Early Experience with Reflexion Health’s Virtual Exercise Rehabilitation Assistant Demonstrates Increased Patient Adherence and Enhanced Patient Satisfaction in Lower-Extremity Joint Replacement Surgery
With more than 1 million cases annually, accounting for an aggregate cost greater than $9 billion, lower extremity joint replacement surgery has become a focus area for efforts to improve outcomes, shorten hospital stays, accelerate recovery, and decrease overall costs. The recent initiation of Medicare’s Comprehensive Care for Joint Replacement (CJR) bundle has brought this into even sharper focus for the ~ 800 hospitals directly affected.1
Improvements in patient risk-stratification, combined with recent advances in surgical technique, have allowed for an increased proportion of outpatient surgeries, sometimes in specially designed outpatient surgical centers.2 For the majority of patients still receiving hospital-based surgery, focus is being placed on decreasing hospital stay, minimizing the number of patients transferred to skilled nursing facilities as well as the duration of stay for those still transferred.
But regardless of the setting for the surgical procedure, the post-operative / post-acute care remains essential to patient recovery. And in part because of reimbursement bundling of care in the 90 days following surgery, this post-acute care (including in-clinic physical therapy and home-health care ) is now being carefully scrutinized.
The Challenges of a Traditional Home Exercise Program
A patient’s progress through the post-acute phase of recovery is typically led by a physical therapist. At its core is an appropriate home exercise program (HEP). The HEP is often tailored to each patient’s extent of disability, and is advanced or adjusted periodically in response to the patient’s progress. Unsurprisingly, there is compelling evidence to suggest that greater doses of therapy are associated with improved clinical outcomes. A key factor to obtaining the required dose of therapy is patient adherence to a HEP - patients derive no benefit from therapy they do not perform.3
Instructional paper handouts have been the traditional method of delivery when prescribing home exercises to patients undergoing physical therapy. The routine expectation is that the patient be able to perform the required HEP independent of the physical therapist. Unfortunately, typical adherence to HEP prescribed in this fashion is quite low, ranging from 15-40 percent of the prescribed dose. This can be due to a variety of factors, including patients lacking understanding on how to perform the exercises, distraction or disinterest on the part of the patient.4 And with incomplete visibility by the treating physical therapist into the actual adherence of individual patients, such lack of adherence has been challenging to address effectively. Faced with the imperative to help patients achieve their optimal recovery, but also confronted with the inability to manage that which they cannot measure, physical therapists often schedule patients for frequent in-clinic visits to directly observe and coach patients through their postoperative recovery.
The Benefits of Virtual Exercise Rehabilitation Assistant VERA
Reflexion Health developed VERA™, an FDA-cleared Virtual Exercise Rehabilitation Assistant, to help provide much of the value of in-clinic rehabilitation sessions while saving patients the time, cost, and inconvenience of travel. VERA was created to improve patient compliance to prescribed therapy, increase oversight by the clinician into each patient’s rehabilitation trajectory, help clinicians better identify those patients that need more in-person care, and in doing this, speed the course of recovery. Importantly, this approach is purpose-built to decrease system and patient costs associated with post-acute care, improve patient satisfaction, and improve outcomes.
VERA’s Virtual Physical Therapy is Effective
This infographic highlights the success of our early experience implementing VERA at a pilot site in Lorain, Ohio. As of now, 186 VERA patients and 82 traditional patients have participated in this ongoing study which has demonstrated that digital healthcare tools such as VERA, when implemented with outpatient lower extremity joint replacement surgery, can serve as a very valuable solution to decrease visit utilization and potentially accelerate recovery while increasing patient satisfaction and convenience.
In combination with improved risk-stratification and new surgical techniques, virtual physical therapy as provided by VERA can help to revolutionize both the patient experience and the patient and system costs of lower-extremity joint replacement.
1 Federal Register | Medicare Program; Comprehensive Care for Joint ... https://www.federalregister.gov/articles/2015/11/24/2015-29438/medicare-program-comprehensive-care-for-joint-replacement-payment-model-for-acute-care-hospitals . 2 "References - The Journal of Arthroplasty." 2015. 18 Aug. 2016 < http://www.arthroplastyjournal.org/article/S0883-5403(05)00361-X/references > 3 Pisters, MF. "Exercise adherence improving long-term patient outcome in ... - NCBI." 2010. < http://www.ncbi.nlm.nih.gov/pubmed/20235201 > 4 Sluijs, EM. 1993. Correlates of exercise compliance in physical therapy. - NCBI. http://www.ncbi.nlm.nih.gov/pubmed/8234458