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Outcomes Software Answers the Hard Questions for PTs

Positive feedback doesn't always signal successful intervention. A patient who is feeling better may also be feeling afraid to be fully functional.

Graeme Keys, PT, Dip. MDT, COMT, CMP, has found that free of pain doesn't mean free of fear. It's the one piece of data the traditional indexes couldn't show him.

So, he turned to tech.

“Therapists are great at being therapists, but we're not great at asking psycho-social questions," says Keys, clinic director at East Tennessee Spine & Sport Physical Therapy. "We might get a feel for someone, but when a computer asks it, it's much easier for us."

Keys has used FOTO to collect and tabulate clinical outcomes since 2003. Prior to that, he used paper and pen surveys, namely the Oswestry Disability Index, the Neck Disability Index (NDI) and the Rolland-Morris Disability Questionnaire. Not only was the statistical analysis complex and time-intensive, it didn't tell him what he truly wanted to know.

His current outcomes management system says a lot about a patient they might not share in person or even on paper, he says. The iPad is mightier than the pen when it comes to patient honesty about their condition, especially fear.

"I use the software to tell me if I'm on the right path and then use it some more to tell me if they're fearful, if they're worried about re-injury, if they're still not functionally capable,” he says. “Then I'm going to spend the time adjusting their treatment plan to get them exposed to those activities and solutions to get them better."

This form of "listening" falls right in line with the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) that he practices. It is founded on the principle of listening to collect a comprehensive history of the patient before treatment begins.

The evidence-based MDT system begins with a thorough mechanical evaluation to establish a “cause-and-effect” relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.

A systematic progression of applied mechanical forces utilizes pain responses and mechanical responses to classify the disorder. Clinicians then develop a specific plan of care based on those examination results that empowers patients to treat themselves when possible.

"I have to be assessing and re-assessing as we go through each visit," Keys says. "The software's become a piece of my assessment.

"To me that's become a very useful component to care. When it tells me that they have elevated fear on the first visit, then that's already on my mind," he says. "But, also I can look at this data and say ‘OK how can I use this to help me give better care.’”

The data analyzed by the system is risk-adjusted for age, body-type and situation, so he gets an accurate picture of what can be expected from treatment. It tells him how many visits, length of treatment and a percentage of expected improvement.

This sets the baseline for Keys, who says he can now do more than simply "fix" the problem.

His meeting and beating of those numbers keep his practice on the right track as well. Outcome data is compared with the thousands of other users of the outcomes management system.

The benchmarking also tells him a lot about his staff - where they excel and where they might need some additional training. Keys and his practice routinely ranks near the top, a success he attributes to the McKenzie Method.

"I love to have real, true quality control just by looking at scores," he says.

But, above all, the software helps him shift from working on pain to helping the person.

“MDT is about treating the patient to be more functional and then to manage it on their own. I cannot be fully helping them to manage it on their own unless I understand their limitations as much as possible," Keys says. “It was something I might have had a gut feeling about, but I wasn’t sure how valid it was.

“Now, I’ll still have that same gut, but I’ve also got the data to support that,” he says.


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