These activities may include sports that involve gripping a stick or racket, such as tennis or skiing. Hobbies such as gaming, gardening, or weightlifting could also contribute. Work activities may also lead to overuse when lifting heavy loads, typing, or using a hammer or other tools. Really, anything involving frequent and repeated grasping or gripping can cause DeQuervain’s. Some mothers even develop this condition by repeatedly lifting their new baby!⁴

The hallmark of DeQuervain’s is pain and discomfort along the thumb, wrist, and forearm. The pain may center over the two tendons along the outside of the wrist. Swelling and pain may also affect the wrist and the thumb. Pain will be present at rest but aggravated by movement, which may limit range of motion and strength. A snapping or catching sensation may accompany thumb movement, and numbness can occur.

Diagnosing DeQuervain’s

To identify DeQuervain’s, check for pain when there is pressure on the thumb and wrist. The Finkelstein test is the most common diagnostic tool for this injury. Instruct a patient to make a fist with the fingers wrapped around the thumb. Then, with the thumb side of the hand facing upward, bend the wrist down toward the floor. If pain is produced over the affected tendons, the test is positive. Significant pain indicates DeQuervain’s Tenosynovitis.⁷

Treating DeQuervain’s in Your Clinic

Treatment for DeQuervain’s includes hands-on techniques, therapeutic exercises, and home program recommendations. Conservative treatment is successful for the majority of patients.³ Your approach may include a combination of manual techniques, exercise, and at-home interventions.

In early sessions, you may need to address pain and swelling immediately. Modalities such as ice massage and cryotherapy can relieve pain. Ultrasound has also been proven to provide pain relief and diminish swelling. Additionally, low level laser therapy has demonstrated analgesic properties in some studies. Both low level laser therapy and ultrasound have also been shown to prevent recurrence of pain and decrease future triggering of pain and discomfort during recovery.⁸

Manual Therapy for DeQuervain’s

Manual therapy techniques have also been shown to have beneficial outcomes.⁹ Using manual techniques on the affected muscles can decrease the constant pull of the tendons and lead to greater progress in therapy sessions. Combining circular friction, cross fiber techniques, and longitudinal work can help resolve the extreme tightness.⁹ As muscle tightness decreases, pin and stretch can continue to lengthen the tissues. IASTM techniques, such as the Graston method or gua sha, can also reduce swelling and increase the ROM of the affected tissues.⁹

Therapeutic Exercises for DeQuervain’s

Therapeutic exercises to increase range of motion and strength can improve the functional use of the hand. Performing assisted thumb abduction and extension can be an effective stretch. Touching each finger to the thumb can increase functional movement abilities. In addition, performing wrist flexion and extension stretches can lengthen surrounding muscles.¹¹

Once pain and swelling have decreased, strengthening can begin. Performing exercises with putty can strengthen the fingers and intrinsic muscles of the hand. Another helpful exercise is gripping and releasing a tennis ball to increase grip strength.³

Home Recommendations

If the patient experiences pain with certain activities, you may need to alter those tasks. Activity modification can reduce further aggravation of the affected areas. Finding new methods for performing hobbies or work activities can get patients back to their daily routines even while recovering.

Consider ways to improve ergonomics, such as maintaining neutral wrist positions, taking rest breaks, or switching arms used during an activity6. In severe cases, patients may need to avoid some activities until reaching a certain point in recovery.

Splinting is a great way to ensure home carryover and has been shown to relieve symptoms.¹² An effective splint or brace can reduce pressure on the affected tendons, allowing them to rest and recover. Some like to use their splints while sleeping to improve their rest. If a splint is too cumbersome, kinesiology tape can have a similar effect.11 Kinesiology tape can help maintain a neutral position, decrease swelling, or address trigger points for pain.

Avoiding Recurrence

Because it is an overuse injury, DeQuervain’s has a high likelihood of recurrence. Training patients in the principles of ergonomics can help them avoid reinjury. Some of the most common ergonomic considerations include:

• Maintain upright posture while performing tasks
• Increase core strength and use that as a foundation of movement
• Keep a neutral wrist position while working
• Change positions and types of movements every 20 minutes
• Choose tools with a handle size that complements the hand and is in a comfortable shape
• Take breaks during work, or shift to different tasks, to avoid straining the same area for an extended amount of time
• Let pain be your guide, and stop when uncomfortable
• Give yourself time to recover after difficult or intensive activities ¹³

Conclusion

DeQuervain’s Tenosynovitis is a fairly common overuse injury, affecting thousands each year.⁴ However, it is easily treatable and preventable when considering ergonomic factors and utilizing activity modification along with traditional therapeutic interventions. In the rare cases when a case is more severe, corticosteroid injections and surgery may be indicated. Fortunately, most cases are easily addressed with a combination of rest, splinting, and home programs.

Sydney Moninger, COTA/L is an Occupational Therapy Assistant and freelance writer. She has more than 10 years of clinical experience working in pediatric, orthopedic, and geriatric settings. Most recently, she has been helping patients at a pain management center for orthopedic injuries. Sydney is passionate about patient education and increasing health literacy in the community, which is what got her started in her writing in the first place. She loves discovering new perspectives that improve her clinical practice, and connecting with others on LinkedIn or her Upwork page.

