The Impact of Digital MSK on Rehab Therapy Patient Success 

As a rehab therapy patient who’s been treated for several injuries, including tears in the labrum, meniscus, and ACL, SaRA Health founder Steven Coen considers himself an outlier when it comes to home exercise program (HEP) compliance. 

“I am one of those patients who, if you tell me to do six exercises, I’m going to do them, and I’m going to record my sets, my reps, and even which color of band I used,” said Cohen, also a Masters National Olympic Weightlifter. “I would do a motion tracking app if you asked me, or you could give me stone tablets to record my sets and reps, and I’d do it.” 

This dedication makes Coen an ideal patient, especially when an estimated 50% of people in treatment are not compliant with prescribed home exercise programs.¹ Despite his laser-focus, however, Coen found the lack of communication between visits disconcerting. 

Between visits, Coen had questions. Should he be feeling pain when performing specific home exercises or activities? Should he be concerned by the decreased range of motion in his hip? Besides obvious pain points, what else should he be noting about his recovery between visits that could help speed recovery? 

“You’re lucky if you remember the last 12 hours of symptoms unless you’ve been writing it down,” he said. “I loved my time in the clinic (being) treated by amazing clinicians, but the lack of continuity between visits just frustrated me to no end. I felt like recovery started and stopped in the clinic.” 

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Healthcare Consumers Welcome Digital Options 

In essence, Coen desired what today is called a hybrid model for his rehabilitative care, an approach that combines in-person visits with digital touchpoints to enable better patient-clinician engagement. This desire to “solve the problem of patient engagement” led to his and a partner’s founding of SaRA Health, which is an automated platform that provides remote therapeutic monitoring (RTM) services for rehab therapy clinics. 

From a patient’s perspective, however, Coen’s desire for better patient-therapist connectivity puts him in good company with a growing number of healthcare consumers who say they are ready to adopt greater digital functionality. 

Sensing an opportunity to bolster efficiency, reach, and outcomes as the industry moves toward value-based care, rehab therapy clinic operators are responding to these demand-based statistics. While some early adopters are far ahead of the curve when it comes to achieving these goals using digital musculoskeletal (MSK) care tools, most practices find themselves in a similar place:

They know their clinics and patients could benefit from using digital MSK tools and services; they just don’t know how to apply these efforts in the most effective ways.

In this chapter, we will discuss the concept of hybrid care – what it is, and why clinics are finding it as an optimal way to serve a variety of patient populations. We will also review ways rehab clinic operators can roll out their first patient-centered digital MSK service.

A Hybrid Approach to Patient-Centered Care

There was a stretch during the pandemic when digital care was an all-or-nothing scenario – when telehealth offered the only means to see many patients during lockdowns. Today’s approach to digital MSK has evolved into a hybrid model.

An effort derived from the wider adoption of digital tools and services by clinicians and their patients, a hybrid model of care combines the benefits of in-person rehab therapy with the accessibility of digital MSK. The result is that patients receive more individualized, convenient, and effective care based on both clinical and non-clinical needs.

“The hybrid model enables care pathways to be personalized in a way that they’ve never been, which improves patient outcomes [and] improves patient satisfaction,” said CityPT founder Andrew Shirk. CityPT is an independent digital platform that empowers rehab therapy clinicians to deliver care digitally, directly to their patients.

“Ultimately, we found that you really have to remain flexible to patient preferences and expectations if you want to start and build lasting, trusting relationships with patients,” Shirk continued. “My vision is more of an omni-care approach where we’re constantly providing care to our patients through any channel that they need at any time, or they can summon up their therapist or some agent that represents their therapist [when needed].”

In other words, hybrid care is not a single approach to patient care. It’s a customized approach that, thanks to the use of digital MSK tools and services, enables practitioners to meet individual patients where they are – based on the needs and the cadences of their lives.

Utilizing Your Digital MSK Toolbox for Hybrid Care

For some patients, the optimal pathway to recovery may involve only in-person visits and an independent home exercise program. For others, it could include a combination of in-person and telehealth visits, with RTM check-ins between appointments. When necessary, some patients can even benefit from just seeing rehab therapists virtually. (See the Patient Story below.)

The ability and willingness to enable patients to “choose their own adventures,” so to speak, is what makes hybrid unique from programs that only offer in-person or virtual care.

The level of flexibility offered to patients, of course, is dependent on the number of digital MSK tools a clinic has in its toolbox. It also depends on practitioners’ willingness to use these tools, which may include a mix of:

• Telehealth
• Patient portals
• Direct secure messaging
• Digital home exercise programs
• Automated reminders (email or text)
• Outcomes tracking and management
• Wearable technologies
• Generative AI applications

Ivy Rehab Network, for example, is ahead of the curve when it comes to the size of its digital toolbox. Along with telehealth and RTM services, Ivy also uses predictive analytics tools to help determine which care pathways are likely to be most successful for patients based on their demographics and past experience at the clinic.

Patient diagnoses no doubt play a role in helping to determine these pathways, said Marla Ranieri, PT, DPT, OCS, Vice President of Innovation and Clinical Excellence at Ivy Rehab. However, patient demographics and personal conditions (i.e., social determinants of health) also carry a lot of weight.

