How To Transition Physical Therapy Patients To Fitness Facility Members
By: Patricia Amend and Teri Wingender,
with Matt Serlo
Physical therapy programs pose great demands on patients, especially those who have never exercised before but who are determined to work hard to rebuild their bodies and their lives. For the duration of the prescribed physical therapy program, adherance is rarely a problem, as there are scheduled appointments with trained personnel to lead the patient through the first part of recovery. Once discharged from physical therapy, however, patients are left to rely on themselves to adhere to post-rehab exercise programs outside of the clinic, and most often neglect to follow through.
Unfortunately, how well and how quickly they completely recovery from their injuries depends on how well they follow their programs. This provides health clubs with a unique opportunity: not only can they help these people continue their rehab programs, but they can help them to make exercise a regular part of their lives -- and new members of the health and fitness facilities.
A sample program
"Most people are pretty compliant when they're in the clinic," says David Griffith, a physical therapist in Virginia Beach, Va. "Once they leave the borders of [the] clinic, it's really tough to get them to see the need for exercise." That's where a fitness facility can help. This summer, HealthSouth, an outpatient physical therapy organization that has more than 1,400 therapy clinics discharging more than 1 million patients per year, introduced Recovery and Beyond, a post-therapy care plan that transitions patients from therapy to regular exercise programs at technology-equipped fitness facilities.
Using a technology-based training network, HealthSouth and local facilities help rehab patients become lifelong, committed exercisers. To date, the program has been implemented at HealthSouth's flagship Birmingham, Ala., facility and a Virginia Beach, Va., facility.
"We believe that this is a great opportunity to
expand our continuum of care for patients, beginning at the time of injury, continuing through recovery and now extending to the maintenance stage," says Richard Scrushy, HealthSouth's chairman of the board and chief executive officer. "Patients will be able to continue their recovery process more effectively after they leave our outpatient centers. Facilities will benefit from access to a stream of post-therapy patients, and HealthSouth will extend its relationship with patients
Technology to help recovery
Using a program such as Recovery and Beyond, a therapist develops a patient's exercise plan, including descriptions, illustrations and demonstrations of each activity. After discharge, patients transfer the therapist's recommended workout program to a fitness center. In the facility, electronic pieces of equipment can provide the patient with exercise feedback, which should be supported by the expertise and encouragement of fitness staff members. Back at the clinic, the therapist can access exercise data to measure a patient's performance and progress. At home, the patient can review the therapist's plan and track personal progress through the Internet.
"Technology can now close the gap between the therapist and the patient," says Matt Serlo, clinical administrator and physical therapist at HealthSouth in Birmingham, Ala. "Once patients have left my clinic, they can access their program on the Internet. Each week, they'll get additional information specific to their injury. In addition, patients can ask questions during and after therapy."
Says Griffith, "This program is increasing the compliance after therapy. You know that when the patient is released, not only do they have the motivation to go to the fitness facility, but they've got staff there who are going to help them, and encourage them, which is what we do in the clinic setting."
Transitioning from rehab
Because patients are often concerned about how much they will have to spend by joining a facility, especially after paying substantial physical therapy or doctor bills, Griffith suggests that facilities offer post-rehab patients a two-week free trial. "Most patients are willing to try out the facility, risk-free. I think it's much more likely to keep that person as a member."
People are identified as rehab patients with a coupon that they bring into the facility. "If fitness staff [members] have any question about a patient's recovery or the program," says Griffith, "they'll give us a call or they can access a patient's exercise program from the Internet. The fitness facilities that our patients use have trained and certified staff, so [we] know that they're getting quality instruction."
The fitness facility can also become a social outlet for patients. New friends can motivate each other: they feel like they're letting each other down if they don't go. "Motivation becomes a byproduct of the personal interaction," says Griffith.
Also, patients who make the transition from a clinical setting to a fitness facility can feel more control over their fitness programs. "I think they feel more responsible for how they do," says Griffith. "[With] computers [they can] see how much they lifted today versus yesterday, and they can push themselves to higher levels of performance."