References

1. Lang, K. et al. 2014. “Conservative Treatment of de Quervain’s Tenosynovitis in Occupational Therapy: A Retrospective Outcome Study”. Grand Valley State University. https://scholarworks.gvsu.edu/cgi/viewcontent.cgi
2. “Extensor Pollicis Brevis”. 2023. Physiopedia. https://www.physio-pedia.com/Extensor_Pollicis_Brevis  
3. “De Quervain’s Tendinosis”. 2023. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis
4. Zelman, D. “What’s de Quervain’s Tenosynovitis?”. 2022. WebMD. https://www.webmd.com/rheumatoid-arthritis/de-quervains-disease
5. Pidgeon, T. “De Quervain’s Tenosynovitis”. 2022. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/
6. “De Quervain tenosynovitis”. 2023. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/de-quervain-tenosynovitis/diagnosis-treatment/drc-20371337
7. “Finkelstein Test”. 2023. Physiopedia. https://www.physio-pedia.com/Finkelstein_Test
8. Ferrara, E et al. “Physical Modalities for the conservative treatment of wrist and hand’s tenosynovitis: A systematic review”. 2020. Seminars in Arthitis and Rheumatism. https://doi.org/10.1016/j.semarthrit.2020.08.006
9. Papa, J. “Conservative management of De Quervain’s stenosing tenosynovitis: a case report”. 2012. Journal of the Canadian Chiropractic Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364060/
10. Muscolino, J. 2017. “How do we treat De Quervain’s syndrome with manual therapy?” LMCE. https://learnmuscles.com/product/digital-comt-subscription/
11. “De Quervains Tenosynovitis”. 2023. Digital Health and Care Wales. https://sbuhb.nhs.wales/hospitals/a-z-hospital-services/physiotherapy/musculoskeletal-physiotherapy/hand-wrist-pain/de-quervains-tenosynovitis/
12. Coldham, F. “The use of splinting in the non-surgical treatment of De Quervains disease: a review of the literature.” 2006. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK73300
13. Moore, S. et al. “Practical Demonstrations of Ergonomic Principles”. 2011. CDC. https://stacks.cdc.gov/view/cdc/57870/cdc_57870_DS1.pdf

The post DeQuervain’s Tenosynovitis: Diagnosis, Treatment, and Management appeared first on BTE.

This guide will take you through the many elements of successful clinic marketing with actionable steps to thrive in today’s healthcare market. Here’s what we’ll cover:

1. How to identify your audience
2. How to set your clinic marketing goals
3. Tailor your message
4. Word of mouth marketing for clinics
   • Building customer relationships
   • Measuring patient satisfaction
   • Testimonials
   • Dealing with negative reviews
5. Digital marketing for your clinic
   • Web development
   • Local SEO
   • Blogging
   • Email
   • Social media engagement
6. Content marketing for your clinic
   • How to develop a content marketing plan
   • Types of content marketing for clinical settings
   • Build patient relationships with content marketing
7. Paid ads
   • Paid search engine marketing (SEM)
   • Paid social ads
8. Local community engagement
   • Volunteer opportunities
   • School and local sports teams
   • Workshops
9. Analytics and performance tracking
   • Website analytics
   • Social media analytics
   • Email engagement analytics
   • Paid advertising analytics

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Identify Your Audience

Understanding the target audience is the foundation of every effective clinic marketing strategy. The more specific, the better. It’s not just “people who live here and need these services.” It’s also factors like age, income, occupation, interests, communication preferences, where they seek information, even how they think about healthcare. Some of this information you can find online, some of it you will learn by experience. The bottom line is – by identifying key demographic and lifestyle factors of your potential clients, you can tailor your messaging to resonate with them more effectively.

Set Your Clinic Marketing Goals

Setting clear and measurable goals is crucial to tracking the success of your marketing efforts. Common goals for outpatient therapy clinics include improving retention, reaching a particular population, building online presence, and diversifying referral sources. Many are familiar with SMART goals, meaning Specific, Measurable, Achievable, Relevant, and Time-bound. This is a great way to put your vision into a concrete, actionable plan.

Tailor Your Message

This is where your background preparation will take shape. The more specifically you defined your target audience and goals, the stronger your message will be. Crafting a compelling and relevant message is key to capturing the attention of your audience. Develop messaging that highlights your clinic’s strengths and services and how you can help clients achieve their goals. Instilling a sense of knowledge and confidence will encourage potential clients to choose your clinic.

Word of Mouth Marketing

Did you know that 92% of people trust recommendations from people they know¹? Word of mouth is a huge part of clinic marketing success. This includes building relationships with your current clients, seeking feedback, and generating testimonials. More on each of those next.

Customer Relationships

Establishing strong relationships with your clients is the cornerstone of word-of-mouth marketing. Excellent customer service and personalized care will create a positive patient experience. In turn, satisfied patients are more likely to recommend your clinic to others. If client referrals aren’t a strong source of referrals for your clinic, check out this article for help with expanding your patient base: Clinic Marketing: You’re Doing it Wrong.

Measure Satisfaction and Get Feedback

The best way to improve your patient relationships is to start by measuring your current status. Measuring your clinic’s Net Promotor Score tells you two important pieces of information. First, it indicates current customers’ satisfaction levels. Second, it can project your future growth as a business.

