You know how your practice has fared during the past year and how the recession will affect your purchasing decisions in 2010. To present you with a bigger picture, Rehab Management recently conducted a survey to gauge how the recession is affecting physical medicine and rehabilitation professionals and practice owners, and whether/how the economic climate is impacting their purchasing strategies and decisions in the coming year. The survey results follow.*
The responses show the following trends:
Nearly 80% of respondents say their practice plans to make facility-based purchases of less than $1,000 in 2010, while only 7% do not. About 14% are on the fence.
More than half of respondents say their practice plans to make capital purchases in excess of $1,000 this year. While a quarter of respondents say no such purchases are planned, almost 20% are undecided—leaving the field wide open to discretionary purchases.
These three categories topped the list of potential purchases in descending order: pain management solutions such as electro-stim, ultrasound, and topicals; fitness equipment; and long-term care solutions such as mobility, and seating and positioning solutions.
Updated technology, treatment trends, and safety/durability of offerings largely spur the capital purchase decisions. Extra features are important to practitioners, but despite the popularity of eco-friendly products in mainstream consumer goods, green did not rank high with respondents—about 2% said it is a factor in their decision-making.
A plethora of favorites emerged as practitioners’ go-to products for rehabilitating clients’ sports and lower-extremity injuries. Among them: ultrasound, e-stim, recumbent cross trainers, bands, treadmills, gait equipment, mobility aids, wheelchairs, bikes, weights, cardio and strengthening equipment, assessment equipment, treatment tables, and modalities.
Practitioners who operate fitness-wellness programs say they favor cardio equipment such as treadmills, bikes, elliptical and step machines, balance systems, weight equipment and free weights, balls and bands, strengthening equipment, mats, kettlebells, recumbent cross trainers, treatment tables, wheelchair-accessible gym equipment, standing frames, upper body ergometers, and pulley systems.
On the short list for purchase in 2010 are wheelchairs, scheduling software and electronic documentation systems, recumbent cross trainers, standing frames, treatment tables, treadmills, balance systems, and exercise machines. The wish lists mentioned many of the same products, and in many cases called for updating current inventory.
Judy O’Rourke is associate editor of Rehab Management. She can be reached at .
Rehab Equipment for a Sports Clinic—Basics to Wish List
When purchasing equipment for your outpatient clinic, first identify what equipment you really need: “the basics.” Then, you will want to consider adding “bonus items,” which can take your clinic to the next level. Finally, you’ll want to research and consider the “big ticket rehab tools.” These are the items that can transform your clinic into a state-of-the-art facility. Consider the size and the cost. Bulky machines can take up floor space—usually in high demand in most clinics (also, more floor space is needed for sport-specific activities, such as plyometrics, agility drills, and return-to-sport testing). Last, equipment such as treadmills and weight machines can be costly. Make sure you are making the best use of your clinic’s budget.
The Basic List
Most clinics have some, if not all, of these items already.
A good stationary bike and an elliptical machine should be part of almost every clinic already.
One of my favorite tools is a simple foam roll. It is great for self-stretching, massage, and myofascial release.
Balance and neuromuscular control are key to good outcomes with all of my patients. I make sure to have a variety of balance toys available in the clinic. These are relatively inexpensive, provide different levels of instability, and add variation to the rehab programs. Balance discs, foam pads, wobble boards, and, most importantly, a flat-based exercise ball—a “must-have” piece of equipment.
Physioballs can be used in ROM exercises, core stabilization, and even proprioception/neuromuscular control exercises. Some of my favorite exercises are prone planks with elbow circles for core stabilization, supine hamstring curls for hamstring and glute strengthening, and single and double leg squats on the physioball for neuromuscular control.
A slideboard is another great tool that can be used in numerous ways from general cardio exercises, to hamstring and adductor strengthening, to core stabilization. Speed ladders are a great tool for return-to-sport progression. The newest piece of equipment in our clinic is a suspension training system, which uses the patient’s body weight as resistance while incorporating core stability—and it replaces numerous pieces of equipment in our facility.
Last is a step-up box or plyometric box, which I prefer, so I can also do plyometric and force attenuation exercises.
The Bonus List
A good treadmill that goes at least 10 mph will allow you to initiate running programs under a controlled environment so you can monitor gait and assess for any deviations.
