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"Wiihab" Hurts my Brain!

ArtwiirehabapI’m still conflicted about this whole Wii-physical therapy link.  One side of me cringes when the concept of Wiihab has become so pervasive that, indeed, a phrase has been coined.  One side of me asks, "Is it so bad?  Maybe it’s professional insecurity creeping up on me that drives my discontent related to Wii-habilitation?"

I do know that I have almost completely stopped reading my Google News "physical therapy" feed.  It seems like for any 20 articles about physical therapy, 19 of them are about this clinic or that clinic using a Nintendo Wii. 

This is not my first post about the conflict the Wii presents.

I was glad to see Science Blogger, Karen Ventii brings this up on her blog, Science to Life.  She points out the lack of science behind the use of the Wii, and even points us to a pending study on just that topic.  She has a nice video parody of Wiihab linked in as well.

The thing is, I don’t care if there is science that says a Wii produced good results in a physical therapy setting.  I really don’t!  Here is why:

Movement, coordination, muscle control, etc., all combined is not a new concept for physical therapists.  We know how these principles impact healing and outcomes, which is why function and active-based treatments are the hallmarks of physical therapist treatments.  Exercise with a Wii, my friends, will only ever be functional for helping people to play the Wii. 

If you, as a patient, suffer from such disinterest in your health and how your body works that you need a toy to provoke interest in healing, I say, "Shame on you!"

And will all those articles on Wiihab please also mention two things:  1)  The clinic in this article is looking for gimmicky, cheap press, and, 2) physical therapists (good ones, at least) do not provide painful, dreadful treatments that are so awful as to require a parlor trick to enable a patient’s endurance of said treatments!

Come on, Wiihab providers!  Are you physical therapists, medical professionals with a doctorate-level education and significant musculoskeletal expertise, or are you a sideshow performer interested in games and cheap thrills?  I guess it depends on whether you give out stuffed animals to patients who beat the video games prior to discharge!

I guess I’m less conflicted than I thought on this…

ERIC

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New PT Blogs!

I’ve often opined about the lack of Physical Therapist presence in the blogosphere.  Earlier this month I issued this challenge and a call for PT’s to become bloggers. 

I’m happy to report that a few took up the challenge and we now have more than 3 PT-penned weblogs!  No small feat, as committing to a solid blog is a significant undertaking.  You need to be brave enough to write what others might see, tech-savvy enough to design a nice page, and dedicated enough to post regularly.

Now, before I offer an introduction to your PT-penned blogs, I must issue another call to action.  You see, blogs need readers.  More than that, they need subscribers.  Thousands of people read the Evidence in Motion blog, but surprising few have subscribed to these other PT related blogs.  My call to action then becomes a call for you to go visit these blogs, subscribe to the feed (or e-mail subscription if you must) and support your hard-working, brave colleagues!

As an aside, you will notice that all these blogs are written by men, leaving Rachael Lowe’s Physiospot Blogs as still the only one hosted by a woman (although we should point out Selena Horner’s posts on EIM) in this largely female profession.  Ladies:  Join in!   

Check em out!

 

Physical Therapist Rover

Physical Therapist Rover

A student-penned blog written by Johnny May.  This blog is a well-written glimpse inside the profession from a student’s perspective.  But you may find Johnny is more than a student, he’s an entertainer as well.

 

 

Evidence Based Rehab

Evidence Based Rehab

Written by Jason Harris, who should be complimented for his use of the new BPR3 blogging standard when presenting posts on peer-reviewed research.

 

The Physical Therapy Etcetera Blog

The Physical Therapy Etcetera Blog

Mark Schwall wants to tell you about Zotero, among other physical therapy related news and topics, etc.

 

So there you have it.  If anyone needs any blogging advice, I’m always available.  Contact info can be found near my bio.

ERIC

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PT Journal 2.0!

Ptj_rss_screenshot

Congratulations to PT Journal for finally getting an RSS feed on their website!!!  Content syndication, podcasts, iTunes subscribe-ability, debates, wow!  These simple, yet totally useful add-ons to the website have really elevated the quality of the journal’s website and now allows readers to have a richer experience during their visits and learn about new evidence in a timely, "push" format. 

For those not in the know…the secret is the little RSS icon in the image above.  What’s RSS?  Find out here.

Now, on to JOSPT…. 

ERIC

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How representative are blogs?

Question A previous post noted the fact that physicians outnumber physical therapists in their authorship of blogs.  I wonder how representative blog writing is of general technology use by medical professionals.  If we assumed maintaining a blog was something that technology savvy individuals tend to do, we could say that physical therapists are losing the technology race to physicians.  Does this lag extend into maintaining electronic health records in clinical practice? 

Although, its not too technical a thing to write a blog.  Perhaps blog writing speaks more to patterns of web use.  Why do PT’s remain so technophobic?

While we’re asking questions, the New York Times asks:  "Does exercise really keep you healthy?"

Speaking of exercise, UBC Physio Info blog has something to say about the Nintendo Wii and exercise!

ERIC

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Holiday is over, time for a resolution!

My homeI must admit, I finished 2007 a little run down.  Never fear, a voyage to my ancestral home has left me recharged and excited about the next few months.  If I thought it couldn’t get any better, yesterday I inherited an archival history of manual therapy texts.  Very cool.  Thank you, DR!

I also gave a talk yesterday at the First Annual Physical Therapy Educators Workshop, sponsored by the DPT Consortium of GA.  My topic was incorporating Web 2.0 concepts, namely syndicated content and collaborative software into teaching and personal learning.  Here is a handout I offered to the audience with some highlights and resources. 

