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Topp R, Greenstein J, Etnoyer-Slaski J. The effect of a mobile health App on treatment adherence and revenue at physical health clinics: a retrospective record review. JMIR Rehabil Assist Technol 2023; 10:e43507. [PMID: 36889337 PMCID: PMC10131932 DOI: 10.2196/43507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND A significant proportion of patients do not adhere to their prescribed course of physical therapy or self-discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contribute to patients achieving the goals of therapy including reducing pain and increasing functioning. Online platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain similar to managing them in person. Behavioral change techniques introduced through digital or online platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. The literature also indicates that a phone-based App provided to patients that includes a reward incentive gamification to complement their care contributed to a greater number of kept appointments in a physical therapy clinic. OBJECTIVE The purpose of this study was to compare the rate of provider-discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based App to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based App to complement their care. METHODS A retrospective analysis of all new outpatient medical records (n=5,328) from a multisite physical health practice were evaluated between January 2018 to December 2019. Patients in the sample self-selected into the 2018 Usual Care Group, the 2019 Usual Care Group and the 2019 Kanvas App Group who downloaded the Kanvas App. Kanvas is a customized private practice App, designed for patient engagement with their specific health care provider. This App included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record each patient was classified as completing prescribed therapy (Provider-Discharged) or not completing their prescribed therapy (Self-Discharged). Also, extracted from each patient's medical record were the total number of clinic visits each patient attended, the total charges for services and the total payments received by the clinic per patient. RESULTS Patients in the 2019 Kanvas App Group exhibited a higher rate of provider-discharge compared to the patients who did not adopt the App. This greater rate of provider-discharges among the patients who adopted the Kanvas App likely contributed to this group attending more clinic visits (13.21+12.09) than the other study groups who did not download the App (10.72+9.80 - 11.35+11.10). This greater number of clinic visits in turn contributed to the patients who adopted the App generating more clinic charges and payments. CONCLUSIONS Future investigators need to employ more rigorous methods to confirm these findings and healthcare providers need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas App. CLINICALTRIAL
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Affiliation(s)
- Robert Topp
- The University of Toledo, 3000 Arlington Ave, Toledo, US
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Heij W, Sweerts L, Staal JB, Teerenstra S, Adang E, van der Wees PJ, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Implementing a Personalized Physical Therapy Approach (Coach2Move) Is Effective in Increasing Physical Activity and Improving Functional Mobility in Older Adults: A Cluster-Randomized, Stepped Wedge Trial. Phys Ther 2022; 102:pzac138. [PMID: 36200397 PMCID: PMC10071485 DOI: 10.1093/ptj/pzac138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/06/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether the superior cost-effectiveness of a personalized physical therapy approach (Coach2Move)-which was demonstrated in a previous trial compared with usual care physical therapy (UCP)-can be replicated in daily clinical practice. METHODS A multicenter, cluster-randomized, stepped wedge trial with 4 clusters consisting of 4 physical therapist practices in the Netherlands was used to compare a personalized physical therapy approach to elicit physical activity (Coach2Move) versus care as usual. Multilevel analyses for effectiveness were conducted for the amount of physical activity (Longitudinal Aging Study Amsterdam Physical Activity Questionnaire) and functional mobility (Timed "Up & Go" Test) at 3, 6 (primary outcome), and 12 months' follow-up. Secondary outcomes were level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient-Specific Complaints Questionnaires), quality of life (Euro Quality of Life-5 Dimensions-5 Levels [EQ-5D-5L]), and health care expenditures. RESULTS The 292 community-dwelling older adults with mobility problems visiting physical therapists were included in either the Coach2Move (n = 112; mean [SD] age = 82 [5] years; 60% female) or UCP (n = 180; mean [SD] age = 81 (6) years; 62% female) section of the trial. At baseline, Coach2Move participants were less