Catch 22 – Underutilization of 2D Slow-Motion Video Analysis

Why is there low utilization of 2D slow motion video analysis of movement by Physical Therapists?

There are many advantages for using 2D slow-motion video analysis for management of movement disorders including increased accuracy of diagnosing movement impairments; improved communication with patients and healthcare team; increased engagement of the patient; and improved understanding of movement and the impact of treatment on that movement.

Yet despite the high value, in my opinion, the use of 2D slow-motion video for analysis of movement and using slow-motion video in treatment with movement system disorders is not occurring as much as it can be and should be.

Studies by Craig Henley and colleagues have published survey results of Board-certified Orthopedic Physical Therapists. Forty-nine percent use 2D slow-motion video analysis in their practice.  However, 91% use 2D slow-motion video for only 25% of their caseload. Henley and colleagues report 75% of Sports Certified Physical Therapists use 2D slow-motion video, yet 84% use 2D slow-motion video for less than 25% of their caseload.

It is estimated that 60% of the general population are visual learners. Physical therapists facilitate learning to move in a more optimal way. Shouldn’t we use slow-motion video for more than just 25% of our caseload as we facilitate the process of clients learning to move in a more optimal way?

Compared to the utilization of static diagnostic imaging techniques (radiography, MRI) of individuals with musculoskeletal pain syndromes depending on the setting there is a problem of overutilization of radiographs.

Compared to the general population utilization of smartphone video recording Physical Therapists are behind the times. The utilization of smartphone video is pervasive in social media and news. Smartphone utilization by clinicians is not pervasive.

There are barriers facing Physical Therapy clinicians to the utilization of 2D slow-motion video including ease of use; privacy issues, and difficulty integrating the video data into the electronic medical record system.

The current state is processes and procedures for uploading video data into the electronic medical record systems it is not occurring, but it can occur.

A “catch 22” comes from a novel written by Joseph Heller describing an impossible situation because you cannot do one thing until you do another thing, but you cannot do the second thing until you do the first thing.

We cannot upload 2D video data into electronic medical record systems until there is enough demand and utilization by enough clinicians to warrant expending resources to modify electronic medical record systems to upload video image data. We cannot increase the utilization of 2D video by clinicians until the process of uploading to electronic medical record systems is addressed.

This dilemma is related to the overarching problem in the delivery of health care of the excessive and burdensome requirements of documentation. The advances in computer technology have not resulted in a decrease in the time required to document medical care. The electronic medical record system made the burden of documentation worse.

Studies have shown more than 50% of a healthcare clinician’s time during a workday is spent on documenting. The burden of documentation is a contributing factor to the burnout of health care professionals.

Healthcare providers have constraints on the amount of time they can spend with a patient. If a clinician is choosing to utilize new technology such as 2D slow motion video analysis of movement it requires choosing to not use some other established habitual processes.

How does a clinician decide what to abandon? How does a clinician decide to implement a new methodology (e.g., video analysis)?

To rephrase a question raised by Larry Benz, will 2D slow-motion video analysis replace, displace, or augment current practice patterns in the management of musculoskeletal pain syndromes? To answer these questions requires an explicit reflective process.

Reflective questions:

What analysis and treatments are directly related to the patient's specific functional goals? Replacing historic patterns of the clinician not relating to the patient’s specific functional goals can occur with new technologies.

Which analysis and treatments are closer to meeting the patient’s expectations? Knowing the expectations of the client is critical to increasing the level of engagement. Agreeing on expectations and seeking a high level of engagement increases effectiveness and efficiency and augments desired outcomes.

Which potential treatments are active therapies, and which are passive therapies? “Give a man a fish you will feed him for a day. Teach a man to fish you will feed him for a lifetime”.  Displacing the time spent on passive interventions can result in longer-lasting outcomes.

Which treatments will enhance the client’s autonomy? Patient-centered medicine has advantages of greater patient satisfaction scores; better patient compliance; higher self-reported functional outcome scores, and fewer malpractice claims against healthcare providers. Replacement of provider-centered services can occur.

Which treatments address dysfunction directly as opposed to altering impairments to improve dysfunction? Case studies and clinical trials suggest motor skill training in functional activities results in greater short-term and long-term improvements in function than those who received strength and flexibility training.  Displacing time spent on traditional therapeutic exercises with functional training may increase efficiency.

Whose expectations am I trying to meet, the client’s, mine, or a third party (regulatory bodies, health insurance carriers)? Displacing processes related to third parties can be contemplated.

Which treatments address the why?

Which treatments have rationale supported by scientific reasoning and/or evidence?

A resolution of the “catch 22 of unitization of 2D slow-motion video analysis can occur by reflecting on what current practice patterns in the management of musculoskeletal pain syndromes need replacement, displacement, or augmentation in current practice patterns.

When Physical Therapists begin integrating 2D slow-motion video analysis into their practice, they will soon learn the value-add of this methodology: improved communication with their patients, and improved engagement of the patient. Visual feedback offered by video is easily understood by the patient. This technology is available to anyone with a smartphone. When our patients begin to expect the use of this technology as part of their physical therapy treatment, and physical therapists utilize video on a regular basis for nearly all their patients (not just 25%), then it will become imperative for EMRs to adapt to the needs of the clinicians. Only when the demand is clear, will EMR companies invest in making video uploads part of their service. If we avoid using video analysis due to the barrier imposed by the EMR, then nothing will change. A Catch-22 only we can resolve.

The information on this website is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You are encouraged to perform additional research regarding any information contained available through this website with other sources and consult with your physician.

Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits

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