What Data Can Do for Patient Engagement in MSK Care

Musculoskeletal (MSK) care practitioners currently face two distinct but related problems:

1) Helping patients understand what you – the practitioner – see.

2) Building care programs around what patients value most: their recovery goals.

Outpatient rehabilitation practitioners such physical therapists (PTs), are movement experts and work to improve their patients’ movement capabilities every day. Unfortunately, the kind of data needed to truly inform these movement-based interventions is sufficiently lacking, which is largely due to an absence of adequate technology and tools. These specialists rely on subjective, yet specialized judgement to determine aspects of movement quality. This type of observational analysis is standard practice in most clinical settings, but it isn’t always the most reliable, or scalable, and requires years of practice to become most proficient.1,2

How Do You Know if Patients ‘Get it’?

A problem in MSK injury assessment, both at the individual and population level, is that while it is expertly subjective with years of education and practice, it is still subjective. Actual movement has never been quantified in a way that can transfer to basic population-level knowledge or for general practice management. Even Patient Outcome Registries, which are common tools used by PTs and physicians for determining intervention efficacy, length of stay and satisfaction, do not include objective metrics.

For example, one of the most common outcome measures used for a variety of musculoskeletal (MSK) conditions and other pathologies is the 6 Minute Walk Test (6MWT).3 The test is exactly like it sounds: patients walk as far as possible in six minutes and are not allowed to sit or lean against a wall during the test (standing breaks are allowed). The test is very simple to administer and has been validated for many different uses, including gait analysis. It can be assumed that an improvement in the 6MWT corresponds to an improvement in performance by the patient, particularly cardiovascular fitness. However, it fails to quantify the movement strategy used during the test. Let’s say the patient is recovering from a knee injury when they take the 6MWT. Questions a practitioner looks to answer:

How much are they limping during the test?

• How much knee flexion is occurring during the swing phase of gait?

• How much knee extension is present during heel strike and weight acceptance?

• How much more symmetrical is the patient’s gait now, compared to the first physical therapy session? How far away is their current movement from their personal goals?

This type of information is paramount to determining the health and movement optimization of the patient, but unfortunately, practitioners cannot extract that from most of the outcome measures currently available in the healthcare industry.

Using Data to Open the Doors of Communication and Understanding

Many results of standard tests and measures in the MSK practitioner world mean very little to the patient and there is often a lack of visual education. Here is some feedback a patient could receive: “Your 6 Minute Walk Test result suggested a clinically important difference not caused by measurement error.” While indicative of effective care, this is not a statement that encourages patient buy-in or repeated healthier habits.

• What if patients could see an optimal 6MWT side by side to their 6MWT results, along with graphical information about how and where there are differences?

• What if a patient was able to see progress from their first 6MWT (from three weeks ago) and how they were progressing after doing their home exercise program (HEP) and two other intervention sessions with their PT?

What happens when movement becomes data to be understood by patients? What happens when patients have “ah-ha!” moments with their practitioner? What happens in behavior and relationships when patients see their own movement visualized and aligned with the words of their practitioner? Trust happens. Engagement happens. Patients stay with the clinic for their full course of care, and they reach their movement health goals.

The concept is clearly highlighted when examining MSK overuse conditions. We know that poor movement can lead to degenerative issues like tendinopathy from repeated tasks performed in both work and sport.4-5 These types of injuries are some of the most common MSK-related disabilities, but current attempts to address workplace movement health have been underwhelming and ineffective.6 This suggests a weakness in provider education and a misunderstanding of the importance of patient movement optimization. There is a disconnect between how movement variables are presented and how they are then interpreted and applied to an individual circumstance.

Making Movement Real

Connecting movement health to our life does not start and stop at the doors of an outpatient clinic or doctor's office. Integrating movement health into all aspects of a broader definition of health and wellness is the clear next frontier of how to approach our physical and mental health. But it needs to be understandable, relatable and contextualized to our own individual goals.

We need to make movement real and actionable for the benefit of both healthcare practitioners and patients. Effective care relies heavily upon our ability to create a therapeutic alliance or strong patient-practitioner rapport. We do this with soft skills, professional skills and proper patient education, all of which play important roles in the perceived value of our interventions.7 Without movement quality data, the full potential of therapeutic alliance has yet to be realized. Moving tests and measures into a digital space leads us to not only creating higher patient engagement but provides us with new methods for helping patients achieve their expected movement goals.

Alex Bryce, Practitioner-in-Residence at linedanceAI

Alex Bryce, MSE, CSCS, is the Head Coach at Strength Care Consultants, and is a Certified Strength and Conditioning Specialist. He is currently pursuing his Doctorate in Physical Therapy at Arcadia University, has earned his Master’s Degree in Exercise Science from the University of Kansas, and obtained his Bachelor’s Degree in Strength and Conditioning with a Minor in Sport Nutrition from the University of Connecticut. Coach Bryce has a unique blend of academic knowledge and real-world experience, working with a number of world champion athletes across a variety of sports. Alex on LinkedIn

References

1. Brunnekreef, J.J., van Uden, C.J., van Moorsel, S. et al. Reliability of videotaped observational gait analysis in patients with orthopedic impairments. BMC Musculoskelet Disord 6, 17 (2005). https://doi.org/10.1186/1471-2474-6-17

2. Viehweger E, Zürcher Pfund L, Hélix M, et al. Influence of clinical and gait analysis experience on reliability of observational gait analysis (Edinburgh Gait Score Reliability). Ann Phys Rehabil Med. 2010;53(9):535-546. doi:10.1016/j.rehab.2010.09.002

3. Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness--a systematic review. Physiotherapy. 2012;98(4):277-286. doi:10.1016/j.physio.2011.11.003

4. Warden SJ. Animal models for the study of tendinopathy. Br J Sports Med. 2007;41(4):232-240. doi:10.1136/bjsm.2006.032342

5. Barr AE, Barbe MF, Clark BD. Work-related musculoskeletal disorders of the hand and wrist: epidemiology, pathophysiology, and sensorimotor changes. J Orthop Sports Phys Ther. 2004;34(10):610-627. doi:10.2519/jospt.2004.34.10.610

6. McCaughey, D., McGhan, G., Walsh, E. M., Rathert, C., & Belue, R. (2014). The relationship of positive work environments and workplace injury. Health Care Management Review, 39(1), 75-88.

7. Babatunde F, MacDermid J, MacIntyre N. Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature [published correction appears in BMC Health Serv Res. 2017 Dec 12;17 (1):820]. BMC Health Serv Res. 2017;17(1):375. Published 2017 May 30. doi:10.1186/s12913-017-2311-3