Home based Physical Therapy Services – unique benefits of observing real-world issues

Traditionally physical therapy services provided at a person’s home occurs when the individual was “homebound.” According to Medicare regulations homebound is the patient requires assistance to leave home and that when they do, it requires a considerable, tasking effort.

This is no longer the case. You do not need to be considered home-bound to receive Physical Therapy services at home. A Physical Therapist can provide service to you at your home.

Advantages of home-based Physical Therapy services are:

  • Convenience – instead of dealing with travel challenges, weather issues, and wait times in outpatient Physical Therapy services I can come to you. You may not have to arrange for babysitters or caregivers for disabled parents
  • Safety in time of the pandemic, greater control of the environment
  • One-on-one care – PT provided at home is the Physical Therapist and you not as frequently in the outpatient clinic the Physical Therapist is managing more than one patient at a time, or a technician is providing care. The therapist is not distracted by other administrative duties. One on one increases the potential for a higher quality of care.
  • Privacy – Many outpatient Physical Therapy clinics provide services in large, crowded, and noisy rooms. The stress level is less when Physical Therapy occurs in the comfortable and familiar environment of your own home.
  • Real-world observation and intervention - The Physical Therapist can see the real-world limitations you are dealing with and make specific recommendations.

Examples of real-world observations & interventions available through home-based Physical Therapy services making a difference in outcomes

Patients with foot pain, and when I come into their home, I observe they are not wearing shoes, and near the front door is a pile of shoes. In many cultures, there is a tradition of removing one’s shoes in-home or in places such as temples or churches. When I observe this real-world activity, I can have a discussion with the patient about the risks and benefits of going shoeless relative to their foot pain. If I saw this patient in an outpatient clinic setting, it is unlikely I would think to ask the question, what do you wear on your feet when you are at home?

A Patient with chronic recurring lateral hip pain, which is worse at night and first thing in the morning. I requested to observe their bed. I felt the stiffness of her mattress on her side of the bed and discovered the area where her hips are was unbelievably soft, compressed, and fatigued. On closer examination I discovered the box spring underneath the mattress was also compressed. Follow-up questions the box spring came from her father who weighed three hundred pounds. Treatment in the short run was to switch to sleeping on the other side of the bed until a new mattress and box spring or plywood support between the mattress and compressed box spring could occur. I would not have been able to identify this factor contributing to her chronic hip pain if I saw her in an outpatient clinic setting.

A Patient with back and hip pain I was able to observe where and how she was sitting while taking online college courses at home. She was sitting on the couch resting the laptop on the armrest of the couch. She was short in stature (4’ 10”). The depth of the seat pan on the couch was very deep/long, so she would side saddle sit with both feet on the couch to the side away from the armrest, and spine leaning towards the armrest. The cushion of the couch had compressed, near the armrest. We found extra throw pillows to support her back and shorten the depth of the seat pan so she would sit with her feet on the floor. We switched the seat cushion from the other end of the couch, so the seat pan was level. Encouraged her to purchase an extension cord so she could power her laptop and move the lamplight, so she had the option of sitting on either end of the couch. I would not have been able to observe this or solved this back and hip pain by seeing this patient in an outpatient clinic setting.

A Patient with back pain and movements of the spine involving rotation elicit pain. Observing the computer workstation at home, the seat pan on the computer chair was loose and wobbly from side to side. After tightening the screws on the seat pan of the chair, he complained the armrest of the chair bumped onto the desk when he rotated the chair to stand up. The solution required adjusting the height of the armrest in addition to stabilizing the seat pan of the chair. I would not be able to observe this factor contributing to his chronic pain by seeing this patient in an outpatient clinic.

Remedial exercises can require lying down on a firm surface. In some homes, this can be problematic finding enough safe appropriate space on the floor to perform exercises. When seeing patients in an outpatient clinic I would provide instruction to lie down to do the exercise. The patient may go home and not feel comfortable getting down on his/her floor and will do the exercises on a soft bed. For some exercises, a flat firm surface is critical. Being able to show the patient how to safely get to and from the floor can improve the effectiveness of exercises. Finding an unincumbered flat blank wall to use when performing remedial exercises can also be a challenge in some homes. In some homes, the only accessible blank wall is in a bath shower stall.

Being able to observe steps to determine whether there are railings, and their location (which side) is important when providing guidance recovering from lower extremity surgery and when using stairs for strengthening and flexibility exercises. In many homes, the rise of the stairs is so steep that the stair tread depth is not deep/long enough to fit an orthopedic cast or walking boot on the step. Being able to see unique structural limitations in a patient’s home facilitates safely altering the plan of care.

A patient with a spinal compression fracture and increased risk of falling I was able to observe challenges of identifying appropriate furniture for remedial strengthening exercise. A standard performance test is the 30-second sit to stand test to assess lower extremity strength and to predict the risk of falling. It requires using a chair and the seat height is 17”. The test can be a remedial exercise. This patient had a favorite rocking chair and lounge chair. Neither of which was appropriate to practice sit to stand strengthening exercises. The best I could find in her home to do sit to stand exercise was the toilet. Initially, she was not strong enough to rise from the toilet without using her hands-on adjacent bathroom sink. Verbal cueing to consciously engage her buttock muscle more and gradually pull less with her hand on the sink is appropriate and progress to no hands when strong enough. It would have been difficult to implement this by seeing the patient in an outpatient clinic.

When recovering from hip or knee joint replacement being able to observe the patient’s actual garage car configuration is helpful. Knowing this information facilitates providing options and guidance regarding getting into and out of their car.

Being able to feel the driver’s seat cushion can occur to identify a lopsided car seat. In old cars, the driver's seat cushion compresses near the door resulting in a seat pan that is not level.

If you are receiving outpatient Physical Therapy and think you could benefit from a home visit to help address real-world structural limitations, ask your Physical Therapist if they can assist. Many Physical Therapy clinics also now provide telehealth visits. A telehealth visit has some shortcomings but does provide an opportunity for visual observations by the Physical Therapist.

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 Damien@damienhowellpt.com

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