As a bonus, some customers may also take this opportunity to give you feedback on what was helpful and what needs to be improved. Customer surveys like the NPS provide valuable perspective that you and your staff might not realize if you don’t ask. Learn more about how to use the Net Promotor Score for your clinic here: Gauging Your Clinic’s Growth Potential by Asking One Simple Question

Testimonials

A staggering 68% of word-of-mouth referral patients say online reviews were the top reason for their provider selection². Given how much people rely on online reviews, this is a marketing tactic you should take advantage of. The best thing you can do is make it easy for clients to leave you glowing reviews online. Some clinics use a QR code in the lobby or email links to their Google profile for reviews. Plus, you can share these online reviews on your social channels for added positive exposure.

For more guidance, read this article: How To Use Customer Testimonials To Fuel Your Clinic’s Business. Physical therapy, occupational therapy, sports medicine, and chiropractic clinics can attract new patients by showcasing testimonials from past successes

Dealing with Negative Reviews

On the other hand, you may get the occasional negative review. The best way to handle negative reviews online is to respond quickly, hear them out, and address the issue. You can respond directly to the comment online, apologize for the sub-par experience, and invite them to email or call you directly for a resolution. Moving the conversation to email or phone helps prevent it from escalating in a public forum and lets you get more details on their experience. Negative reviews are almost inevitable, but you can use them to repair and strengthen your customer relationships.

Digital Marketing for Clinics

Building your clinic’s online presence is crucial for success. Leveraging multiple digital channels will help you broaden your reach, build relationships, provide valuable healthcare information, and grow your clinic. In this section, we’ll explore several elements of digital marketing for clinics, including web development, local SEO, blogging, email marketing, social media, and content marketing.

Web Development

Your website often provides the first impression to people seeking information about your clinic. A professional and easy-to-use website should accomplish the following:

• Showcase your services
• Highlight the expertise of your staff
• Show patient success stories
• Provide educational content, such as articles and videos
• Allow online booking

Creating and maintaining a quality website does require time and skill. Depending on your goals, you may be able to accomplish this in-house with user-friendly builders like WordPress. However, many small businesses prefer to hire contractors for web development. Professional web developers can create higher-quality sites with advanced capabilities that enhance the overall user experience. This route can save you time and ultimately help grow your clinic.

Local Search Engine Optimization (SEO)

When people search for therapyservices in your area, you want to be one of the first options Google serves up. Search engine optimization (SEO) is the ongoing process of developing your website to do just that. SEO involves several elements that work together over time to boost your rankings. If you’re new to SEO, here are a few simple improvements to get you started:

• Keyword research – Make a list of terms and phrases that you want to rank for, and tailor your web content around those terms
• Meta descriptions – Each page of your website should have a meta description and headings that clearly describe what the page is about and incorporate your keywords assigned to that page
• Test the site / page speed – Use Google’s page speed test to see your website’s performance. The faster your load time, the better. The report includes specific recommendations to improve your speed.

SEO is a topic that deserves its own article, and even its own blog! The world of local SEO is vast, with seemingly endless tips, strategies, and updates (to keep up with ongoing algorithm changes). If you don’t want to tackle this yourself, it’s a good idea to check with a freelance SEO specialist or agency. Outsourcing can save you time and stress, produce better results, and have a positive ROI. Pro tip – most SEO professionals also have the skillset or network to help with your other digital marketing efforts. Finding a freelancer or agency with a broad marketing skillset gives you more benefit for your investment.

Blogging

Blogging is one of the biggest contributors to SEO. Keyphrase-rich articles are an excellent opportunity to educate patients and drive web traffic. Post articles regularly that address common patient concerns, specific diagnoses, treatment techniques, exercise and wellness tips, and other relevant topics.

Producing this content online not only provides helpful info for patients, but it is a strong signal to search engines that your website is a trustworthy source of information. Take it a step further by inviting readers to subscribe to your blog. With a subscription, your audience can  stay up-to-date on the latest posts and clinic announcements. Starting a subscriber list via your blog opens another opportunity for email marketing.

Direct Patient Communication Through Email

You likely already use email for appointment reminders, scheduling, billing, etc., but it’s worth noting here. Email marketing can keep your patients informed about clinic updates, promotions, and healthcare tips. Regular communication helps foster patient relationships and encourages return appointments.

Email marketing platforms like Mailchimp, HubSpot, and Constant Contact can save you time with templates and automated sending. The list of available email platforms, even those that specialize in healthcare, is extensive. Most offer a free version with optional paid upgrades. It will take some research to find the right email platform for your clinic. When browsing, here are the important criteria to look for:

• Number of allowed contacts
• Number of email sends per month
• HTML email templates
• Automated workflows – For example, the ability to automatically send a confirmation email when someone submits a contact form on your website.
• Contact list creation and customization
• Contact profile tagging

Social Media Engagement

We’re well past the days of questioning whether a clinic needs social media. As 41% of people use social media to choose a healthcare provider, the value to your clinic is clearNow it’s a matter of how to engage followers and grow your account.

You don’t have to be an influencer to drive business with social media. But if you’re curious about how influencer accounts build a loyal and engaged audience, read What The Influencers Got Right: Social Media Marketing in Rehab

For most clinics, it’s enough to follow these three best practices: post regularly, create visually engaging content, and interact with the community. Posting frequency isn’t an exact science, but you should aim for at least once per week. Save time by creating a batch of short, simple posts all at once and scheduling them in advance.