Strength training machines offer less core activation and they’re not functional or sport specific, but there are times when patients may benefit from strength training exercises on these machines.
An adjustable cable column machine gives you plenty of options for upper and lower extremity strengthening, core stabilization, and functional training. You’ll need enough space around the unit to allow you to perform functional and sport-specific exercises such as the standing single arm press and row.
Vasopneumatic cold compression units are great tools for both postsurgical patients and the everyday sprains and strains associated with sports clients. The portable unit combines the positive effects of compression and cold therapy to reduce pain and swelling.
Vibration therapy is new to the rehab setting. We have found it to be effective in improving proprioception/neuromuscular control in our lower extremity patients. It can be highly effective in improving flexibility when performing self-stretching and mobilization exercises.
Weighted vests allow you to do much more functional and sport-specific exercises compared to having the athletes hold dumbbells, tubing, or medicine balls, which limit the ability to perform specific movement patterns and put the resistance outside the athlete’s center of gravity.
The Big Ticket List
Finally, I have a list of equipment I would purchase if I had an unlimited budget.
The first item is an antigravity treadmill, which allows you to reduce body weight by up to 80% and attain speeds as high as 18 mph. It enables partial weight-bearing ambulation without an assistive device, initiates running while decreasing weight-bearing stresses, and even performs partial weight-bearing exercises without the belt moving.
Next is an isokinetic unit for lower extremity strength testing with return-to-sport assessment. These units give valuable side-to-side strength comparisons when determining if an athlete is ready to initiate a return-to-sport program. They also have some benefit with high velocity and eccentric training.
Another big purchase would be a computerized balance assessment unit. The unit in our clinic enables us to perform numerous tasks giving us side-to-side comparisons, which we use in determining an athlete’s neuromuscular recovery.
The last item is an air resistance cable column unit that enables high velocity movements for functional and sport-specific training with fluid, consistent resistance that plate resistance units don’t allow.
The right equipment will help you perform assessments that give objective measurements on a patient’s progress with rehab. Knowing when to use and not to use each piece of equipment may be more important than what you purchase for your clinic.
Justin Shaginaw, MPT, ATC, manager of sports medicine, Good Shepherd Penn Partners Penn Therapy and Fitness at Pennsylvania Hospital, Philadelphia.
Purchasing Decisions for a SCI and TBI Facility
Darrell Musick, PT, director of physical therapy, and Kenneth R. Hosack, MA, director of provider relations at Craig Hospital, Englewood, Colo. The facility treats patients with spinal cord injury and traumatic brain injury. Most are trauma-related cases; about 50% result from motor vehicle accidents, 20% from falls and sports-related injuries—largely diving accidents. The interdisciplinary team includes physicians, nurses, physical and occupational therapists, speech-language pathologists, clinical psychologists, neuropsychologists, respiratory therapists, therapeutic recreation practitioners, patient and family service counselors, dietitians, a chaplain, and nurse educators. Craig Hospital employs some 565 full-time employees, for about 80 inpatients and about 50 outpatients. The facility staffs approximately 30 OTs and 30 PTs, 12 to 15 speech pathologists, 25 respiratory therapists, and about 10 full-time recreation therapists.
Many Capital Purchases Planned
Craig Hospital’s physical therapy department is planning on many capital expenses, each totaling more than $1,000, in the coming year. The occupational therapy, speech, and other departments have additional capital needs, which are not noted in this article. “The heaviest area where I will spend the most amount of capital will be in updating our wheelchair evaluation fleet,” says Musick. Craig owns an in-house fleet of some 350 wheelchairs—demo chairs—which comprise power, power recline, and manual chairs. Craig plans to update its fleet. “We have over $100,000 designated toward high-end power wheelchairs and manual wheelchairs.” In bulk, this represents the top of the list in terms of cost.
“When a patient first gets here, we like to trial them in different types of equipment before they purchase their own,” says Hosack.
“The other thing that’s most expensive, we’ll be ordering a sixth FES bike, which is the RT300, for our bike program,” says Musick. “Our volume during our high-census period has increased enough where we’re unable to meet the demands with five bikes. We’ll be adding a sixth bike this next quarter. The price tag will be about $15,000,” notes Hosack.