“I think of behavioral economics as in, how are we changing the way [patients] behave and helping them understand and really connect with us on the plan of care?” Ranieri said. “Some of that is through hybrid – offering those touchpoints [that] make it easier and accessible and just part of their lives versus, ‘I have to make it to my physical therapy appointment clinic two or three times a week. I can’t manage that. That’s too much.’”

Remote Therapeutic Monitoring as a Hybrid Solution

One of the more timely and effective examples of a hybrid digital MSK service is remote therapeutic monitoring (RTM). A reimbursable way for rehab therapists to track patient adherence and progress between regular appointments, RTM can take on several forms while utilizing a number of different digital MSK tools.

For example, RTM can be as simple as a phone call, text, or direct message that enables rehab therapists or care navigators to personally check in on the progress of patients. The same can also be done via telehealth tools, which further enable practitioners to review mechanics, range of motion, etc., providing an opportunity to teach patients new or modified exercises, as needed.

And, of course, wearable devices and generative AI technologies are emerging as other ways for rehab therapists to track a patient’s journey more fully outside the clinic.

Regardless of form, however, early studies indicate that RTM programs are positively impacting patient success. Not only is the additional engagement reducing the number of self-discharges, but the patients who are completing their plans of care are more likely to reach their recovery goals.

One case study by SaRA Health, for example, found that at a single practice, Medicare patients who used RTM consistently achieved better outcomes in fewer visits and at a lower cost of care.³ These lower costs, however, don’t necessarily mean less revenue for the clinic thanks to the use of CPT codes for the reimbursement of RTM services.

“Just because there was a lower total cost of care does not mean the practice was worse off financially,” Coen said. “Even though there are fewer visits, which I know is typically a big red flag for a lot of practice owners, especially private practice owners, these [CPT] codes are extremely high margin and need to be in the calculus for how you think about the use of digital tools for RTM.”

Tips for Building Your Clinic’s Digital MSK Toolbox

With all the hats rehab therapy clinic owners and operators already wear on a daily basis, the prospect of investing in and rolling out a new digital service may seem overwhelming. As the rehab therapy landscape continues to evolve, however, those who fail to adapt to digital trends and the demands of healthcare consumers run the risk of falling behind in their markets.

For those who feel behind the digital MSK curve, however, don’t fret. Building your clinic’s repertoire of digital MSK tools and services should be a deliberate (not rushed) process that will be as unique as your clinicians and patients.

To get started, consider the following expert tips for rolling out a patient-centered digital MSK tool or service:

1. Start with a Small Pilot Program

Bringing experience piloting programs that developed online scheduling, text, and telehealth tools during the pre-pandemic era, Raniera joined the Ivy Rehab Network team to help its clinics successfully move forward into the clinical landscape.

She suggests that if your clinic is new to the digital MSK landscape, start by considering a readily available service within your existing EHR/EMR software (i.e., telehealth, digital HEP, etc.). Contact your EHR/EMR rep to learn what they offer, which may seamlessly integrate with the software.

“Don’t roll it out to everyone,” she said. “Start with a small pilot and roll it out to a therapist or group of therapists that are interested in it. You want to use your most engaged therapist who will support and drive the initiative to set it up for success.”

Coehn agrees with finding an in-house champion who’s been eager to incorporate digital elements into the way they interact with patients.

“Every practice we go to, there’s always one or two people who are rip-roaring ready to do this,” he said. “Let them become the super users who help drive these services forward. And if it works out and leads to great outcomes, they can help you sell it much easier to the rest of the practice.”

2. Set Specific and Measurable Goals

Just as rehab therapists instruct patients that they can’t achieve goals that aren’t specific, measurable, achievable, relevant, and time-based (SMART), clinicians should heed their own advice when establishing a new digital tool or service.

“Pilots are failures if you don’t know what you’re going to measure,” Ranieri said. “So, you have to decide what it is that you want to achieve with your program and how you’re going to measure the success of that.”

If the goal, for instance, is to improve outcomes, patient-reported surveys and outcome measurement tools may be used to measure success. If it’s to reduce the number of patient drop-offs, missed appointment numbers and plan-of-care success rates will be important to track.

“You really have to decide what it is that you want to achieve by implementing this technology service, take the baseline, then implement and see if it is improved afterwards and if it’s the right platform, service, or technology for you,” Ranieri said. “Final words of encouragement – there is never a good time, and you will always be ‘too busy.’ Don’t let that stand in your way. Make innovation a priority for your company, and always be thinking about how you could serve your patients better.”

3. Tap into the Experience of Others

No rehab therapy clinic should feel alone along the journey toward a digitally enhanced future. From individual clinics to large professional associations like the American Physical Therapy Association (APTA), rehab therapists with experience implementing new digital MSK tools for outpatient care are often eager to offer tips and advice.

The APTA, for instance, offers such resources as a Telehealth Certification Series, RTM resources, assessments on individual health app safety and effectiveness, and a wealth of other knowledge related to digital MSK. Click here to learn more.