physically active compared with UCP participants (mean difference = -198; 95% CI = -90 to -306 active minutes). At 6 months, between-group mean differences [95% CI] favored Coach2Move participants on physical activity levels (297 [83 to 512] active minutes), functional mobility (-14.2 [-21 to -8]) seconds), and frailty levels (-5 [-8 to -1] points). At 12 months, the physical activity levels of Coach2Move participants further increased, and frailty levels and secondary outcomes remained stable, whereas outcomes of UCP participants decreased. After the Coach2Move implementation strategy, physical therapists utilized significantly fewer treatment sessions compared with before the implementation (15 vs 22). Anticipated cost savings were not observed. CONCLUSION This study replicated the results of an earlier trial and shows that Coach2Move leads to better mid- and long-term outcomes (physical activity, functional mobility, level of frailty) in fewer therapy sessions compared with UCP. Based on these and earlier findings, the implementation of Coach2Move in physical therapist practice is recommended. IMPACT This article describes the implementation of the Coach2Move approach, a treatment strategy that has proven to be cost-effective in a previously conducted randomized controlled trial. Implementation of Coach2Move in a real-life setting allowed an evaluation of the effects in a clinically relevant population. Coach2Move has been shown to increase physical activity, improve functional mobility, and reduce frailty more effectively compared with UCP therapy and therefore has application for physical therapists working with older adults in daily clinical practice. LAY SUMMARY Coach2Move is a new physical therapy approach for older adults. Implementation of Coach2Move in daily clinical practice can help people better outcomes over a longer period of time against similar costs compared with regular physical therapy.
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Affiliation(s)
- Ward Heij
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
| | - Lieke Sweerts
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
| | - J Bart Staal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
- Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Health Evidence, Section Biostatistics, Nijmegen, the Netherlands
| | - Eddy Adang
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, the Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | | | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
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Carpenter CR, Southerland LT, Lucey BP, Prusaczyk B. Around the EQUATOR with clinician-scientists transdisciplinary aging research (Clin-STAR) principles: Implementation science challenges and opportunities. J Am Geriatr Soc 2022; 70:3620-3630. [PMID: 36005482 PMCID: PMC10538952 DOI: 10.1111/jgs.17993] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
The Institute of Medicine and the National Institute on Aging increasingly understand that knowledge alone is necessary but insufficient to improve healthcare outcomes. Adapting the behaviors of clinicians, patients, and stakeholders to new standards of evidence-based clinical practice is often significantly delayed. In response, over the past twenty years, Implementation Science has developed as the study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners and policymakers. One important advance in Implementation Science research was the development of Standards for Reporting Implementation Studies (StaRI), which provided a 27-item checklist for researchers to consistently report essential elements of the implementation and intervention strategies. Using StaRI as a framework, this review discusses specific Implementation Science challenges for research with older adults, provides solutions for those obstacles, and opportunities to improve the value of this evolving approach to reduce the knowledge translation losses that exist between published research and clinical practice.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brendan P Lucey
- Department of Neurology, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Beth Prusaczyk
- Department of Medicine Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Thackeray A, Waring J, Hoogeboom TJ, Nijhuis-van Der Sanden MWG, Hess R, Fritz JM, Conroy MB, Fernandez ME. Implementing a Dutch Physical Therapy Intervention Into a U.S. Health System: Selecting Strategies Using Implementation Mapping. Front Public Health 2022; 10:908484. [PMID: 35899163 PMCID: PMC9309571 DOI: 10.3389/fpubh.2022.908484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoach2Move is a person-centered physical therapy intervention that has demonstrated success in changing physical activity behaviors among older adults in the Netherlands. In this manuscript, we describe how we developed an implementation plan for Coach2move in a U.S. population and healthcare