Recently, you may have seen the widely published editorial in hundreds of health journals calling for emergency action on climate change. While the focus of that editorial was primarily external to healthcare, calling on governments to do more overall, we would be remiss to not take a moment to consider what “emergency actions” we might be able to take within our own profession that can result in improved sustainability and improved relationships with our environment.
In many regards, the care model physiotherapy is based upon has been extremely consistent since the early days. Patients come to a clinic (likely driving their fossil fuel burning vehicle) where they meet with a provider, they receive an intervention, and they go home to perhaps do some additional work on their own in the form of a home program. The patient probably paid or had paid for these services a handsome sum of money, and the limiter to how many interventions the patient could receive is the scarcity of provider appointments (open appointments are never a good thing for providers!) or scarcity of funding to support repeated and frequent interventions. I have long considered several aspects of this care model to be unsustainable for both economic and environmental reasons. Additionally, the nature of the relationship between the patient and provider leaves the profession vulnerable in many regards: we don’t know exactly what a patient does outside of our care, we don’t know how exactly the home program is going, and the limited engagement seems out of sync with so many other aspects of our daily lives where information is pushed to us, and we have access to certain data even before we ask for it (What was my resting heart rate 3 minutes ago, Apple watch?).
Eric Robertson, PT, DPT, MFA
A/Prof Clinical Physiotherapy
Eric is a physical therapy educator and visual artist from Salt Lake City, UT. Eric’s clinical expertise is in orthopaedic manual therapy and he has extensive experience in distance-based educational and health models. His artwork explores the concepts of environmental reconciliation and climate change. Visit www.ericrobertson.com to see some of his artworks.
Recently, Heidi Jannenga penned a blog post highlighting the lack of good data in physical therapy and pointed out that payers are requesting more and more data to justify treatments. Combining the notion that certain aspects of our care model are not the most sustainable, and that there is a way to improve the data collection we have demonstrating our care are big drivers to my work over the past several years into virtual care models and remote patient monitoring (RPM) inside physical therapy. Done well, remote care has the potential to upend how physical therapists interact with patients and improve our impact, reach, and benefit to society all while being just a little bit friendlier to the environment.
The ability to gather ongoing data about how patients move and function when not in our clinics is perhaps the single largest opportunity to affect the care model of physical therapy. While the quantification and tracking of our lives certainly carries some serious concerns, there are some tangible benefits as well. For example, the Apple Watch has been able to send emergency alerts when it detects a possible fall when configured to do so. And, just last week, Apple’s iOS 15.0 software release included a Health app addition that reports on gait steadiness. Apple is using the iPhones built-in, ever-present, accelerometer with their own algorithm to judge steadiness while walking and therefore fall risk. Apple then steers users to a collection of exercises based on the Otago Exercise program out of New Zealand. This sounds strikingly similar to physical therapy, although it lacks the individual evaluation and response that is central to any PT intervention. Enter the PT innovators.
Star Pond. Photo by Eric Robertson: www.ericrobertson.com
A handful of startups are trying to combine the strategy taken by Apple with actual physical therapy care models. A good example of this is OneStep. OneStep takes the data provided by a smartphone’s accelerometer and supercharges it. That data is detailed out to a much more specific degree than what Apple’s Walk Steadiness score delivers (they provide analysis of over 17 parameters) and so a provider might be able to see what components of a patient’s movements might be contributing to an “unsteady gait” along with other general movement-related data that occurs over time. Taken further, the ability to gather data about a patient’s movement in their native environment contains a number of other important considerations that extend beyond the biomechanical aspect. OneStep’s model is to combine this enhanced data gathering and RPM with a seamless connection to remotely positioned physical therapists using their digital PT platform. The app includes HEP, along with gait-related insights and real-time feedback for the patient. Suddenly, patients can obtain physical therapy services anywhere, in a less costly manner, without the need to travel, and providers can learn more about the patient’s movements without actually seeing them in the clinic. New insights into how a patient might maximize their health and optimize their movement in their preferred/home environment might be realized.
Technologies that combine RPM with physical therapy are doing much more than making care convenient for patients. They’re learning more about patient movements. They’re improving the relationship opportunity between providers and patients. They’re enabling physical therapists to get out of their clinics. And, importantly, they’re initiating a remodelling of the traditional provision of physical therapy. As a patient, I can be motivated to walk and do other non-carbon-consuming activities, get feedback from my physical therapist, and eliminate the time and energy required to go visit a clinic. As a bonus, we all learn more about how to impact patient movement and get the data to demonstrate our value as a profession.
While this kind of innovation inside PT isn’t likely to move the needle much on climate change by itself, small innovations inside of healthcare, repeated many times are all part of the stance we must take as citizens of the Earth if we are to meaningfully improve our environmental prognosis. It’s certainly not as simple as providing distance-based care. After all, the very devices that care is consumed with, carry their own environmental impact. Lithium mining, in particular, creates some nasty byproducts that don’t get much attention.
It will take some careful balancing and complex thinking to get from now to more sustainable models of healthcare and physical therapy provision. The balance of various environmental impacts needs to be considered. But so too does the benefit to patient health, the ability for patients to integrate movement into their lives, and perhaps even enabling more active transportation strategies. I’m not sure if virtual care solves all of these issues, but I’m all for starting the reimagination of how physiotherapy is provided and adding to the spectrum of ways we can impact society.
Header image: Brine No.1 by Eric Robertson. www.ericrobertson.com