Falls and mobility limitations are largely preventable and there are opportunities for improving outcomes and access to quality focused care in both healthy and chronically ill older adults Mobility limitations are expected to add an additional $42 billion to healthcare costs by 2040 if new mobility specific care paradigms are not established. Currently, there is no drug therapy for mobility limitations and the most efficacious treatment is rehabilitative care. Principal investigators Jonathan Bean, MD and Terry Ellis PhD determined four attributes, limb strength, limb speed, range of motion and trunk muscle endurance, as predictive of decline in both basic and advanced mobility skills among older adults through the in-person intervention study, Boston RISE. In collaboration with patient engagement platform, Wellpepper, Inc. they have devised a methodology for delivering these interventions remotely via a digital intervention which is designed to improve patient mobility skills as well as muscle strength, endurance and power and to decrease the risk for fall-related injuries such as hip fracture. Using mobile devices running Wellpepper's patient engagement solution, the seniors can receive personalized video care instructions and easy-to-follow, customized strengthening and exercise prescriptions, and they will engage in regular communications with their healthcare providers through the Wellpepper application. Programs can be adjusted remotely as participants gain strength and mastery, without the need for internal visits. This enables greater access to care as one physical therapist can manage multiple patients and decreases barriers that seniors often have in traveling long distances to appointments. This methodology has been proven to work in a prior study conducted by Dr. Ellis for remote care of Parkinson’s patients. “Mobile Health Technology to Promote Physical Activity in Persons With Parkinson Disease” (Study is complete).
However, it does not address the cost issue, as this type of remote care is not currently reimbursed, which could limit adoption. Co-collaborator on the project Jennifer Perloff, PhD, Heller School for Social Policy and Management, Brandeis University is evaluating the costs of delivering care in this method and the ability to prevent falls vs. the costs of falls and decreased quality of life for seniors.
We are very excited about this new study, currently in progress, and have entered this challenge to further scale the outcomes through the OpenIDEO challenge. First, we would like to increase the impact and distribution by making this exercise protocol free of charge for users in any healthcare organization or plan looking to prevent falls in their senior population by providing the best care regardless of location and transportation access. Scaling this intervention would enable the research team to further refine the intervention based on feedback from thousands of patients and hundreds of physical therapists. It would also provide valuable insight to even further improve the technical experience for seniors. Second, the OpenIDEO challenge would enable us to raise awareness of the impact of this intervention with both CMS and private payers so that they are able to develop new models to support this proven cost-saving and outcome-driven initiative.
Working together with all stakeholders: providers, payers, researchers, and seniors and families we believe we can significantly decrease fall risk and improve quality of life.
- Patient visits clinic to meet with Physical Therapist (PT)
- PT develops exercise program for the patient
- PT records a video of patient doing exercises while PT gives detailed instructions
- Patient leaves clinic with exercise program in an app on their phone
- Patient watches video and does exercises at home
- Patient interacts with PT via messaging within the app
Exercise programs can also be adapted for those with a caregiver. The patient and caregiver visit the clinic and a video is recorded of the caregiver assisting the patient with exercises while the PT narrates instructions. Both are taught how to use the app to follow the program at home. The patient and caregiver can communicate with the PT via messaging within the app.
We have demonstrated our plan to clinics and primary care physicians who have expressed interest in our train the trainer combined with mobile technology approach to falls prevention. We plan to partner with a community clinic to implement our falls prevention program. We will hold regular feedback meetings with both clinicians and users to modify this new delivery of care model. Because our app is already being used by physical therapists in a number of clinic settings, we already have a continuous quality improvement plan in place.
“I had my first knee replacement in the summer of 2015 and my second in the winter of 2016. I wasn’t good at remembering exactly how to do the exercises the first time. It was so much simpler using the app. It was more personal, I don’t know why. It would ding me and tell me when to do the exercises again. I thought it was easy to use. I would not want to have another knee surgery without the app. For me, it worked perfectly. It was user friendly. I am 81 years old and it wasn’t hard for me at all!” Evergreen Health Patient
“This program has empowered me, lifted my morale, renewed my hope, and given me tools. Thank you for helping me regain my life!” Patient with Parkinson’s Disease, Boston University Center for Neurorehabilitation