system using Implementation Mapping.MethodsWe established an implementation planning team of researchers, patients, and clinicians. The Consolidated Framework for Implementation Research provided an overall structure for consideration of the context for implementation. Implementation Mapping guided the planning process. The implementation planning team worked sequentially through the five tasks of Implementation Mapping (1) Identify needs, program adopters and implementers; (2) Identify adoption and implementation outcomes, performance objectives, determinants, and matrices of change; (3) Choose theoretical models and implementation strategies; (4) Produce implementation protocols; (5) Evaluate implementation outcomes. In this manuscript, we identify our evaluation plan but not results as data collection is ongoing.ResultsClinic managers and physical therapists were identified as program adopters and implementors. Performance objectives necessary steps to achieving implementation outcomes were linked to Coach2Move fidelity indicators with implementation by the physical therapist. These included delivery of person-centered care, motivational interviewing, meaningful goal setting, shared decision-making in planning, and systematic monitoring and follow-up. Determinants linked to these performance objectives included knowledge, outcome expectations, skills and self-efficacy, and perceived norms. Implementation strategies were selected based on a review of methods effective for influencing these determinants. This resulted in four primary strategies (1) educational meetings and dynamic training, (2) peer-assessment meetings, (3) changing the electronic health record template, and (4) reminders and prompts. Measures of intervention acceptability, appropriateness, and feasibility will be collected after training and early in implementation. Fidelity and effectiveness measures will be collected over the next 12-months.ConclusionImplementation mapping provided a systematic process for identifying what physical therapists would need to implement Coach2Move with fidelity. The result was a matrix linking behavioral determinants and performance objectives. These matrices of change allowed for systematic identification and tailoring of implementation strategies to the needs of our population and setting. The process was acceptable to diverse stakeholders, facilitated communication across stakeholders.
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Affiliation(s)
- Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Anne Thackeray
| | - Jackie Waring
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rachel Hess
- Division of Health System Innovation and Research, Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Molly B. Conroy
- Department of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Groot L, Gademan MGJ, Peter WF, van den Hout WB, Verburg H, Vliet Vlieland TPM, Reijman M. Rationale and design of the PaTIO study: PhysiotherApeutic Treat-to-target Intervention after Orthopaedic surgery. BMC Musculoskelet Disord 2020; 21:544. [PMID: 32795283 PMCID: PMC7427768 DOI: 10.1186/s12891-020-03511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background Physiotherapy is a proven effective treatment strategy after total knee and hip arthroplasty (TKA/THA), however there is considerable practice variation regarding its timing, content and duration. This study aims to compare the (cost-) effectiveness of a standardized, treat-to-target postoperative physiotherapy strategy with usual postoperative care. Methods Using a cluster randomized study design, consecutive patients scheduled for a primary TKA/THA in 18 hospitals in the Netherlands will be assigned to the treat-to-target physio therapy strategy or usual postoperative care. With the treat-to-target strategy a standardized, individually tailored, exercise program is aimed at the attainment of specific functional milestones. Assessments are done at baseline, 6 weeks and 3, 6, 9 and 12 months follow up. The primary outcome will be the Knee injury / Hip disability and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS / HOOS-PS) at 3 months follow up. Secondary outcomes are the numeric rating scale for pain, the Oxford Knee and Hip Scores, performance-based test and the EuroQol 5D-5L for quality of life. Healthcare use, productivity and satisfaction with postoperative care are measured by means of questionnaires. In total, 624 patients will be needed of which 312 TKA and 312 THA patients. Discussion The study will provide evidence concerning the (cost-) effectiveness of the treat-to-target postoperative physiotherapy treatment compared to usual postoperative care. The results of this study will address an important evidence gap and will have a significant impact in daily practice of the physio therapist. Trial registration Registered in the Dutch Trial Registry on April 15, 2018. Registration number: NTR7129.