Most clinics grow their engagement by posting exercise and wellness tips. Here are a few example posts from clinics with very strong social media following:

Remember, social media engagement is a two-way street. Interact with similar accounts to reach new followers and show your expertise. Accounts like @ThePrehabGuys, @ThePhysioFix, and@OT.4.Lyfe provide an online community for physical therapy, occupational therapy, and other rehab-related content.Explore any of these accounts to see how they leverage content for multiple platforms to grow strong online engagement.

Content Marketing for Your Clinic

Under the umbrella of digital marketing, content marketing is an information-driven strategy. The clinic provides valuable and relevant information, establishing itself as a trusted authority on certain topics. This credibility extends to both patients and search engines, as digital content engagement provides a huge SEO boost. Content marketing is an opportunity to connect with your audience and ultimately create stronger patient relationships and clinic growth.

How To Develop a Content Marketing Plan

Before writing your first blog post, it’s crucial to develop a plan. This plan will serve as a roadmap, guiding your efforts and ensuring that they align with your clinic’s goals. Many of the same general marketing principles apply to content marketing:

• Define your goals – Common goals include increasing retention, attracting a specific type of patient demographic, building your online presence, diversifying referral sources, etc.
• Identify your target audience – Consider factors such as age, gender, location, occupation, interests, pain points, and healthcare preferences.
• Research – Explore the content that’s already available online. Look at your competitors, i.e. other clinics or publishers of similar content. Pay attention to what formats are the most effective, whether blog posts, social media videos, infographics, etc.
• Develop content topics –Brainstorm a list of topics and themes that align with your clinic’s expertise and your audience’s interests. You may also seek input from your clinical staff.
• Publishing schedule – Consistency is key in content marketing. Create a publishing schedule that is reasonable given your resources and ensures a steady flow of fresh material.

Types of Content Marketing for Clinical Settings

The format of your content is just as important as the topic. For the most part, the format will be dictated by the complexity of topic itself and your available resources. The most popular formats are blog posts, videos, and e-books.

Blog posts are a versatile tool for providing articles on specific conditions, patient concerns, treatment techniques, and other relevant topics.  Videos are a highly engaging way to demonstrate exercises, showcase success stories, or do a live Q&A with your clinic staff. E-books are a long-format resource that can delve deep into specific healthcare topics. E-books should be thoroughly researched and carefully planned. Offering free e-books on your website in exchange for contact information is a great way to drive engagement and build your email list.

How To Build Patient Relationships with Content Marketing

Your content should be driven by patients’ questions and concerns. By addressing these issues proactively, you can establish your clinic as a trusted resource. Here are a few ideas to spark your content creation:

• Patient education – Create articles, videos, or e-books about certain conditions, treatment techniques, and recovery processes. Blog posts are a great format for explaining common diagnoses and treatment approaches.
• FAQs – With input from your staff, create a list of frequently asked questions. Create a blog article or web page that provides detailed answers in a Q and A format. This helps patients find information easily and positions your clinic as a reliable source of information.
• Success stories – Include your testimonials in your content marketing. With permission, share success stories from patients who have benefited from your services. Real-life examples demonstrate your expertise and instill confidence in potential patients.
• Prevention and wellness – Offer content on preventive measures and general wellness. Content about a healthy lifestyle can attract a broader audience.

Paid Advertising for Clinics

No discussion of clinic marketing strategy is complete without considering paid advertising. While word-of-mouth and digital marketing can get you far, paid ads can put you farther ahead. Advertising allows you to reach a larger and more targeted audience, driving website traffic, patient inquiries, and appointment bookings. Up next, we’ll explore two options for paid ads: search engine and social media.

Paid Search Engine Marketing (SEM)

Paid SEM places your advertisements at the top of Google’s results page. Of course, there are many search engines, but for our purposes, we will stick to Google Ads (frequently referred to by its former name, AdWords). Search ads allow you to reach a broader audience of qualified individuals – such as someone in your clinic’s zipcode searching for knee pain tips.

With Google’s advertising platform, you are in control. Choose the keywords and phrases you want to target, dial in to audience demographics, and set a monthly maximum budget. It also provides suggested headlines and copy to help populate your writing. Most importantly, Google Ads provides extensive performance metrics. This reporting allows you to track key metrics like clicks, impressions, cost-per-click, and more.

Paid Social Media Ads

Social media ads promote your clinic by getting your chosen post in front of more qualified people. Like SEM, social media ads have the benefit of a wider reach to a targeted audience. Engaging posts encourage likes, clicks, shares, and follows. Depending on your campaign setup, you may even complete appointment bookings directly through the platform.

The most effective social ads are highly visually engaging. Use video, bold images, and carousel ads to showcase your clinic’s facility, staff, success stories, and more. Social media ads allow you to set and adjust your budget to a level that works for your clinic.

Expand Your Geographic Reach

You have probably found that most of your client base is local, living within a few square-mile radius of your facility. Clinics that want to expand that geographic reach can do so by providing engaging, technology-driven rehab. Patients will travel farther to get a unique, interactive therapy experience they can’t get anywhere else. Take a look at this case study where Vereen Rehabilitation expanded their geographic reach thanks to a one-of-a-kind treatment experience.

