Modernizing the Pre-habilitation Regimen

The implants associated with most total joint replacement procedures have remained relatively unchanged in the last five to 10 years. New models emerge promoting a new feature or benefit, but for the most part, the actual technology resembles the offerings of the last decade or more. The technology around the implant, however, is changing dramatically and enabling a much more effective overall treatment program for the patient. Supporting devices that address the needs of the pre- and post-operative segments are incorporating cutting edge technologies, making them smarter and enabling doctors to keep a much better eye on patients in recovery.
 
The results of a study involving a mobile, AI-based PreHab solution were recently published in the Annals of Translational Medicine. That study demonstrated the use of PeerWell’s platform “significantly improved hospital length of stay, discharge disposition, and skilled nursing avoidance for patients undergoing total knee replacement surgery,” according to a press release put out by the company. Specifically, according to PeerWell, use of the firm’s solution resulted in a “25 percent drop in hospital length of stay, an 80 percent increase in going home without the need for home care, and a staggering 91 percent reduction in discharges to skilled nursing facilities.”
 
Considering how impressive the figures of this study were, ODT was able to speak with one of the physicians involved in the report, Dr. John Tiberi of Cedars-Sinai. Dr. Tiberi addressed several questions about PeerWell’s technology, the value of PreHab, and what improvements could still be to come.
 
Sean Fenske: Can you please explain PreHab and why it’s important to the success of a total joint replacement procedure?
Dr. John Tiberi: Multiple studies have shown that PreHab, or pre-operative patient optimization, is an effective way to improve patient outcomes and control costs for total knee arthroplasty.
 
Fenske: What are the challenges associated with conducting the PreHab in the traditional manner?
Dr. Tiberi: The challenges associated with offering pre-habilitation in a clinical setting are twofold. First, insurance plans cap the number of physical therapy sessions patients can use. Surgeons want to preserve most or all of these sessions for use after surgery. Second, true pre-habilitation requires many clinical disciplines. Physical therapy alone is inadequate. Patients should be trained in anxiety and pain management, home safety, nutrition optimization, and how to manage the logistics of surgery.
 
Fenske: How does tele-PreHab address those challenges?
Dr. Tiberi: Tele-prehab systems, like PeerWell, offer patients the ability to get comprehensive, multidisciplinary pre-habilitation without requiring extra time from clinicians. Patients can get higher quality preoperative optimization without requiring extra time from overworked staff or exhausting their insurance benefits.
 
Fenske: Is patient compliance impacted when he/she is instructed to tele-PreHab versus the traditional PreHab?
Dr. Tiberi: It is challenging to measure compliance with advice given by a physical therapist when a patient goes home. PeerWell’s tele-prehab system uses AI to absorb data from patients and create personalized daily programs. PeerWell can then track compliance to these daily programs, giving us an entirely new view into patient behavior. The system’s data shows high compliance with daily programs, with an average of 40 modules completed before surgery.
 
Fenske: What has been the payer’s reaction/response to tele-PreHab?
Dr. Tiberi: Any organization that bears risk in providing care—whether that is a health insurance or worker’s compensation payer, an ACO, or even physicians running a surgery center—is keenly interested in pre-habilitation. It is one of the most effective ways to improve quality and control costs in surgery.
 
Fenske: How does this technology fit into the value-based healthcare movement?
Dr. Tiberi: Our data shows this technology is a promising way to address the biggest drivers of surgery cost: length of hospital stay and discharge disposition. Addressing these costs is one of the largest opportunities on the table in value-based healthcare as total joint replacement surgery is the #1 procedural cost for Medicare.
 
Fenske: What further improvements or enhancements would you like to see in the tele-PreHab platform?
Dr. Tiberi: I would like to see the continued development of new ways to track recovery and the incorporation of those data streams into the system’s program creation capabilities.