On-Site Physical Therapy for Workplace Pain Relief

 

with Kyle Wolfe, SPT

Background

My whole life I have played ice hockey and endured many injuries. This led to quite a bit of time spent at physical therapy in the OP ortho setting for rehabilitation. As I spent more time in the clinic getting to learn the field of PT, while being introduced to a variety of treatments, I made the decision that physical therapy is what I wished to pursue for a career. Considering my injuries have primarily been soft-tissue related, at some point along the way I grew a fascination toward the theory and application of manual therapy and modalities. This has grown into a passion to make the physical therapy experience unique to the individual, while offering them treatment options that not only improve their wellbeing, but that are also enjoyable. I firmly believe that physical therapy should be patient centered as well as patient-driven. We as providers have the knowledge to offer treatments, including exercise, that will improve a patient’s well being. However, I feel that many physical therapists forget the importance of allowing their patients to be a part of the decision making process. Further, I feel that many therapists get caught up in the day-to-day that they forget to make physical therapy a positive experience for both themselves and the patient.

While my partner, Kyle Wolfe SPT, and I have different backgrounds leading into this project, our combined interests for pain management with physical therapy interventions led us to the creation of an On-Site Physical Therapy model. The premise of this business is that we would travel to large corporate offices or factories with many employees, and provide physical therapy services at the convenience of their workplace. The project is divided into two main parts; 1. A feasibility study, which contains some of the fundamentals of a business/marketing plan; and 2. An evidence table, that explores the research surrounding manual therapy and modalities for short-term pain relief. Combined, these products provide us with some of the tools needed to successfully implement an evidence-based physical therapy business.

 

Overview & Purpose

The motive behind this project was to explore a business model that offered patients treatment options that meet them where they are in the rehabilitative process. Simply put, many patients are not ready to make lifestyle changes that incorporate exercise. My personal belief is that it is okay if an individual is not ready to commit to an HEP. I would much rather provide passive treatments that reduce their pain, while building rapport with the patient, so that I can persuade them to integrate exercise at a later time. By pushing the patient toward an intervention that does not align with their goals and motivations, I believe many therapists are facilitating an unpleasant patient experience that does not lend to positive outcomes. A secondary motive for pursuing this project was to offer a way by which physical therapists could positively impact the opioid epidemic in this country. The premise here is that while passive PT treatments do not enable the patient to take charge of their health, they are a better alternative to taking medications. If we as PT’s can intervene to divert, or reduce the need for medication, I believe we would not only lower the total cost of healthcare, but we would also reduce the likelihood of opioid addiction with these patients.

 

Statement of Need

In 2012 the NIH reported that nearly 40 million Americans are experiencing severe levels of pain and that over half of the population reported pain within three months prior to the survey.¹ Just 4 years later, in 2016 the NIH reported 50 million Americans were experiencing chronic pain.² These values have been on a steady incline over the last decade and have coincided with the rising costs of healthcare in America and the birth of the Opioid crisis.³

One of the objectives of the On-Site Physical Therapy clinic is to provide pain mitigating solutions to North Carolinians as a means to reduce the need and/or the desire to seek out expensive medical evaluations and treatments. We anticipate that our passive treatment modalities will reduce the reliance on opioids for pain management. In many instances, our services will be the patients’ first exposure to physical therapy. This has a unique benefit of not only exposing our profession to a wider audience, which benefits all physical therapists, but it will also result in more patients receiving care that is appropriate for their degree of disability. By inserting ourselves into the patients’ lives at earlier stages of disease process, we can make key determinations whether this patient is appropriate for physical therapy, or if they require medical intervention beyond our scope of practice. In many instances, patients who are appropriate for physical therapy services seek medical care that supersedes their need. Therefore, the expense of the evaluation and treatment they ultimately receive far exceeds what is necessary for their particular condition.⁴ When Physical therapy is used as a first intervention, it’s been found to be a cost-effective way to save time and money for that individual.⁴ By providing individuals with services that are not excessive, but that are appropriate for their need, we can help reduce the total costs of their medical care.

 

Product Links
The products of this project are complementary. Below you will find the links to my sections of the feasibility study which include the User Profile, Employer Recruitment Email, Flexible Payment Models, Superbill and Employee/Employer surveys. In addition, you will find an evidence table and CAT that review manual therapy interventions for pain relief. To view the remainder of the feasibility study, please visit Kyle Wolfe’s capstone page.

 

Feasibility Study

User Profile

• A brief description of the demographics and psychographics of two types of employees that would benefit from our business model.

Employer Recruitment Email

• An introductory email for prospective employer clients that describes our services and benefits they will receive.

Flexible Payment Models

• Flexible payment models to cover our services that appeal to businesses of all sizes.

Example Superbill

• An example document that allows cash paying customers to submit services to their insurance for reimbursement.

Example Survey (for prospective patient/employees)

• A market research tool to identify interest of employees for our services.

Example Survey (for prospective employers)

• A market research tool to identify interest from employers for our services.

Complete Feasibility Study (Both Chris & Kyle’s Contributions)

 

Literature Review

MT vs Exercise – Evidence Table

Critically Appraised Topic (CAT)

• Manual therapy versus exercise on pain and disability, specific to neck pain.

 

Evaluation
Over the course of our 3rd year I worked closely with Dr. Hacke discussing the capstone and my closely related independent study on dry needling. I received feedback along the way that helped shape the products of this capstone, but also supported my growth as a clinician. This project was a collaborative effort between myself and Kyle Wolfe where we combined our passion for pain management under the physical therapy scope to combat the rising issue of chronic pain, and lost productivity in the workplace. The intended audience to review our materials would include health care practitioners and employers of corporate businesses. An evaluation form was created in order to receive feedback about the proposed benefits and feasibility of our business structure.

Evaluation Tool

 

Acknowledgements

There are quite a few people that deserve credit for the success of this project. I would like to thank professor Jon Hacke, DPT, PT, MA for agreeing to oversee this project as well as my independent study on dry needling. He was incredibly receptive to my ideas and offered practical and timely feedback all along the way. In addition, I would like to thank our two committee members Ellen Roeber, DPT, PT, MDT Certified, and Justin Wilhelm, DPT, PT, OCS. Both Ellen and Justin are physical therapy practice owners and their feedback is invaluable to our success down the road when we pursue this business. I would also like to thank my project partner Kyle Wolfe for his diligence, structure, and timeliness working on this project. We have very complementary skill sets and I look forward to pursuing this business with you.

Finally, I would like to thank our classmates, who first learned of this business idea in our PHYT 705 – Managing Contemporary Practice class taught by Dr. Roeber. Kyle and I have received and integrated input from our peers and I really appreciate the support and enthusiasm toward this business.

 

References

1. NIH analysis shows Americans are in pain | National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/nih-analysis-shows-americans-are-pain. Accessed January 7, 2021.
2. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006. doi:10.15585/mmwr.mm6736a2
3. The Economic Burden of the Opioid Epidemic on States: The Case of Medicaid | AJMC. https://www.ajmc.com/view/the-economic-burden-opioid-epidemic-on-states-case-of-medicaid. Accessed January 7, 2021.
4. Payers: Embrace the Value of Physical Therapy to Reduce Costs | AJMC. https://www.ajmc.com/view/payers-embrace-the-value-of-physical-therapy-to-reduce-costs. Accessed January 7, 2021.
5. Mitchell RJ, Bates P. Measuring health-related productivity loss. Popul Health Manag. 2011;14(2):93-98. doi:10.1089/pop.2010.0014