A manuscript authored by a team from The Vert Mooney Research Foundation (DBA US Spine & Sport Foundation) and Spine & Sport Physical Therapy (www.spineandsport.com) was recently published in the APTA Physical Therapy Journal of Policy, Administration, and Leadership:
Katz R, Schwartz S, Phelps B, Faust S, Mortimer D, Verna JL, Mayer JM. Telehealth in physical therapy practice for musculoskeletal disorders: case series. The APTA Physical Therapy Journal of Policy, Administration, and Leadership, November 2022.
The manuscript reports on the development and implementation of a telehealth program during the COVID-19 pandemic. The novel aspects of being an early adopter of physical therapy telehealth in a private practice environment, along with research design and analysis via a non-profit foundation, are particularly noteworthy. An abstract of the published manuscript is shown below.
Study Design: Administrative case report.
Objectives: The objectives of this paper are to: 1. summarize the current regulatory considerations for physical therapy telehealth services for musculoskeletal disorders; 2. describe the implementation process of a telehealth program by an outpatient physical therapy organization across its 20 clinics during the SARS-CoV-2 (COVID-19) pandemic; and 3. provide recommendations for regulatory, organizational and research changes needed to support implementation of long-term telehealth services in musculoskeletal physical therapy practice.
Background: The COVID-19 pandemic has greatly disrupted the delivery of healthcare services. Telehealth provides a possible solution for improving delivery of services by enhancing access and fostering patient-centered approaches but has not been well-described in physical therapy practice.
Methods: The implementation processes of telehealth services by a large outpatient physical therapy center in California are described. Three patient cases are summarized for a more detailed description of the experience.
Analysis: Telehealth services were successfully implemented in a large outpatient physical therapy center in response to the COVID-19 pandemic. Initial responses from patients with musculoskeletal disorders and physical therapists about telehealth services were positive.
Conclusions: Telehealth has the potential to enhance physical therapy practice, though its specific structure and magnitude are unclear. Regulatory and organizational changes as well as research trials are needed to help clarify the role of telehealth.
A team from Spine & Sport Physical Therapy (www.spineandsport.com) and The Vert Mooney Research Foundation (DBA US Spine & Sport Foundation) (www.usspineandsportfoundation.com) will present findings of a 3-year FEMA-funded Fire Prevention & Safety grant at the 2023 American Physical Therapy Association Combined Sections Meeting. The grant (Implementation of a Regional Firefighter Wellness Initiative; EMW-2017-FP-00711; Mayer JM (Principal Investigator), Lane CL (Co-Principal Investigator), Verna JL, et al.; The Vert Mooney Research Foundation) represents the latest in a 20+ year history of collaboration between the research and clinical organizations. An abstract of the accepted platform presentation is shown below.
Schwartz S, Lane CL, Duong A, Phelps B, Verna JL, Mayer JM. Physical Therapy engagement in a regional firefighter wellness initiative: implementation and preliminary outcomes. American Physical Therapy Association Combined Sections Meeting. San Diego, CA, February 2023 (accepted).
Purpose / Hypothesis: Firefighters have high rates of musculoskeletal disorders (MSDs) and related comorbidities such as obesity, behavioral disorders, and sleep disorders. Specific guidance on implementing interventions to combat MSDs in firefighters and integrating physical therapists within occupational injury prevention and wellness programs is not well characterized. The purpose of this presentation is to describe the implementation and preliminary outcomes of a regional firefighter wellness initiative, emphasizing the role of physical therapists within an interprofessional team.
Subjects: 429 career firefighters from 15 Southern California departments participated. Eligibility criteria were broad, considering the pragmatic and practice-based design. 88% of participants had a history of MSDs.
Materials and Methods: An observational cohort project was conducted over 18 months. Assessments included anthropometric, fitness, and patient-reported outcomes, particularly for MSDs and related health risk indicators. Interventions included worksite exercise, injury prevention, and educational courses that were customized for risk levels, goals, and preferences. Interventions were delivered by an interprofessional team in one-on-one and group settings, via face-to-face and telehealth sessions. Physical Therapists conducted in-clinic assessments, fitness training at stations, and telehealth consultations. The initiative was implemented during the COVID-19 pandemic and severe wildfires, which disrupted delivery and adherence. A multifactorial approach was used to overcome implementation barriers and improve adherence. Analysis consisted of quantitative and qualitative techniques to assess awareness, behaviors, health outcomes, and implementation.
