There’s been an explosion in the creation of rehabilitation technology over the last 10 years. As rehabilitation professionals, we’re fortunate to provide our patients with more opportunity for recovery than we ever have previously. However, these technologies are often very expensive capital purchases which can be challenging to justify in an environment where reimbursement rates and lengths of stay continue to decline. Therefore, it’s important to critically evaluate each piece of technology for potential purchase to ensure maximum return on investment of our specific patient populations.
Interdisciplinary team evaluation
When evaluating a piece of rehabilitation technology, it’s important to take an interdisciplinary approach to ensure that a variety of stakeholders' needs are met. It’s important to include the following groups in the evaluation process:
- Therapists who will be using the technologies on a daily basis
- Senior administration to understand the financial impact of the technology
- Researchers to evaluate research potential
- Engineering to assess maintenance and warranty issues
- Most importantly, patients and caregivers to understand their true goals and priorities
Therapists acceptance and responsibility
Therapists are extremely motivated to help their patients recover. They commonly go above and beyond to ensure their patients reach their maximum potential. In order to embrace technological advances, they need to be included in the decision making regarding the initial purchase of a piece of advanced technology as well as how to implement the device in their continuum of care. When making these purchasing decisions, therapists must be responsible for evaluating the clinical utility of these technologies such as how many therapists/aides are required for initial setup of the device and how long the setup process takes. They need to complete a literature search to understand the known efficacy of the interventions provided by these technologies for the specific patient populations they treat. They must also put time and thought into how these devices will be implemented into their continuum of care from inpatient rehabilitation through outpatient and community programs. This information will be a large part of their contribution to the interdisciplinary team evaluation of advanced technologies for purchase in their organization.
A member of the senior administrative team for the organization must be included in the evaluation of an advanced technology purchase. This team member is responsible for understanding the financial picture of purchasing this device including, but not limited to the following: initial capital purchase price; ongoing maintenance and warranty packages; and must share with the team the fiscal priorities for the organization over the next 3-5 years. It is important to understand not only the immediate impact of a piece of advanced technology but to also consider how this investment may or may not support the five-year strategic plan of the organization.
Members of the research department of the organization should provide the interdisciplinary team with a perspective of potential research gaps that exist with the advanced technology being evaluated. They too should complete a thorough literature review prior to meeting with the interdisciplinary team as well as delving into a review of potential grant opportunities. They must share their knowledge regarding the opportunity to complete research with this specific technology as well as potential upcoming funding opportunities.
Advanced rehabilitation technologies often include a complex interaction of hardware and software. When technologies are first on the market, they can often exhibit both software and hardware challenges even during the first year they are acquired. They also often come with yearly warranty packages that often come with a very hefty price tag. It’s important for the engineering department of each organization to critically evaluate the in-house expertise they have to manage both the hardware and software of each specific piece of technology. Many hospitals now employ both mechanical engineers as well as electrical engineers who may be able to troubleshoot and fix small problems that occur with these advanced technologies. Along with evaluating in-house expertise, a thorough understanding of the cost of the warranty package and what it entails is very important to the decision making process of whether or not to purchase an advanced technology.
Patients and families
The perspectives of patients and families are critical to making successful decisions about which, if any, types of advanced technologies should be purchased. It’s important to include patients and families on this team and/or to survey patients from the various diagnostic groups our organizations provide care to in order to truly understand what type of recovery and opportunity for recovery are most important to them. Patients and families are very savvy when it comes to what types of advanced technologies are now available and many anecdotally report that technology availability is included in their decision making process when determining which rehabilitation hospital they choose for themselves or their loved ones. This information should be gathered and provided to the interdisciplinary team to be included in the decision making process for advanced technology purchase.
Our organization utilized the perspectives of the various team members reported above when deciding to purchase the Indego exoskeleton in 2016. Craig Hospital was involved in a multi-center research study utilizing the Indego in 2015. This research opportunity provided therapists with first-hand knowledge of the system in terms of clinical utility (patient appropriateness; setup time; number of staff required for safety) so it allowed them to bring a unique hands-on clinical perspective to the decision making. The therapists involved in the trial came away with a very positive experience with the system and advocated for its purchase. As an administrator, I was able to evaluate the opportunity for integration throughout our continuum of care and to assess the financial impact in regards to patient lengths of stay, outpatient benefit limits and involvement in our community wellness program. Also, my understanding that maintaining Craig’s position as a leader in spinal cord injury and traumatic brain injury rehabilitation and research is one of the foundational aspects of our five-year strategic plan, led me to support our purchase of the Indego exoskeleton. Our research team evaluated the many gaps (bone density, recovery of walking, balance reaction training and much more) in the literature surrounding exoskeletons and agreed there was great potential to make meaningful contributions to this field and also supported the purchase of this device. Our engineering team had experience with the system during the research study and felt comfortable with the response time and follow through from the Parker Hannifin technical support. Most importantly, the subjects and their families who participated in the trial really enjoyed using the device and reported they believed this technology was among the “next steps” in neurorehabilitation and should be a part of the care we provide at Craig Hospital. Therefore, the decision from the interdisciplinary team was to purchase this device as soon as it was approved by the FDA for personal use.
With the increasing opportunities to provide our patients with the latest in rehabilitation technologies, also comes the responsibility to vet each technology carefully to ensure we’re providing our patients with an optimal opportunity for recovery while focusing on technologies that improve their quality of life.
This article was contributed by Candy Tefertiller. Candy, PT, DPT, ATP, NCS is the Director of Physical Therapy at Craig Hospital. Candy received a B.S in Biology from Mount Olive College in 1997 and a Master’s in Physical Therapy from East Carolina University in 2000. She then completed a Doctorate of Physical Therapy degree from Rocky Mountain Health Care University in 2008. Candy has been working in the field of neurological rehabilitation since 2000 and received an assistive technology practitioner (ATP) certification in 2005 and became a certified neurological clinical specialist (NCS) in 2007. She has been involved in numerous research projects and has focused much of her career on interventions and program development promoting recovery after neurologic injury or disease. Candy is a member of the American Physical Therapy Association and the Neurologic Section.
Craig Hospital is a world-renowned, 93-bed, private, not-for-profit rehabilitation hospital and research center that specializes in the care of people who have sustained a spinal cord and/or a brain injury. Craig provides a comprehensive system of inpatient and outpatient medical care, rehabilitation, neurosurgical rehabilitative care, and long-term follow-up services. Half of Craig's patients come from outside of Colorado. Craig has been ranked as a top 10 rehabilitation center by U.S. News and World Report for 27 consecutive years. Craig has received the NDNQI® award in 2009, 2012, 2013, 2014 and 2015 for the highest quality outcomes in nursing care in a rehabilitation facility. Craig was voted by employees as a "Top Work Place" by the Denver Post for the past three years and was ranked in the top 150 places to work in healthcare by Becker's Healthcare in 2014.