Page 26 - Mobility Management, March 2017
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outcomes of case studies and clinical experience. It is important to note that CMS seems to be placing greater emphasis on evidence-based practice when formulating coverage policies for DME. As clinicians and manufacturers, we need to advocate and collaborate for more and better research. — Lori Potts, PT, Rifton
One of our goals as an industry is to raise awareness that CRT products have features, technology and complexity that go beyond what is provided by DME. We want to show that these “high-end” products are not just for luxury or convenience, but that they provide medical and functional benefits not achievable with standard products. Being able to demonstrate their efficacy through outcomes measures and scientific evidence is critical to achieving this recognition, not only from funding sources that pay for them, but also from clinicians and suppliers who prescribe and provide them, and legislators who help us change policy.
The technology of CRT products available today is more sophisticated and complex than ever. Add that to the myriad choices of different makes and models of products, and the selec- tion of the best wheelchair and seating for each individual can be a daunting task. I think it has become increasingly important for those involved in the selection of seating and mobility solutions to understand not only what works, but how and why it works. It’s important to understand the science behind the technology.
As an industry, we should be able to show that outcomes are improved when CRT is appropriately prescribed and provided. We should be able to demonstrate the decrease in incidence of things like pressure injuries, postural deformities, physiological complications, pain and hospital readmissions. Funding sources should be able to see overall cost-saving benefits. Clinicians and suppliers should be able to see the efficacy of their choices. And the consumers should be able to see the increase in independence, health and quality of life. — Elizabeth Cole, MSPT, ATP, director of clinical applications, ROHO/Permobil
As a clinician, when recommending seating, positioning and mobility solutions for clients, I rely on a combination of three things: evidence from the research available; my clinical experi- ence; and the needs/goals/preferences of the client.
Clinical experience is important because we learn from all our clients and interactions with the CRT team over the years.
Paying attention to new research, evidence about outcomes, and new technology is important because it informs our practice and helps us to consider why we are recommending what we
do, as well as when to implement evidence into our practice and maybe try something different.
For example, if we are recommending a power wheelchair and a power seating system with tilt, recline and elevating legrests for a client who is at risk of pressure injuries and needs power seating to perform weight shifts, then we should also understand the evidence about power seat function utilization, compare it
26 march 2017 | mobilitymanagement
to our clinical experience, and make client recommendations accordingly. We know both from our clinical experience and from evidence that wheelchair users rarely access positions of tilt and recline necessary to achieve adequate pressure relief. We also know from evidence that users who receive smartphone based- coaching on when to do pressure reliefs, what position to go to, and how long to stay there, improve their outcomes significantly in being able to follow an appropriate weight-shifting regimen.
If we understand from our client that they want to be as active, healthy, and independent as possible, stay in the wheelchair longer, get more things done, and mitigate risk for skin problems, then the recommendations are a good fit for the client as well. — Ginger Walls, PT, MS, NCS, ATP/SMS, regional clinical education manager, Permobil
Achieving best practices when making equipment recommen- dations requires a combination of current research, clinical expe- rience and client goals. Evidence-based solutions are essential to innovate practice patterns and equipment applications. When evidence is translated into a clinical tool that can be used in a treatment setting, the team can make a more informed deci-
sion to achieve optimal equipment recommendations for each individual. — Jennith Bernstein, PT, DPT, ATP, regional clinical education manager, Permobil
A Balanced Approach
I value research and the insights it can provide the clinician, for example, with regard to best ergonomic setups for independent ambulation with least shoulder girdle damage, or tilt and recline applications to minimize or prevent pressure injury, improve functionality and comfort.
But I also value clinical expertise and judgment. Seating has evolved as a result of clinicians, equipment suppliers and manu- facturers working jointly to meet a need and improve on it where possible. As a physical therapist, one of my roles is to analyze the movement and function of a client and promote improvement where possible. My clinical skills (knowledge of movement, observation and handling techniques) and past experience play a large part in a wheelchair evaluation. Through the use of these, I can make an informed decision regarding the specifics of seating details needed to aid the client, particularly with regard to the neurologically involved client, such as cerebral palsy or traumatic brain injury. The more multifaceted the problem of movement, the more difficult to design and measure specific parameters in the research. Possibly the reason for less research in seating and mobility in these areas. Hence, research and clinical expertise are both needed. — Missy Ball, MT, PT, ATP, PhysioBall Therapy
I think people can get too caught up in evidence. I don’t care how somebody mapped on a cushion in your study. I need to know
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