Craig is also working on program development in gait training with spinal cord injury patients. “We’re partnering with Becker Orthopedics and Hanger Orthopedics, and they’re working with us to get a new brace called a stance control orthosis,” says Musick. “This is an evaluation model that’s able to be modified to evaluate patients so that we can get them their permanent brace in a timely way.” Craig plans to get four of them. Musick says the retail price per brace is upwards of $6,000 or $7,000.
Providing Current, High-End Equipment
The biggest factor prompting the purchases is providing rehabilitation patients with the most current, high-end equipment, Musick says. “With the wheelchairs, there’s a natural need to be current with the model that they’re going to be choosing, and offering what’s out there in 2010. On the stance control braces, that technology is emerging from the prosthetics world, giving some new equipment and new dimensions that we weren’t able to offer a few years ago.”
Craig has increased its program and is offering a gait clinic, and with the clinic, it’s a natural fit to seek more diversity in its orthotics.
Musick says Craig is most proud of its intensive FES bike program. “We’re also excited about our gait clinic and gait program for both TBI and spinal cord injured clients,” he says. “We’re taking it to another level.”
Hosack says: “For a rehab facility to own that much of our own equipment that we can use with our patients—by the time we go to order equipment, it’s not a guess. We’ve tried people in different types of equipment, different styles according to their weight, height, posture, seating, functional skills, and skin. So we’re making informed decisions to get the most appropriate equipment for people because of that demo fleet of chairs.”
Keeping the fleet updated thus becomes all the more important.
Purchases Planned for Midwest Rehabilitation Hospital
Bruce A. Brasser, RN, MSN, MBA, vice president of clinical services and risk manager, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Mich, an 80-bed inpatient facility. It operates four primary inpatient programs: spinal cord injury, brain injury, stroke, and pediatrics. It staffs about 90 full-time therapists between its inpatient and outpatient therapy centers, including PTs, OTs, and speech and recreational therapists. The outpatient center sees some 45,000 therapy visits annually. Mary Free Bed was the only hospital in Michigan to earn the Michigan Quality Leadership Award in 2009, says Brasser.
Capital Purchases Include Expansion of Successful Project
Mary Free Bed is planning capital purchases that include expansion of its ceiling-mounted lift systems in patient rooms. “Phase 1 of this project has been very successful, making caregivers more efficient and reducing back and shoulder injuries for our employees,” says Brasser. “We will be also purchasing surveillance monitoring systems for patient rooms to enhance our patient safety program, especially for those patients recovering from traumatic brain injuries.
“One of our organizational priorities is having a dedicated workforce that strives to exceed the expectations of our patients, and the lift system will protect the health of our employees and contributes to the quality of care that we deliver to our patients,” he says. “Likewise, the surveillance cameras will help us improve the safety of our services, which is another priority at Mary Free Bed.” The hospital has maintained a comprehensive set of therapy equipment to assist with the rehabilitation of sports/lower extremity injuries, and has no immediate needs in this area, he says.
East Coast Multisite Practice Seeks Staff Input for Purchases
Robert Babb, PT, MBA, founder and practicing physical therapist at the Physical Therapy & Wellness Institute, with locations in Quakertown, Lansdale, and Montgomeryville, Pa—and a fourth clinic in Trooper, planned in March. Since 2002, the practice has grown to four clinics with more than 35 employees, meeting close to 2,000 new patients a year. Baby Boomers dominate the practice demographics, with the mean age of clients at 47 years old. Payor mix for physical therapy service is 58% private insurance, 15% Medicare, 14% work injuries, 6% auto accidents, 5% HMO, and the rest cash-paying, self-pay clients. For patients who had financial responsibility according to their plans, the average patient co-pay and/or coinsurance for each visit in 2009 was $2,740, says Babb.
Purchases Planned in phases
“We just upgraded our software program, spending over $26,000 on the software, hardware, and new server,” says Babb. Three administrators attended APTA’s Private Practice conference in Colorado in November, where they got hands-on with four possible software products.
“There is always a list posted in our office for future projects and equipment, and once or twice a year we make purchases with the staff input,” says Babb. “Top three items right now include instrument assist tools for soft tissue mobilizations, mechanical cryotherapy compressive units, and mats for our balance training.”
Babb says the practice will try to get “full life” out of all of its equipment, including treadmills, weight-training pieces, and all physical therapy modalities. “We feel very comfortable paying more up front for a product that has a proven record in our industry, and will not be quick to jump on some of the new equipment fads with lots of bells and whistles,” he says.