Is Virtual Physical Therapy a Placebo? Similar to what Christopher Columbus did in Jamaica
THE DANGER OF POORLY TRIAGING MUSCULOSKELETAL PATIENTS
By Ali Alhimiri, MD CEO, Founder at Modus
A total lunar eclipse occurred on 1 March 1504. During his fourth and last voyage, Christopher Columbus induced the inhabitants of Jamaica to continue provisioning him and his hungry men, successfully intimidating them by correctly predicting a total lunar eclipse for 1 March 1504
Musculoskeletal MSK Care
Simply put, 90% of MSK complaints are resolved in 90 Days CMAJ 2012, assuming we don’t cause harm with aggressive, unnecessary care.
Full disclosure: I think a placebo is a great option for care as long as it’s not harmful and it’s reasonably priced for the value it offers.
Properly caring for MSK patients requires a trained, experienced Physician to:
- Hands-on patients with complete in-person physical exams can be done by a physical therapist or trained Physician
- Identifying the red flags (cancer, infections, etc.) and triaging them to the proper care promptly can be done by a physical therapist or trained Physician.
- Reassuring the (90% of patients) that their condition is not serious and will resolve within weeks, Patients want to hear that from a doctor they trust. Otherwise, they will run to the ERs and Thoughtless care providers.
- Treating patients with conservative nonsurgical care and using procedures/surgery when the benefits outweigh the harm, Only trained Physicians are qualified to do this.
Predicting and preventing which patient will end up on the path to chronic pain and disability; only trained Physicians are qualified to do this.
Failure to adequately address one or more of the above duties will lead to “preventable / Mega catastrophic claims.” The 5% of MSK claims end up costing 50%. Triaging to the wrong level of care or the wrong doctor can lead to unnecessarily aggressive and harmful care.
So, virtual PT providers pitch to clients the “secret sauce” of technology, as well as coaches and physical therapists, to achieve the ultimate goal of surgical avoidance.
They advertise digital exercise / physical therapy programs, offering those who suffer from pain the narrative that they can receive better or more cost-efficient physical therapy if trained therapists guide them through their mobile apps.
But does this technology make a difference? Or are we, like the native inhabitants of Jamaica, adopting whatever narrative is being peddled regardless of its benefit just because of dire, unpredictable circumstances?
Virtual PT providers are probably a good solution for having chronic pain patients engaged digitally and getting more compliance.
Virtual PT providers exist because the current system squeezed the time with doctors and therapists who are unable to attend to patient needs in the few minutes that the system had allowed, so naturally, patients will end up walking into the surgeon’s office out of frustration, and end up with expensive, aggressive care that changes their lives forever.
The Virtual PT providers owe us proof that they are making a difference (Thus far, the published studies are of poor quality).
They should conduct and publish a study comparing two groups of patients and outcomes (The payers’ clients should fund such studies). I propose a simple study:
Study Principles
- Study should be conducted by independent investigators (not working for the Virtual PT providers, nor accepting any compensation from them in the future)
- Virtual PT patients vs. controls
- The control should be treated by primary care doctors supported by physical therapy and preferably non-surgical MSK specialists (physical medicine and rehab or sports medicine) who spend at least 15 minutes with each patient
Outcomes Measures:
- Surgical rates
- Overall cost
- Opioid use
- Disability rate
Virtual PT providers can differentiate themselves from Christopher Columbus.