Local Community Engagement

For immediate impact, however, maximizing the volume of clients you draw from your local community is a great place to start. This is your most fertile field for bringing in new patients. Picking the best channels for promoting your local presence will depend on the demographics and socioeconomics of your community, and on the clinical offerings you want to promote. There is no one-size-fits-all formula, but let’s explore a few of the best tried-and-true tactics many successful clinics are employing.

Volunteer Opportunities

Volunteering your services in the local community is one of the most powerful tools to increase visibility and drive more business. While it may seem paradoxical, offering free services can yield a significant payoff in new patient acquisition. Participating in local community events increases brand visibility, creates valuable personal interactions, reaches people who otherwise may never have heard of your clinic, and as a bonus, presents an opportunity for social media engagement. Read on for three ways to engage your local community.

Fitness Events and School Sports

Increasingly, growth-minded clinics are getting involved in local fitness events, such as races and obstacle course events. Onsite services such as stretching or recovery a great way to develop new patient relationships. Some clinics even go so far as to offer recurring workshops to local schools and athletic teams to establish a relationship and to drive clinic visits down the road.

Community Fairs

Getting involved in non-sports-related events is an oft overlooked opportunity to generate good engagement. Outdoor concerts, holiday festivals, and other fairs offer booth spaces for local businesses. Take advantage of the opportunity to establish local visibility and connect with prospective patients. Your booth can offer basic screening, feedback on musculoskeletal ailments, massage, and information on how your clinic can help their condition.

Condition-specific Workshops

Broad visibility is great, but sometimes you may want to promote your services in a more directly focused manner. Offering workshops specific to certain conditions and treatments is a great way to attract individuals who need your help. Whether you host them at your clinic or a community center, you create the opportunity to engage prospective patients and clearly showcase your clinic’s expertise.

Key Performance Indicators for Clinic Marketing

At BTE, we’re all about tracking performance. Of course, we focus on measuring patient progress with objective clinical tools, but the same goes for clinic marketing. Your digital footprint can become your biggest driver for patient acquisition. But how do you know how effective your website and marketing efforts are? Just like in occupational therapy, physical therapy, athletic training, and chiropractic practice – you need objective measurement to inform your decision-making. Otherwise, you’re just guessing.
The beauty of digital marketing is that it’s all measurable, so you get clear feedback on performance. Whether you want to track website traffic, online form submissions, email opens, views and clicks on your ads, incoming calls, or other marketing KPIs, you can measure it all digitally. These reports will tell you whether your efforts are working, or whether your strategy could use help from an outside marketing specialist.

Website Analytics

Starting with your website performance, Google Analytics is the most robust tool available and it’s free. Google Analytics can get as detailed as you need. You can measure monthly visitors, total pageviews, what pages (or content) draw the most visitors, time on page, traffic source such as social media or search engine, and more.

Chances are, your web designer already set your site up with Google Analytics. In that case, just log in to your account to see your stats and start monitoring progress. If you don’t already have Google Analytics, all you have to do is sign up online with a Gmail account. Then, ask your web designer to simply integrate the analytics code into your website to start collecting data. The entire process should only take minutes. Because Google Analytics offers so much data, you may need support in figuring out how to find what you need. Thankfully, there are a plethora of educational videos online to help you learn the platform.

Additionally, Google Analytics experts are easy to locate as well if you find that you could benefit from some outside help to manage the traffic reporting and make sense of the numbers. For a small investment, you could generate some good returns. Often, Google Analytics experts will also be adept at Search Engine Optimization (mentioned earlier in this piece), so you can benefit from the convenience and cost savings of having the same resource help you in both areas.

Email Marketing Analytics

Other marketing channels like email, social media, and paid advertisements have their own KPIs and systems of measurement. One of the most important benefits of an email management platform like MailChimp is the performance insight. These platforms will report valuable stats like opens (an indicator of subject line quality), clicks (indicator of content quality), spam reports, and more.

Social Media Analytics

Social media analytics are best measured in a third-party platform like Hootsuite. That’s because they will report metrics like followers, impressions, and clicks across all your accounts in one convenient dashboard. These reports combined with the scheduling capability make social media management software a valuable part of your clinic marketing.

Paid Advertisement Analytics

Your paid advertisements have analytics built in. The stats available depend on the structure of your campaign. Basic metrics like impressions (the number of times your ad was shown to a user), clicks, and cost per click are simple ways to track your campaign. More detailed metrics require some research and strategizing to optimize your ad dollars

For example, cost of acquisition tells you the cost of an ad that someone viewed, clicked, and acted on to book an appointment and become a new patient. This metric would require integration with your website analytics or contact management software for a complete picture. You could use this metric to determine whether you need to dial up or down your budget on a certain campaign, and compare digital ads to other marketing efforts in terms of new patient acquisition.

Again, this may be something you want to delegate to a digital marketing specialist. Setting up your advertising and marketing analytics up front will set you up for success in achieving your goals. You’ll learn what works and what doesn’t, where you should cut back or increase spending, which tactics work best for your marketing goals, and how people interact with your clinic online. You’ll never have to wonder, is my marketing working?

