Hi, my name is Mark Ryan with the Stedman Clinic and Stedman Research Institute in Vail, Colorado. My current role here is Rehabilitation Coordinator for Dr. Mark Philippon, who specializes in hip preservation techniques, particularly femoracetabular impingement. I want to thank Anna for having me today. And our topic is communication and team concept athletic care with the objectives to provide a framework to help you build a team of professionals to provide your patients with exceptional care. And we're going to use our program as an example on how to implement strategies for delivering a post-op rehabilitation protocol digitally, which is something we've gone to in the last few years. Opening up research opportunities to establish evidence-based practices through data collection, and also providing quality feedback about your patient's progress. Building a team around a surgeon allows the practice to run smoothly by improving patient selection, clinic flow, effective data gathering, and keeping track of patient progress. In order to do that, however, several questions need to be answered to bring everyone in line. Number one, what surgeries does the surgeon perform? What insurance does the practice take? What age group does the practice serve? As no practice can be all things to all people. So narrowing down your patient audience allows you to move on from patients outside your scope and put more focus on those that fall within your scope. Some potential roles in your team include the practice manager, a patient screener, clinical staff, front desk person, and my role is a rehab coordinator. Some team members may act in several roles or there may be overlap of the roles, depending on the size of your team. This is a list of those roles I just talked about. The practice manager or PA, in our case, coordinates the surgeon's OR schedule as well as clinic and other work obligations of the surgeon and provides clinical support. They're able to prescribe meds as needed, help with injections. They understand all facets of the practice, including helping the OR if needed. Our front desk scheduler screens calls, schedules all appointments. They're able to discuss the new patient process, clarifies insurance questions. Does your practice take Medicare and Medicaid, for example, or what other exclusions do you have? Trying to determine patient appropriateness. Do you specialize in hip preservation or THA, your foot, ankle, shoulders, etc.? Your clinical staff, they're able to bring patients back, getting a history, perform initial physical exams, prepare injections, do dressing changes, etc. And a lot of our clinical staff are athletic trainers that have gone through our athletic training fellowship and prepare them for that role. The screener may be unique to our practice, but they gather all the pertinent information about patients, their past images, past surgical operative reports, etc. And then me as the rehab coordinator, I track patient progress. I help set up PTs in their hometown. I build a network of trusted physical therapists, in this case around the country, but maybe yours does more local. And then we advance rehabilitation programs when appropriate based on patient feedback. Our appointment schedules, we see patients preoperatively, and we use these to gather information about patients' current physical status, painful movement patterns that they may have, and baseline function. This allows the clinicians to better set patient expectations. We found that patients struggling with higher pain levels, muscular weakness, etc., can expect a longer recovery, and that is best communicated beforehand. We use handheld dynamometry for strength testing. We measure all hip motions, and we use our functional veil hip sport test as a tool to assess painful movement patterns, muscle endurance, and stability. And we also use this test postoperatively to help determine readiness to return to sport. Our next follow up is typically between eight and 10 weeks. We repeat the range of motion and strength measurements for comparison to their pre-op, and also determine their readiness to progress to the next phase of the rehab, and also to begin at least the beginning return to sport program. In order to do that, we need to build a rehab program. So what we've done is we find a PT group somewhere in your area or around the country that is willing and able to accommodate your rehabilitation needs. We do rely on this external team to see our patients within whatever your practicing range is to implement the postoperative rehab protocols. Very important if you can find a lead therapist who has expertise in your area of surgical expertise, and also has the space and equipment for your patient's needs. They need to have a willingness to offer patients one-on-one therapy if that's needed, and they also need to maintain good communication and feedback about your patient's progress. In order to build a rehabilitation program, you have to do some research into past and present rehabilitation protocols and their philosophies. For most body parts, there's no current absolute consensus on how to do things, so you must establish your own core values and build your program around those. In designing a progressive treatment plan, we want to base that on general tissue healing timelines. Those might include postoperative weight-bearing status, your range of motion restrictions post-op, also taking into account individual patient variability, your patient's age, their current function, if they've had prior surgeries, in this case with us within their hip, and then time since the onset of symptoms. Patients that have longer time frames of symptoms without being treated tend to have a harder recovery time due to muscle function breakdown and compensation patterns. You want to establish some type of criteria to share with your physical therapists in order to set their short- and long-term goals, and also help answer those when-can-I types of questions like when can I come off wedges, when can I drive, when can I run, etc. Patient communication. As the rehab rehabilitation coordinator, my primary role is to establish relationships preoperatively via email, pre-op appointments, etc., and then keeping those lines of communication open at all times through email and phone and proactively contacting patients at regular intervals to check on their progress at their key milestones. These might include weaning off crutches prior to the eight-week recheck so we don't see any surprises there, prior to returning to practice, and return to play. We have adopted a digital rehabilitation platform to help us do this. It has been extremely beneficial, and this has been in response to the digital age of information. We contacted an online rehab portal to help deliver our protocols to our patients. This allowed patients to access their program online or through an app on their phone at any time. Patients can complete the program, click on a complete activity button, and it helps us monitor compliance to the program. In addition, patients communicate through the portal with questions, comments, or issues. We found in the year 2020, 86% of our patients activated their account, and 63% of them logged in weekly, so we know they're using the program. We can easily modify any exercises, delay milestones if someone falls behind or is moving faster than we expected. There's videos and written exercise descriptions of all of the exercises that improves the quality of the information, and it also provides analytics in that we can collect modified HRSA scores, for example, and other daily questionnaires to monitor their progress. Some of the options, AMP Recover is the one that we use. PT Genie is a more recent one that's coming out, and there are several others on the market. Just as an example, like I said, we use AMP Recover. The platform provides a library of exercises you can manipulate to build exercise programs that are appropriate for your patient's current abilities. It allows the super user, in this case myself, to set up the exercises, the sets, the reps, the frequency, days of the week, et cetera. This is an example of the patient's homepage. You can see along the left-hand side of the slide is patient and surgical information. This can all be viewed by you, the super user, the treating physical therapist back home, and the patient. The dials along the top represent the latest range of motion measurements that the PT can update at regular intervals. In the center left of the slide, you can see criteria met or unmet, leading up to the progression to the next rehabilitation phase. Then in the center right shows various trends of the patient regarding pain and sleep quality, and these are all monitored through a daily questionnaire so they can track their progress. This slide represents what you, if you were to use a program such as this, the super user page. It helps monitor all the activity of the patients using the platform. It displays the compliance, your communications between you and your patients, the status of patients within the rehab protocols, as well as outcome scores. This platform has enhanced our patient experience by ensuring that all parties, including our practice, the patient, and the treating physical therapist are all on the same page with the rehab protocol. Thank you again to Anna, and thank you for your time. Enjoy the conference.

communication

team building

athletic care

digital post-op rehabilitation protocols

patient care