Patient Self Monitoring to Transfer Physical Therapy Exercise from Clinic to Home (Washington)

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Summary:

Each year, more than 17 million patients are diagnosed with conditions that might benefit from physical therapy. Although adherence to home exercise is the most important factor in functional recovery, patients often fail to perform the exercises correctly or as frequently as prescribed. Factors that affect adherence include patients’ feelings of helplessness and level of motivation, methods and adequacy of instruction, and physical therapists’ guidance and encouragement.

This project developed an image-based electronic health record (IBEHR) to give patients visual feedback in real time and provide accurate information on home exercise to the physical therapist. The IBEHR shows patients their exercise performance by recording an avatar when they exercise at home and comparing it with an avatar recorded of the patient exercising correctly in the clinic under the physical therapist's supervision. The IBEHR reveals deviations from correct exercise form to help patients perform their exercise correctly.

The specific aims of this project were to:

  • Develop the software for synchronizing the clinic and home avatars, aligning them, and measuring deviations.
  • Perform alpha and beta testing. The alpha test measures the limits of accuracy of body tracking by the IBEHR. The beta test verifies that the user interface is easy to use by both physical therapists and patients.
  • Assess the efficacy of the IBEHR to improve adherence in 60 patients with anterior knee pain or anterior cruciate ligament (ACL) injury.

The hardware and software for IBEHR was developed and underwent alpha and beta testing. The initial study plan had been to evaluate the impact on adherence of IBEHR for those with anterior knee pain or ACL injuries. However alpha testing found inaccuracies in the software’s ability to track lower extremity exercises. Despite modifications to the software, the accuracy was unable to be improved. When testing showed that these exercises could be more accurately tracked in shoulder injuries, the clinical target was changed. Implementation of the IBEHR for shoulder pain was completed and an exercise library for shoulder pain in various medical conditions was developed. Beta testing was completed with one physical therapist and three patients. All reported the system easy to use. The planned clinical testing of the system was not completed during the grant term due to lack of time.

The project team concluded that currently available IBEHR technology is accurate at tracking exercise involving the upper but not the lower extremity. Given the speed at which the field is moving it is likely that lower extremity tracking will be possible in the near future. The results of this research demonstrated a high level of acceptance of the IBEHR by both the physical therapist and patients. Its ready acceptance demonstrates the potential value of IBEHR for helping patients transition from clinic to home-based physical therapy exercise.

Patient Self-Monitoring to Transfer Physical Therapy Exercise from Clinic to Home - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 021733
  • Project Period: 
    September 2012 – March 2014
  • AHRQ Funding Amount: 
    $298,834
  • PDF Version: 
    (PDF, 201.3 KB)

Summary: Each year, more than 17 million patients are diagnosed with conditions that might benefit from physical therapy. Although adherence to home exercise is the most important factor in functional recovery, patients often fail to perform the exercises correctly or at the frequency prescribed. Adherence depends on feedback from the exercise prescriber, which patients typically only receive at clinic visits that may be weeks apart. Infrequent contact and minimal monitoring of patients’ home exercises also makes it difficult for the physical therapist (PT) to determine why patients fail to recover as expected.

This project is developing an image-based electronic health record (IBEHR) to give patients visual feedback in real time, comparing their performance at each repetition at home with a personal avatar created from a recording of themselves performing the exercise correctly in the clinic under the PT’s supervision. The patient can then transmit recordings of home exercise to the PT for rapid review and feedback. By recording the exercise performed at home, the IBEHR provides monitoring data that informs the PT whether the patient adhered poorly to the prescribed exercise frequency or duration, performed the exercise incorrectly, or if a different exercise would be more beneficial.

Specific Aims:

  • Develop the software for synchronizing the clinic and home avatars, aligning them, and measuring deviations. (Ongoing)
  • Perform alpha and beta testing. The alpha test measures the limits of accuracy of body tracking by the IBEHR. The beta test verifies that the user interface is easy to use by both PTs and patients. (Ongoing)
  • Assess the efficacy of the IBEHR to improve adherence in 60 patients with anterior knee pain or anterior cruciate ligament (ACL) injury. (Upcoming)

2012 Activities: Dr. Sheehan and her team are completing the design of the IBEHR. Testing to measure the accuracy of IBEHR body tracking began with upper-body portions of the product. Dr. Sheehan has received institutional review board approval and the University of Washington has initiated a patent process for this device. Dr. Sheehan is working with a co-investigator at the University of Washington Sports Medicine Clinic to refine the IBEHR in preparation for patient recruitment.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

* This target population is one of AHRQ’s priority populations.

Patient Self Monitoring to Transfer Physical Therapy Exercise from Clinic to Home - Final Report

Citation:
Sheehan F. Patient Self Monitoring to Transfer Physical Therapy Exercise from Clinic to Home - Final Report. (Prepared by the University of Washington under Grant No. R21 HS021733). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 325.28 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 
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