Conclusion

As you have seen here, a well-planned clinic marketing strategy can help your physical therapy, occupational therapy, sports medicine, or chiropractic practice thrive. Whether you’re opening a new practice or looking to breathe new life into a longstanding clinic, engaging in these marketing activities will get you to your goals. Understanding your audience, setting clear goals, and tailoring your message are foundational to successful clinic marketing. Nurturing word-of-mouth marketing and cultivating customer relationships will help you establish trust within the community.

Digital marketing spans website development, SEO, blogging, email and social media to create a strong online presence for your clinic. Augment your efforts with content marketing that builds mutually beneficial relationships between your clinic and potential patients. Paid advertising channels like SEM and social media expand your reach even further. Local community engagement creates positive interactions and local recognition of your clinic. Throughout the process, analytics reports will inform your decision making. Clinic marketing strategies that blend tradition with innovation will help your clinic thrive, ensuring a prosperous future in the ever-evolving healthcare landscape.

If you found this article helpful, explore our other articles on clinic marketing, practice management, treatment tips, clinical research, and more. Subscribe to TherapySpark to get monthly updates on all things rehab.

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References

1. Nielsen. (2012). Global Trust in Advertising and Brand Messages. https://www.nielsen.com/insights/2012/global-trust-in-advertising-and-brand-messages-2/
2. Pew Research Center. (2011). Online Search Summary Charts. https://www.pewresearch.org/internet/2011/02/01/summary-charts/
3. Brevo. How to Use Email Automation Software for Marketing. https://www.brevo.com/blog/email-automation-software/
4. Search Engine Watch (2012). 33% of US Consumers Use Social Media for Health CareInfo (Survey). https://www.searchenginewatch.com/2012/04/22/33-of-u-s-consumers-use-social-media-for-health-care-info-survey/

The post Everything You Need To Build a Clinic Marketing Strategy appeared first on BTE.

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Documenting Functional Loss for Personal Injury

Documenting functional loss is a critical part of personal injury cases. This clinical data indicates the severity of the injury and supports the provider’s recommendation for treatment. When followed by a re-evaluation after treatment, this data should show exactly how the patient has progressed and whether they need additional treatment.

To support these clinical recommendations in a personal injury case, the evaluation should include objective measurement. This is where Dr. Munderloh’s MCU program stands out.

Using the MCU’s evaluation protocol, Dr. Munderloh measures both strength and range of motion of the cervical spine and generates a report showing the patient’s deficits. “For personal injury cases, it justifies functional loss and medical necessity. We always use the MCU for documentation purposes,” says Dr. Munderloh.

Dr. Munderloh gets referrals from other providers who have heard about the MCU ­– typically, pain management groups and personal injury attorneys. He says the MCU’s objective evaluation and documentation are what attract these personal injury referrals.

“They think it’s amazing to see it and they’re impressed we have this technology in our clinic,” says Dr. Munderloh.

Unlike many rehab scenarios, personal injury involves what’s known as “sincerity of effort.” At times, a patient may not be exerting their best effort during an evaluation. If this happens, the MCU’s data capture software will recognize abnormal levels of effort. “You can’t fake out the machine,” says Dr. Munderloh.

For those who are interested, here’s how that works: the patient’s effort is indicated by the test’s coefficient of variation. During an isometric strength test, the patient performs their best push three times in a row. Someone giving their best effort every time will have a very low coefficient of variation across the three pushes. A high number means the level of effort was inconsistent, and the clinician should remind the patient to give their best effort. The patient cannot see the screen during testing, so the clinician only needs to cue them when to start.

Motivating Patient Compliance

Patient compliance is key for any successful treatment, but especially for complex issues like neck pain. With the MCU, Dr. Munderloh says patients are fully committed to completing the full course of treatment.

With a new patient, Dr. Munderloh starts by showing blinded progress reports from past clients. He also educates them on the importance of strengthening the neck. When clients understand how the treatment benefits them, they’re more compliant, which ultimately leads to long-term relief.

When patients get their initial evaluation report, it’s usually the first time they’ve seen their condition visualized in a concrete way. The report shows exactly where the weakness or imbalance is, and a target range for where their strength and range of motion should be after completing the program.

For people suffering from chronic neck pain, the reports are a powerful visualization and motivator. “People like to know what their problem is, and the reports are really good for that,” says Dr. Munderloh.

Strengthening the Neck for Lasting Relief

Dr. Munderloh treats a wide range of patients at his practice. He recommends the MCU for any patient with any cervical condition, from chronic neck pain to post-fusion recovery.

“We can isolate muscles specifically in the neck and strengthen those,” he says. Rather than other practices that might use methods like elastic bands, Dr. Munderloh takes a more targeted treatment approach by strengthening the neck muscles in isolation. With the MCU, Munderloh can identify the specific side, angle, and movement for improvement – for example a left 45* flexion that is 30% below the healthy strength range for that patient.

“Patients are more compliant, and it’s significantly easier to use and more accurate than JTECHs,” says Dr. Munderloh. Traditional hand-held tools lack the MCU’s ability to pinpoint weakness and asymmetry, compare that with normative data on both strength and ROM, document functional improvements, and facilitate individually dosed exercise sessions.

Dr. Munderloh says this technology absolutely sets his clinic above others. The MCU keeps patients engaged and provides a higher standard of care. “If someone increases their strength 10-20%, that can completely eliminate your neck pain, and in our experience, the results have been long lasting,” says Dr. Munderloh.