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Affiliation(s)
- Lichelle Groot
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands. .,Department of Orthopedic Surgery, LUMC, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Maaike G J Gademan
- Department of Orthopedic Surgery, LUMC, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Clinical Epidemiology, LUMC, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wilfred F Peter
- Department of Orthopedic Surgery, LUMC, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wilbert B van den Hout
- Department of Medical Decision Making & Quality of Care, LUMC, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Hennie Verburg
- Department of Orthopedic Surgery, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedic Surgery, LUMC, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands
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Heij W, Teerenstra S, Sweerts L, Staal JB, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Implementation of a Cost-Effective Physical Therapy Approach (Coach2Move) to Improve Physical Activity in Community-Dwelling Older Adults With Mobility Problems: Protocol for a Cluster-Randomized, Stepped Wedge Trial. Phys Ther 2019; 100:653-661. [PMID: 31846501 PMCID: PMC7297439 DOI: 10.1093/ptj/pzz183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/08/2019] [Accepted: 08/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Coach2Move is a personalized treatment strategy by physical therapists to elicit physical activity in community-dwelling older adults with mobility problems. OBJECTIVE The primary objective of this study is to assess the effectiveness and cost-effectiveness of the implementation of Coach2Move compared with regular care physical therapy in daily clinical practice. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION A multicenter cluster-randomized stepped wedge trial is being implemented in 16 physical therapist practices (4 clusters of 4 practices in 4 steps) in the Netherlands. The study aims to include 400 older adults (≥70 years) living independently with mobility problems and/or physically inactive lifestyles. The intervention group receives physical therapy conforming to the Coach2Move strategy; the usual care group receives typical physical therapist care. MEASUREMENTS Measurements are taken at baseline and 3, 6, and 12 months after the start of treatment. The primary outcomes for effectiveness are the amount of physical activity (LASA Physical Activity Questionnaire) and functional mobility (Timed Up and Go test). Trial success can be declared if at least 1 parameter improves while another does not deteriorate. Secondary outcomes are level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient Specific Complaints questionnaire), quality of life (EQ-5D-5 L), and health care expenditures. Multilevel linear regression analyses are used to compare the outcomes between treatment groups according to an intention-to-treat approach. Alongside the trial, a mixed-methods process evaluation is performed to understand the outcomes, evaluate therapist fidelity to the strategy, and detect barriers and facilitators in implementation. LIMITATIONS An important limitation of the study design is the inability to blind treating therapists to study allocation. DISCUSSION The trial provides insight into the effectiveness and cost-effectiveness of the Coach2Move strategy compared with usual care. The process evaluation provides insight into influencing factors related to outcomes and implementation.
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Affiliation(s)
- Ward Heij
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, the Netherlands,Address all correspondence to Mr Heij at:
| | - Steven Teerenstra
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Health Evidence, Section Biostatistics
| | - Lieke Sweerts
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare; Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics
| | - J Bart Staal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare; and HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, the Netherlands
| | | | - Thomas J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare
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Cantone M, Santos G, Wentker P, Lai X, Vera J. Multiplicity of Mathematical Modeling Strategies to Search for Molecular and Cellular Insights into Bacteria Lung Infection. Front Physiol 2017; 8:645. [PMID: 28912729 PMCID: PMC5582318 DOI: 10.3389/fphys.2017.00645] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/16/2017] [Indexed: 12/13/2022] Open
Abstract
Even today two bacterial lung infections, namely pneumonia and tuberculosis, are among the 10 most frequent causes of death worldwide. These infections still lack effective treatments in many developing countries and in immunocompromised populations like infants, elderly people and transplanted patients. The interaction between bacteria and the host is a complex system of interlinked intercellular and the intracellular processes, enriched in regulatory structures like positive and negative feedback loops. Severe pathological condition can emerge when the immune system of the host fails to neutralize the infection. This failure can result in systemic spreading of pathogens or overwhelming immune response followed by a systemic inflammatory response. Mathematical modeling is a promising tool to dissect the complexity underlying pathogenesis of bacterial lung infection at the molecular, cellular and tissue levels, and also at the interfaces among levels. In this article, we introduce mathematical and computational modeling frameworks that can be used for investigating molecular and cellular mechanisms underlying bacterial lung infection. Then, we compile and discuss published results on the modeling of regulatory pathways and cell populations relevant for lung infection and inflammation. Finally, we discuss how to make use of this multiplicity of modeling approaches to open new avenues in the search of the molecular and cellular mechanisms underlying bacterial infection in the lung.
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Affiliation(s)
| | | | | | | | - Julio Vera
- Laboratory of Systems Tumor Immunology, Department of Dermatology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum ErlangenErlangen, Germany
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