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kaywing
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| Joined: | Sun Jul 16th, 2006 |
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| Posts: | 4 |
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Posted: Wed Mar 4th, 2009 10:23 pm |
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This is Kay Wing again. Over the years we have altered our treatment approach slightly as we have more clinical data, however, we continue to see patients for at least 3 hours per day for at least 4 days per week for at least 6 weeks if at all possible. This is for full body rehab, not just gait training. In our experience, this is still essential.
Reimbursement is always an issue as you well know. We cannot always see the pateints in the intensity that we know is most efficacious, but we can approx. 60% of the time. We pre-authorize whenever possible, but many insurance companies don't preathorize. We ALWAYS know what the patients coverage is before they start therapy so we can plan an intensity appropriately around their insurance coverage. We also feel that any intensity is better than no intensity at all and at least try to see the patient for 1 hour of OT and 1 hour of PT 5 times per week.
I wish I had an easy answer. As clinicians start treating appropriate patients (stroke in our case) in a more appropriate intensity it will become the new standard of care in the future There is also evidence that if we treat stroke and neuro disability with the proper intensity and quality up front we have the potential not only to improve quality of life for survivors and care givers, but to save significant amounts of money in future health care costs as a consequence of falls, debility, weakness, etc.
The literature that answers the question of dose/response is just starting to come out. This is the reference for our publication.
Wing, Lynskey, Bosch. Topics In Stroke Rehabilitation. Intensive Therapy-A Retrospective Data Analysis. May-June 2008. 247-255.
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jkelly
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| Joined: | Fri Jun 20th, 2008 |
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Posted: Tue Mar 3rd, 2009 03:08 am |
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I know this is an old string...but we have been struggling with this at our clinic as well. Much of the research in chronic adult stroke patients with meaningfull, clinically relevant outcomes, uses intensities that are rare in the outpatient setting.
Examples:
Gait training induced cortio-motor excitibility:
http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=17507641&site=ehost-live
They used BWSTT 5 days a week for 4 weeks.
Results from the STEPS trial:
http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009748873&site=ehost-live
They used BWSTT 4 days a week for 6 weeks.
I am also very aware of a "Stroke Camp" that takes place at the University of Indianapolis, modeled after Kay Wing's clinic, that provides intensive BWSTT, as well as intensive constraint-induced movement therapy for the upper extremity daily for 2 weeks, with some impressive outcomes.
I think many of us are aware of the need for increased intensity during our interventions using BWSTT. But what level of weekly intesity is necessary to make meaningful changes? Besides Kay Wing, are there any clinics out there using a more intensive approach, and getting reimbursed?
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kaywing
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| Joined: | Sun Jul 16th, 2006 |
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Posted: Wed Dec 6th, 2006 04:34 am |
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We often treat patients on a daily basis for 2-4 weeks at a time.
Kay Wing SWAN Rehab
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kdmpt
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| Joined: | Fri Jul 7th, 2006 |
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Posted: Sat Jul 29th, 2006 12:58 am |
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| From a customer: I think we are often stuck into a 2 or 3 time a week schedule. I wonder if an intensity of daily for 2 weeks for some of our long tern patients is enough to give them a boost to a new level of functioning. Insurance authorization is more often a limiting factor but we have not done any intense programs like this before. Do you have any information on this type of program and when it would be appropriate or not?
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