Innovation in total knee replacement rehab: The tech for virtual PT in value-based healthcare

Continuous Passive Motion devices (CPMs) were first used in the hospital setting to promote range of motion, pain control and mobility immediately following a Total Knee Arthroplasty (TKA) procedure. Over time, the use of CPMs shifted from the hospital setting to the home setting to help in Phase 1 recovery following the surgical procedure.

Roughly five years ago, Kinex Medical Company saw an opportunity to take a traditional CPM machine, a device that has been around for over 40 years, and update it to be more relevant than ever in the care of patients undergoing TKA and other lower and upper extremity elective procedures.

Recent literature suggests that using CPM in conjunction with physical therapy has the potential to increase post-acute costs. However, as surgical techniques and technology improve, the use of rehabilitation apps and other innovative products as a substitution for some traditional physical therapy visits are not only getting equivalent outcomes, but significantly improving patient satisfaction, lowering post-acute care costs, and allowing patients to practice social distancing and rehabilitate in the safety of their own homes during the COVID-19 pandemic, without sacrificing outcomes. In most cases, the KinexCONNECT is saving a minimum of $800-$1,000 per case compared to traditional physical therapy and home health care. Over the last three years, patients are reporting that the device helps them relax more, sleep better and enjoy the rehabilitation process. Many patients point out that the convenience of rehabilitating in their own home is a significant convenience compared to having to drive, or have a friend or family drive them to their physical therapy appointment, especially in the winter months.

Kinex Medical’s new device, the KinexCONNECT, is a tablet-powered home rehabilitation system that combines range of motion through a CPM, along with patient compliance monitoring, customized exercises for the specific procedure, along with daily survey questions to prevent or recognize complications or readmission. One of the biggest issues in the past was a CPM’s inability to capture utilization and compliance data. We had to rely on patient self-reporting to determine if they used the CPM as prescribed. Through the KinexCONNECT, we are able to monitor patient’s total time and progress on the device in real time, interact with the patient to ensure post-op instructions are being followed, verify that the prescribed exercises are being completed, and ensure that all goals are being met. When a patient has an issue, Kinex can quickly intervene and get them back on track. Over the last three years, we have prevented multiple manipulations. We have also prevented ER visits due to pain control, constipation, and have even identified signs and symptoms of deep vein thrombosis (DVT), a potentially life-threatening complication.

Although there are many rehabilitation apps that are entering the market, the KinexCONNECT has a number of key features that make the product truly unique. The KinexCONNECT comes “batteries included” with its own Internet connection. Where some solutions require the patient to own a smartphone or tablet as well as know how to download an app, the KinexCONNECT comes with a tablet that is set to a kiosk mode and ready to use. Each tablet is connected to a cellular network, avoiding the need for a patient to have Wi-Fi. It also allows the KinexCONNECT to connect in remote areas where connectivity is limited.

The KinexCONNECT platform can decrease the touchpoint barrier and allow for more interaction between the patient and the provider. It allows for a high degree of connectivity with a patient, while still maintaining “safer at home” guidelines. The unique patient portal allows staff to securely monitor patient progress through dashboard reporting, progression graphs, alerts, and team notes. The KinexCONNECT minimizes the need for post-op clinical visits in the office.

Each doctor who prescribes the KinexCONNECT customizes his or her preferences. The doctor and his or her team select which video-based exercises are most appropriate from a comprehensive video library, and customize a specific list of questions that are asked daily. Once the doctor’s preferences are determined, a fully customized post-operative protocol is established and the protocol populates on the tablet upon initiation of treatment. The types of questions asked are asked for a number of reasons. Questions are asked to prevent readmission, reinforce discharge instructions, measure compliance, or act as a reminder for frequently asked questions. The patient data is gathered by Kinex and communicated back to the doctor through a number of ways. Kinex is able to push reports directly into an EMR, through a secure portal, or even hand delivered. Unlike many platforms, the KinexCONNECT does not require physicians and their staff to install a program or app. The remote patient monitoring is web based and resides 100 percent outside the firewall of the physician or health system so no downloading from an outside vendor is required.

In order to maintain a high level of security, the KinexCONNECT communicates back to Kinex using TLS1.2 encryption, ensuring privacy and security. No PHI is transmitted to, transmitted from, or stored on the KinexCONNECT tablet.

The original intent in the design and development of the KinexCONNECT was to create an orthopedic rehabilitation solution following TKA and other orthopedic procedures for value based care models such as Bundled Payments for Care Improvement Advanced (BPCI Advanced). Kinex has collected data on over 11,000 patients over the last two years and is obtaining extremely high patient satisfaction scores, superior outcomes, and significantly lower post-acute costs, which makes KinexCONNECT so valuable in a value-based care model for all parties involved. As stated above, the KinexCONNECT is saving on average $800 to $1,000 a case while achieving similar outcomes to clinical based physical therapy. The KinexCONNECT positions orthopedic surgeons and hospitals as leaders in telerehabilitation as well as rehabilitation risk management.

As U.S. hospitals and surgery centers start to resume elective surgeries following the COVID-19 pandemic, there are a number of factors that will be critical to ensuring the success of resuming these procedures. One of the first steps in resuming elective surgeries is ensuring patient safety and comfort in returning to a hospital or surgery setting. Patient selection and testing for the virus will be critical, however patients will need to safely rehabilitate and recover following surgery as well. Most experts agree that even as the COVID-19 pandemic significantly slows down, public health measures such as social distancing will remain in place indefinitely. Furthermore, if there is a resurgence of the virus in the winter, people will need to socially isolate and maintain appropriate distance from others. We are already receiving calls and virtual meeting requests from hospitals and doctors around the country, including overseas, about implementing the KinexCONNECT for orthopedic post-op rehabilitation following COVID-19. As the possibility of social distancing may be with us for a few years to some degree, it is critical that patients are able to safely rehabilitate without compromising quality.

Using the KinexConnect for post-acute rehabilitation following TKA and other elective procedures allows the patient to rehabilitate safely in their own home while maintaining the social distancing requirements required during the COVID-19 pandemic. Partnering with Kinex and the KinexCONNECT allows hospitals and ASCs to provide a safe, effective rehabilitation platform upon discharge while saving cost, saving time, improving patient engagement, and staying connected to the patient post discharge. The KinexCONNECT is quick and easy to implement, currently available in most states across the U.S., and fully scalable.

Recently Parvizi et. al. published a Current Concepts Review: Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic in The Journal of Bone and Joint Surgery, Inc. The guidelines were developed by the International Consensus Group (ICM). Question IV.6 asks “Should Any Changes Be Made in Postoperative Care Protocols for Patients Undergoing Elective Surgery During the SARS-CoV-2 Pandemic? The response/ recommendations were the following:

1. The length of hospital stay for patients should be minimized.

2. Postoperative rounds by the surgeon may be done with the use of telemedicine, whenever possible.

3. Patients should be discharged home, and transfer to inpatient rehabilitation should be minimized.

4. The patient should be instructed how to perform self-directed physical therapy at home.

5. Post-discharge visits to the office should be minimized, with the majority of the follow-up being done by telemedicine.

6. Office visits should be limited to those who are having issues/complications such as wound-healing problems, suspected fracture, stiffness, and so on.

7. Digital health programs and wearable sensor technologies that allow monitoring of patients will play a larger role in management of patients in the future.

8. Social distancing should be resumed and at-home visits avoided, unless absolutely essential.

This article is sponsored by Kinex Medical Company.


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