Post-cervical Fusion Recovery

Dr. Munderloh recalls one particularly memorable recovery with a patient who had undergone cervical fusion surgery. One year after the surgery, the patient showed muscular degeneration above the fused segments. Manipulation wasn’t an option, so he recommended gradual strengthening with the MCU. The results were amazing.

“We tripled his strength in 20 visits and completely eliminated his neck pain.”

The built-in Neck Disability Index provided a powerful visual motivator as the pain rating decreased with each visit. Dr. Munderloh says the MCU produced “impressive results in a relatively short amount of time.”

Generating Referrals

With results like this, word quickly got around in the local community. Dr. Munderloh began getting referrals for the MCU by word of mouth. He’d send MCU progress reports to the other doctors and attorneys working on his clients’ personal injury cases, which sparked their curiosity. He would then host tours of his clinic where he’d explain how the MCU works along with other modalities for well-rounded care.

The high compliance rate and objective proof of progress make his clinic the preferred choice for personal injury referrals. He says, “Nobody else is able to really quantify people’s strength in this area.”

The ability to document progress with objective data make his personal injury reports virtually indisputable. “It’s based on the numbers and how they feel,” he says.

Objective Evaluation + Evidence-based Treatment

Whether for injury recovery or chronic neck pain, patients who come to Dr. Munderloh are ready for help. He frequently sees people who have tried “everything else.” Combining the MCU with other modalities like cervical traction, adjustment, and nutrition, he is able to provide lasting relief. The MCU’s objective evaluation reports identify specific areas for improvement, which guide the treatment progression. Exercise sessions apply evidence-based strengthening for a personalized experience for every patient.

Ready to see what the MCU can do for your practice? Contact us for a quote on a new or Certified Pre-Owned MCU.

The post Bulletproof Your Personal Injury Case: Documentation, Compliance, and Care with MCU appeared first on BTE.

• Diabetes
• Alcoholism
• Heart and vascular issues
• Smoking

Dupuytren’s can mimic a few other common hand conditions. That being said, once you’ve seen a few people with the ailment, diagnosis and treatment are fairly straightforward.²

In this post, we’ll take a deeper look at Dupuytren’s Contracture and cover some key topics related to diagnosing and treating this condition.

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Diagnosing Dupuytren’s Disease

Dupuytren’s Contracture occurs due to a thickening of the fascia on the palmar side of the hand. As a result of this thickening, the affected fingers will often move into a flexed position, which tends to get worse over time.³

However, multiple different conditions lead to flexed, seemingly stuck fingers. For instance, stenosing tenosynovitis (trigger finger) may affect the flexor tendons of one or more fingers, leading to the curling of said digits.⁴ Additionally, injuries to the median or ulnar nerve may present similarly to Dupuytren’s.

Unfortunately, there aren’t many accurate, specific tests for Dupuytren’s. Often, the clinician will need to simply rule out other common conditions and make a diagnosis based on patient history, functional ability, and any other information available.

Below, I’ll list a few tests and diagnostic methods that can be used for this condition. However, it bears repeating that these tests should not be relied upon in isolation for a diagnosis of Dupuytren’s.

Tabletop Test

A simple and informal measurement, the tabletop test requires the patient to lay his hand on a flat surface, palmar side down. If he is unable to extend his fingers, creating a flat hand, this is considered a positive finding indicative of Dupuytren’s.⁵

As you might have guessed, there hasn’t been a ton of research done on this special test. Seeing as it is a very basic assessment, it’s not to be relied upon for diagnostic purposes in the absence of other data.

Palpation

Palpating the palm can help to identify some of the characteristic nodules and tissue thickening seen in Dupuytren’s contracture. Palpation (when combined with visual inspection, detailed below) is one of the most crucial aspects of the evaluation. Identifying the deformity through palpation can go a long way toward making a diagnosis.

Visual Inspection

Dupuytren’s can affect one or more fingers. However, it most commonly affects the fourth and fifth digits. The affected flexor tendon will often appear to be thick, tight, and may look to be almost pressing through the skin, like a taut cord.

By simply visually inspecting the palmar surface of the hand, clinicians can be fairly confident in their diagnosis of Dupuytren’s.

Management of Dupuytren’s

Treating Dupuytren’s is a tricky prospect. Patients frequently need surgery, but some conservative treatments can provide relief.^,7 Below, we’ll review some of the common non-surgical and surgical options available for Dupuytren’s.

Massage

Some patients with Dupuytren’s elect to pursue non-surgical options. Massage is often the first go-to technique. Various massage methods can work, but transverse friction massage seems to be the obvious choice for this condition.

By applying pressure perpendicularly to the line of the affected tendons, the rehab professional can provide relief from the constant tightness present in the condition.⁸

Exercise

Especially in the early stages of Dupuytren’s, exercise can preserve the strength and mobility. While it might not counteract the progressive flexion, exercise can keep the patient as active and functional as possible.

Exercise is also often indicated after injection or surgery. Resuming flexibility and strengthening exercise is a key component of the rehab process.

Surgery

Surgery for Dupuytren’s seeks to release the trapped tendons.⁹ Depending on the patient’s age and the severity of the condition, surgery can significantly help patients find relief and improve function.