Creating lifelong exercisers
According to the results of a study conducted in 1999, technology can increase compliance with post-therapy programs. The study was conducted at Physical Therapy Sports Rehab at The Club at Woodbridge in Woodbridge, N.J. It followed a group of men and women who had shoulder disorders (impingement, decompression, strain, dislocation, rotator cuff tendonitis and tear) who were referred to physical therapy by a physician.
The patients were assigned to "standard treatment" or "treatment with technology" groups within a combined physical therapy/fitness setting. Treatment protocols for both groups consisted of three exercise sessions per week for up to 10 weeks. Identical protocols were used for both groups, and the clinical outcomes were identical.
The study showed that technology can have a positive impact on the efficiency of the therapists, and on the likelihood that patients would transition to maintenance routines after therapy. Twice as many of the technology users in the study transitioned to a maintenance exercise program compared to those in the control group.
Strong ties that patients form with fitness facility staff and other facility members also helps keep them at the club. "They have camaraderie because there are a lot of people doing exercise for similar reasons," says Griffith.
Technology-equipped fitness centers and healthcare
Technology has the potential to impact the effectiveness and efficiency of healthcare, with its ability to track patient performance and promote wellness services on a national level. "It has been a real treat to have the ability ... to produce data, which I have often forwarded to physicians, given to patients
:and kept in my own files as part of medical records. It has truly made my job easier and significantly more objective
," says Penny Kilgore, P.T.A., at the Pensacourt Sports Center in Pensacola, Fla.
"Significant efforts to improve quality of care while controlling costs will be an ongoing challenge," says Douglas Ribley, director of fitness and wellness with Akron General Health System. "With the feedback and monitoring that technology provides, the system is of great benefit to the physical therapy industry, as well as to exercisers who want to maintain a safe and results-oriented exercise regimen."
HealthSouth is expecting that its program will not only benefit recovering athletes, but also seniors and people who have previously led inactive lifestyles, a demographic that is becoming important to many fitness facilities.
For many fitness centers, a successful partnership with a therapy provider can lead to a stream of highly qualified new prospects, and an enhanced image as a community wellness center. FM
A Patient's Perspective
Last Memorial Day, my volleyball league had our first tournament, and I tore my ACL. I needed a tendon transplant and major surgery on my knee. I had been advised that I was going to get a lot of muscle atrophy, so, between the injury and the operation, I trained on the bicycle in a knee brace to help me prepare for surgery.
After surgery, I worked with a physical therapist who designed a graduated program to help me rehabilitate as quickly as possible without re-injury. After three weeks, when I regained flexibility in the joint, I realized I could do my rehab program at [a fitness center]. Then, once a week, I went to my physical therapist, who wrote a report. However, the report [was] inconclusive because they'd have to take my word about what exercise I'd been doing.
So, one week, I brought my computerized exercise report to my physical therapist.... Then, I took my physical therapy report with my exercise report as an attachment to my orthopedist.
There's absolutely no doubt in my mind that the electronic encouragement and personal feedback from technology ... helped spur me on to a quicker, more thorough rehabilitation.
I'm in the best physical shape of my life since the military.... I've been working out with a knee brace, [and] I have a new appreciation for what athletes coming back from injury go through. I want to continue to live a physically active life and to feel good.
Different people need different kinds of encouragement to incorporate exercise into their lifestyle. Fitness technology [can] help people feel like they're making progress. Getting that continual feedback is supportive of maintaining a behavior that is sometimes difficult to sustain."
-- Dennis McDowell,
member of Cowart Family Ashford Dunwoody YMCA, Atlanta, Ga. Director, public health training network, and director, division of media and training services, for the Centers for Disease Control and Prevention in Atlanta, Ga.
About Patty Amend
Patricia Amend has been writing for fitness and medical journals for the past 15 years. Her second book, The 30-Minute Fitness Solution: A Four-Step Plan for Women of All Ages, co-authored with JoAnn Manson, M.D., will be published by Harvard University Press in 2001.
About Teri Wingender
Teri Wingender writes about fitness, health and nutrition for national magazines and the web. She is an AFAA-certified personal trainer.
Matt Serlo is the facility administrator for the HealthSouth facility in Birmingham, Ala.