Results: 35% (138/398) and 5% (17/312) of eligible participants completed 9- and 18-month follow-up assessments, respectively. For participants at the highest risk at baseline, significant improvements (p < 0.05) were observed at 9 months in waist circumference, back and core muscular endurance, functional movement quality, exercise frequency, dietary intake, and sleep quality. Most participants agreed that “Participation in this program has motivated me to focus more on methods to improve my injury prevention, physical fitness, nutrition, sleep.”
Conclusions: Improvements in awareness, behaviors, and key health risk indicators were observed in participants of a firefighter wellness initiative. While low adherence limits generalizability, implementation during major public health emergencies provided an opportunity to inform future occupational health programs including Physical Therapists within interprofessional teams. Future research is needed to fully characterize the role of Physical Therapists within occupational health settings.
Clinical Relevance: Occupational wellness and injury prevention programs are critical for those at high risk for MSDs, such as firefighters. Integration of Physical Therapists within these settings can help enhance the health, well-being, resiliency of first responders.
A team from The Vert Mooney Research Foundation (DBA US Spine & Sport Foundation) recently presented findings of a 3-year FEMA Fire Prevention & Safety grant – Implementation of a Regional Firefighter Wellness Initiative – at two national conferences – American College of Sports Medicine (ACSM) in June 2022 and American Chiropractic College – Research Agenda Conference (ACC-RAC) in July 2022.
- Lane CL, Mayer JM. Worksite exercise adherence in firefighters: findings during a global pandemic and record wildfire season. American College of Sports Medicine Annual Meeting, San Diego, CA, June 2022 (e-poster).
- Mayer JM, Verna JL, Lane CL. Implementation of a firefighter wellness initiative during record wildfires and a global pandemic. Association Chiropractic Colleges – Research Agenda Conference, San Diego, CA, July 2022 (podium).
Abstracts of the presentations are shown below.
ACSM, June 2022
ABSTRACT: Occupational injury is prevalent in firefighters and exercise programming is beneficial to prevent injury and hasten recovery. Yet, implementation of worksite exercise programs has been intermittently successful. PURPOSE: The purpose of this study was to assess adherence factors in firefighters enrolled in a worksite fitness program during a global pandemic and record wildfire season. METHODS: A cross sectional study was conducted in career firefighters (n = 429) from 15 Southern California departments enrolled in a 9-18 month worksite fitness program. Exercise adherence, completed exercise sessions in the intervention period, was compared to baseline age, history of musculoskeletal (MSK) conditions, completion of wellness educational courses and physical fitness measures. ANOVA, T-Tests, or Chi-square were used to assess relationships between exercise adherence and baseline characteristics. RESULTS: Exercise adherence was poorer than anticipated and was attributed to the COVID-19 pandemic and record wildfire season. Significant weak correlations with exercise adherence were noted for age (r = 0.112, p = 0.035), BMI (r = -0.113, p = 0.033), back muscular endurance (r = 0.217, p < 0.000), core muscular endurance (r = 0.113, p = 0.035), and flexibility exercise frequency (r = 0.113, p = 0.035). Those with MSK history had a higher adherence rate than those without (History: 13.2 +/- 22.7%, No History: 4.7 +/- 7.4%, p = 0.021). Those who completed wellness education courses had a higher adherence rate than those who did not (Completed: 29.9 +/- 31.1%, Did Not Complete: 7.2 +/- 14.9%, p < 0.000). No significant relationships were noted between exercise adherence and waist circumference, bodyfat%, Functional Movement Screen, or cardiovascular and resistance exercise frequencies. CONCLUSION: These findings suggest that the most adherent participants were more fit, older, and had a MSK history. However, the poor adherers were less fit, suggesting that firefighters who need exercise programming the most were not adherent. While more research is needed, future iimplementation efforts should minimize delivery barriers, consider a hybrid approach of face-to-face and virtual sessions, and focus on delivering to firefighters who are most vulnerable to MSK conditions.