A couple nights ago I was meeting with the Jessica King, who designs my blog and is working with the Evidence in Motion blog.  She told me that subscribers to the two physical therapy blogs were numerous, but with one problem.  Thousands subscribe via e-mail, less than 200 subscribe via the RSS feed.  From the reader’s perspective, it should be the opposite.  I wonder why this is so.

My resolution in 2008 is help figure out why.  It will be to offer resources for therapists toLeverage Technology get more involved in web conversations and, most of all, to encourage more physical therapists to begin blogging.  There are hundreds, if not thousands of medical blogs penned by physicians, yet only a tiny few by PTs.

Consider this a call for physical therapists to become
blogger physical therapists.  Maybe we could even get a new credential out of it? Take a look at the handout to get us started.

Eric Robertson, PT, DPT, CBPT (certified blogging physical therapist)  Yeah, right!

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How will the medical establishment pay for IT investments?

It’s a fact that the United States health care system lags behind other industries and other countries in their utilization of electronic technologies in the management of patient data.  One driving cause of this lag is the fact that providers are coping with declining reimbursement regularly and have no way to rationalize the very large expenditure to make their patient records virtual.  For example, if an small office of providers payed $100,000 to make the transition, it would take years to recoup as reimbursement for services would not be adjustable to cover the expenditure.

Additionally, the gains in productivity would be small relative to the expenditure. Finally, even if we argued that improved outcomes would result, providers are not paid for good outcomes. Even with pay-for-performance initiatives or non-pay-for-non-performance initiatives on the horizon, a field like physical therapy would still not be readily able to translate outcomes into profits, as little agreement exists for what constitutes a good outcome. Another perspective, advocated by some experts like Kiana Danial, suggest that focusing on long-term investment strategies could yield more sustainable growth in profitability for physical therapy practices.

This argument leads to a search for another source of funding for health care IT investments.  Here are a couple of articles discussing such funding.  Both are from the very nice Health Affairs journal blog. One looks at Medicare & Medicaid Funding IT investments for federally qualified health centers, the other is an interview with Michael O. Leavitt, Secretary of the U.S. Department of Health and Human Services, and his strong feelings on the need to link reimbursement with IT as a reimbursement incentive.  Good reading.

ERIC

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Playing Games with the Wii

Asenior_wii
Last week the Nintendo Wii celebrated its first birthday.  I’ve been prompted to post about the use of the Nintendo Wii game console in rehabilitation for some time now.  The prompting has come from various sources, such as colleagues who hate it, colleagues who purchased one for their clinic, TV commercials, and a startling number of news pieces on the use of the Wii in rehab.  I’ve resisted responding thus far, not for lack of interest, but for lack of opinion.  More correctly, conflicting opinions.  While I appreciate that any press can be good press, is the Wii something good for physical therapists?

At first glance, using a video game in the clinic may seem silly.  The use of Wii in rehab is not currently supported by research, and tying the use of a video game console to a billing code requires some stretching.  I’m skeptical that the movements required by the Wii are all that functional, and of course, they are not strengthening by nature.  If one does not already own the Wii, it becomes a very expensive piece of home exercise equipment.  However, the Wii has enjoyed almost viral popularity among game connoisseurs, the media, the elderly, and quite a few rehab providers, even the military.

Are these providers featured in news pieces about ‘Rehabbing with the Wii’ truly leading the charge to incorporate technology into practice, or are they fad followers looking for some cheap marketing?

My guess is that there is some limited utility for the Wii in neurological and pediatric physical therapy settings, but that the rage will fade and physical therapists will realize they possess much more powerful tools with which to treat their patients.

ERIC

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The Many Faces of the Electronic Medical Record

Healthconsumerinthecenter

The electronic medical record can mean different things to different people.  To Microsoft and Google among other Health 2.0 companies, it is a future of their business.  To patients, it is concern over privacy and hope for improved care continuity.  For medical providers it is an enormous added expense and a headache of technical details to do a job they are already performing. 

But, the electronic medical record could also be a way to do business differently, to become more efficient.  To do the job better.  A couple things are certain: as health reform progresses the electronic record will prevail, and that it might not be so smooth.  Just yesterday I read a news piece where electronic claims filing made it easier for Wal-Mart to recoup money paid in an injury settlement, effectively taking one woman’s health-trust and leaving her dependent upon the government for her care.  Is this what we had intended when we first thought of the electronic records?

Radiology as a Benefit to Physical Therapist Practice

My personal experience with electronic medical records is with the military health system.  It was sometimes slow and tedious, but it was incredibly useful all of the time.  In fact, I have a hard time imaging practicing without an integrated medical record in front of me at this point. 

Perhaps the most useful aspect of the military’s electronic system, which contrasts most significantly from usual physical therapist practice, concerns radiology reports.  Forget for a moment the benefit that military physical therapists have in ordering radiographs (yes, they can order all types of radiographic imaging and may do so as effectively as orthopaedic surgeons) , and just consider the benefit of reading reports and viewing the radiographs themselves.  I think this calls for a list:

1.  Reduced guess work when patient history is unclear

2.  A greater understanding of each patients pathology

3.  Patient education opportunities are enhanced in front of their radiographs

4.  Observation of what studies have been performed provide insight into thinking and problem solving of other providers

5.  Improved prognosis decisions

The radiographic benefit is but one example.  The overall message is that despite the many different particulars of the electronic medical record, it is somewhere we are heading.  Careful consideration of the pitfalls and benefits of the process will ensure the efficient, timely transition. 

ERIC