July 12, 2022 | Net Health

6 min read

FOTO: Celebrating 30 Years of Using Data to Advance Physical Therapy

A former president of the Washington Physical Therapy Association (WPTA), FOTO® co-founder Ben Johnston was an active participant in the American Physical Therapy Association’s (APTA’s) lobbying efforts during the 1990s.

Net Health has partnered with APTA to bring you the future of virtual physical therapy. Learn about Digital MSK.

These efforts served to strengthen his resolve, and that of fellow FOTO® co-founder Al Amato, that data was going to be critical for the future advancement of the physical therapy profession.

“I can remember sitting in a Medicare executive committee hearing doctors out there wondering, out loud, whether physical therapy had any value at all,” Johnston said. “At one time people viewed physical therapy as a hot massage. There wasn’t any data – none whatsoever – that proved physical therapy worked … that it changed people.”

Of course, physical therapy does change people. The wider acceptance of this statement is something we may take for granted today.

But, 30 years ago – back in 1992, when Johnston and Amato built the foundation of what would become FOTO patient outcomes, now a Net Health® company – there was scant data to support this claim.

By the time Johnston attended the committee hearing, however, he, Amato and the FOTO® team were already in the process of perfecting the capture of valid, reliable and risk-adjusted outcome measures that helped lead the profession into the 21st Century.

And throughout the last three decades, as patient assessments exceeded 44 million and participating clinicians surpassed 24,000, FOTO® has continued to remain active in both publishing research and sharing data for others’ research that may lead to improvements in, and a better understanding of, physical therapy’s impact on healthcare outcomes.

Over this time, in fact, FOTO® has provided data for use in 127 studies published in peer-reviewed journals1.

“Our data was right at the forefront of the research that proved that physical therapy was of benefit,” Johnston said. “We were able to stand up to Medicare to prove – and show through data – that it was a valuable and reimbursable service.”

Using Data to Drive Change in Rehab Therapy

According to both Johnston and Amato, FOTO® started off as a consortium of five corporate-level physical therapy entities. In 1992, these entities pooled resources to develop a pencil-and-paper survey meant to capture data related to patient outcomes.

The information collected by the consortium drew interest within a profession that longed for data. But, encouraging a wider population of PTs to participate in its collection proved difficult.

For starters, the patient survey was 17 pages long. In addition, many smaller practice owners were hesitant to share patient information with their corporate counterparts, causing all five corporate entities to pull their support from FOTO®’s efforts.

Unwilling to give up, however, Amato purchased FOTO® and put Johnston in charge of operations. They soon hired Dennis Hart, PT, PhD, as their Director of Research and Development.

“From the very beginning, we knew the basis of the outcomes tools developed in the late 80s and early 90s had flaws,” Amato said. “For the next 16 to 18 years, Dennis continued perfecting the tools we used to measure outcomes. It got more sophisticated.”

FOTO®’s paper survey evolved into a single page before eventually becoming computerized, using sophisticated algorithms to ask patients questions through computer adaptive testing (CAT) in 2004.

“We were the first and ultimately became the largest outcomes measurement reporting system in the world,” Amato said. “We had more data than anybody else did. When we were able to computerize the process … it was probably three or four years after that, we had enough data where Dennis and his colleagues were able to apply the data and [were] able to report.”

FOTO® also began to realize a number of corollary applications for their data which reached beyond simply learning how patients responded to care. Rehab therapists could utilize the data, along with FOTO’s machine learning predictive analytics models, to evaluate individual practitioners, improve reimbursement, determine educational needs within a practice, and even market their clinics.

A Long-Time Resource for Researchers and Practitioners

Today, as we commemorate 30 years as the top rehab therapy database for patient outcomes, demographics and more, reflecting the real world of clinical practice in the U.S., FOTO® continues to support the future of healthcare as a resource for both researchers and care providers.

The FOTO database has been regularly utilized by researchers from top U.S. and international academic universities as well as industrial leaders in healthcare research.

Such research has regularly proven the reliability and validity of the FOTO patient-reported outcome measures and analytic models.

Studies using FOTO data have also shined a light on the overall effectiveness of the profession while continuing to drive meaningful change throughout rehab therapy. Clinical research FOTO data has supporting include topics such as:

  • Associations between telerehabilitation and outcomes during the COVID-19 pandemic2
  • Efficient screening for fear of movement in outpatient settings3
  • The impact of physical therapy residency or fellowship education on clinical outcomes for patients with musculoskeletal conditions4
  • Associations between interim patient-reported outcome measures and functional status at discharge from rehabilitation for non-specific lumbar impairments5
  • Implications of practice setting on clinical outcomes and efficiency of care in the delivery of physical therapy services6

And of course, FOTO® has become a powerful system of tools for individual rehab therapists and clinical teams who seek real-time information on treatment effectiveness and efficiency. These tools enable them to manage quality care metrics, track patient satisfaction and market their successes.

“From the very beginning, we’ve tried to encourage researchers to use our data for the betterment of the physical therapy profession,” said Amato. “We have been in the forefront from the very beginning in supporting outcomes research not only in our own internal staff, but anyone else who has a valid research question.”

Harnessing the Past to Create Better Futures in Therapy

The role of Predictive Analytics in Outpatient Rehab Therapy.


1 FOTO Patient Outcomes, “FOTO Peer-Reviewed Articles”
2 NIH: National Library of Medicine, “Is Telerehabilitation a Viable Option for Patients with Low Back Pain? Associations between Telerehabilitation and Outcomes during the COVID-19 Pandemic,” Feb. 23, 2022
3 NIH: National Library of Medicine, “Efficient Screening for Fear of Movement in Outpatient Settings: Short Form and Computer Adaptive Tests for Fear Avoidance and Negative Pain Coping,” Feb. 1, 2022
4 NIH: National Library of Medicine, “The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients with Musculoskeletal Conditions,” February 2015
5 Springer Nature, “Associations Between Interim Patient-Reported Outcome Measures and Functional Status at Discharge from Rehabilitation for Non-Specific Lumbar Impairments,” Sept. 30, 2019
6 Journal of Orthopaedic & Sports Physical Therapy, “Implications of Practice Setting on Clinical Outcomes and Efficiency of Care in the Delivery of Physical Therapy Services,” Oct. 28, 2014

Share this post

Subscribe and See More