Unfortunately, even with surgical correction, the contractures may reoccur. This may necessitate multiple surgeries.

Injections

Collagenase injections are a popular treatment option for Dupuytren’s. Interestingly, these injections seem to be effective for many people, leading to long-term improvement.¹⁰ These treatments tend to be well-liked by both patients and providers due to the long-lasting effects and because they provide an alternative to surgery.

Manipulation

Often paired with injections, manipulation of the affected finger joints can provide relief and improved mobility. Manipulations can be performed soon after the injection, or even up to seven days post-injection. Some studies cite positive results regardless of the timing of the manipulation.¹¹

Conclusion

Dupuytren’s contracture is a progressive condition which affects the tendons of the hand. This issue is often diagnosed through a combination of visual examination, palpation, physical testing, and ruling out other similar issues.

Treatment for the condition often involves surgery and/or collagenase injections. While rehab professionals may not have many tools to combat the disease progression, they certainly can help clients maintain strength and mobility in the hand after surgery or injection. Also, nonsurgical options are necessary for those patients for whom surgery and injections are contraindicated.

Bennett Richardson, PT, DPT, CSCS is a Physical Therapist and writer. He is the owner of Richardson PT LLC, a mobile, cash-based physical therapy service out of Pittsburgh, PA. Ben is passionate about many health-related topics including weight loss and athletic performance. To get in touch with Ben, visit www.richardsonpt.com

References

1. Salari, N., Heydari, M., Hassanabadi, M. et al. The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 15, 495 (2020). https://doi.org/10.1186/s13018-020-01999-7
2. Dutta A, Jayasinghe G, Deore S, Wahed K, Bhan K, Bakti N, Singh B. Dupuytren’s Contracture – Current Concepts. J Clin Orthop Trauma. 2020 Jul-Aug;11(4):590-596. doi: 10.1016/j.jcot.2020.03.026. Epub 2020 Apr 15. PMID: 32684695; PMCID: PMC7355095.
3. Grazina R, Teixeira S, Ramos R, Sousa H, Ferreira A, Lemos R. Dupuytren’s disease: where do we stand? EFORT Open Rev. 2019 Feb 20;4(2):63-69. doi: 10.1302/2058-5241.4.180021. PMID: 30931150; PMCID: PMC6404791.
4. Gehring MB, Yang K, Zein Eddine SB, Hettinger PC. Abstract: Correlation between Stenosing Tenosynovitis and Dupuytren’s Contracture in the Hand. Plast Reconstr Surg Glob Open. 2018 Sep 26;6(9 Suppl):65-66. doi: 10.1097/01.GOX.0000546804.58887.89. PMCID: PMC6212047.
5. Field PL, Hueston JT. Articular cartilage loss in long-standing immobilisation of interphalangeal joints. Br J Plast Surg. 1970 Apr;23(2):186-91. doi: 10.1016/s0007-1226(70)80036-4. PMID: 5428674.
6. Eckerdal, D., Nivestam, A. & Dahlin, L.B. Surgical treatment of Dupuytren’s disease – outcome and health economy in relation to smoking and diabetes. BMC Musculoskelet Disord 15, 117 (2014). https://doi.org/10.1186/1471-2474-15-117
7. Ball C, Izadi D, Verjee LS, Chan J, Nanchahal J. Systematic review of non-surgical treatments for early dupuytren’s disease. BMC Musculoskelet Disord. 2016 Aug 15;17(1):345. doi: 10.1186/s12891-016-1200-y. PMID: 27526686; PMCID: PMC4986253.
8. Christie, W. S., Puhl, A. A., & Lucaciu, O. C. (2012). Cross-frictional therapy and stretching for the treatment of palmar adhesions due to Dupuytren’s contracture: A prospective case study. Manual Therapy, 17(5), 479–482. https://doi.org/10.1016/j.math.2011.11.001
9. Aykut S, Baydar M, Büyük AF, Öztürk İA, Özden E, Öztürk K. Surgical treatment results for dupuytren’s disease. Acta Ortop Bras. 2017 May-Jun;25(3):71-73. doi: 10.1590/1413-785220172503164827. PMID: 28642664; PMCID: PMC5474406.
10. Nordenskjöld J, Lauritzson A, Åkesson A, Atroshi I. Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands. Acta Orthop. 2019 Dec;90(6):517-522. doi: 10.1080/17453674.2019.1663472. Epub 2019 Sep 10. PMID: 31500473; PMCID: PMC6844429.
11. Reynolds B, Tobin V, Smith JA, Rozen WM, Hunter-Smith DJ. The effectiveness of manipulation of fingers with Dupuytren’s contracture 7 days after collagenase clostridial histolyticum injection. Journal of Hand Surgery (European Volume). 2020;45(3):286-291. doi:10.1177/1753193419890770

The post Dupuytren’s Contracture: A Debilitating Condition of the Hand appeared first on BTE.

OT Practice magazine by AOTA gathered expert advice from those who know how to start, run, and grow a successful Occupational Therapy clinic. Discover helpful insights from management consultants, experienced managers and owners, and experts in clinic growth, compliance, and more.

Featuring BTE’s own John Vermette, Director of Provider and Product Management, this article details first-hand lessons on managing your practice. Click below to read the full article.

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The post Building Your OT Practice: Advice from Industry Leaders appeared first on BTE.