ACC-RAC, July 2022
ABSTRACT: Objective: Firefighters have elevated rates of cardiovascular, musculoskeletal, and sleep disorders. However, specific guidance on implementing interventions to address these conditions is largely unavailable. The purpose of this project was to implement a firefighter wellness initiative targeting obesity, musculoskeletal injuries, and sleep disorders. Methods: An observational cohort project was conducted in 429 career firefighters from 15 California departments. Assessments included anthropometric, fitness, and patient-reported outcomes that are known health risk indicators. Physical fitness, injury prevention, and educational interventions were customized and triaged according to needs, goals, and risk levels. Interventions were delivered over 9-18 months in one-on-one and group settings, via face-to-face and telehealth sessions. The initiative was implemented during record wildfires and the COVID-19 pandemic, which disrupted delivery. Results: 127 firefighters completed 9-month follow-up assessments. For those at highest risk at baseline, significant improvements (p < 0.05) were observed in waist circumference, muscular endurance, functional movement, exercise frequency, dietary intake, and sleep quality. Conclusion: Improvements in key health risk indicators were observed in firefighters who participated in a wellness initiative. While the relatively low adherence may limit generalizability, the unprecedented environment provided an opportunity to inform future implementation of occupational wellness program
Charity L. Lane, Ph.D., CPT, FNS, GFI – Board Member and Director of Program Development of US Spine & Sport Foundation – successfully defended her PhD doctoral dissertation on “An Exploration of Administrative and Shift Leaders’ Perceptions on Barriers and Facilitators to Adoption and Maintenance of Firefighter Physical Fitness Programs”, Health and Human Performance, Concordia University Chicago. The study’s novel findings and subsequent implementation and research recommendations will aid the fire service in shaping robust and sustainable worksite fitness programs aligned to NFPA standards and WFI guidelines. Congratulations, Dr. Lane!
Leonard N. Matheson, PhD recently received the 2021 Health Advocate Award from the American Occupational Therapy Association (AOTA). The Health Advocate Award expresses appreciation for extraordinary contributions of national significance that led to the advancement of health promotion and/or health care. AOTA – a leading body of the Occupational Therapy profession in the world – recognized Dr. Matheson’s contributions as a “Work-Oriented Neurorehabilitation Pioneer, Educator, and Policy Advocate.”
Dr. Matheson is a founding Board Member of The Vert Mooney Research Foundation and President of EPIC Neurorehabilitation & Psychology Services. As a Clinical Psychologist and researcher, his contributions to the field of occupational rehabilitation across many domains are unparalleled. More importantly, he is an outstanding mentor, great friend, and has touched the lives of many people around the world.
Congratulations, Dr. Matheson!
Fire Engineering recently published the article:
Mayer JM, Andres A, Lane CL. Implementation of a regional firefighter wellness initiative during a global pandemic. Fire Engineering, 2021;September:2-6
It discusses the Foundation’s FEMA-funded grant, highlighting experiences with one partner fire department. The article is found at this link:
USSSF Director of Program Development and Board Member, Charity Lane, was recently published in the first 2021 edition of the NSCA TSAC Report (#60) on the topic of Sleep programs in the fire service.
Lane CL, Melton B. Sleep improvement programs in firefighters – a critically appraised topic. National Strength & Conditioning Association (NSCA) Tactical Strength and Conditioning (TSAC) Report, 2021, 60.
Full text available here – NSCA member access only: https://lnkd.in/g4WSfW3
Dagenais S, Hayflinger C, Mayer JM. Economic evaluation of an extended telehealth worksite exercise intervention to reduce lost work time from low back pain in career firefighters. Journal of Occupational Rehabilitation, 2021(Jan 4) (online ahead of print).
Found here: https://pubmed.ncbi.nlm.nih.gov/33394268/
Purpose Low back pain (LBP) is a leading cause of lost work time (LWT) in firefighters and is related to poor muscle endurance. Although exercise can improve muscle endurance, it must be continued to sustain benefits, and it is unknown if it can reduce LWT. This study conducted an economic evaluation of an extended worksite exercise intervention in career firefighters. Methods A randomized controlled trial allocated 264 firefighters to telehealth with remote instruction (“telehealth”), direct exercise supervision (“direct”), or brief education (“control”). The telehealth and direct groups performed worksite exercises twice weekly for 12 months. Outcomes included quality adjusted life years, LWT from LBP (24-h shifts), costs of LWT from LBP, and net monetary benefits. Results A total of 216 firefighters were included in the economic analysis (telehealth n = 71, direct n = 75, control n = 70). Sixteen experienced LWT from LBP (telehealth n = 4, direct n = 4, control n = 8). The mean number of 24-h shifts lost from LBP were 0.05 (telehealth), 0.28 (direct), and 0.43 (control). Mean study intervention costs per participant were $1984 (telehealth), $5269 (direct), and $384 (control). Net monetary benefit was $3573 for telehealth vs. direct, – $1113 for telehealth vs. control, and – $4686 for direct vs. control. Conclusions Worksite exercise reduced LWT from LBP in firefighters. Telehealth was less costly and more effective at reducing LWT from LBP than direct exercise supervision. If the costs of telehealth were further reduced, a positive net monetary benefit might also be achieved when compared to no intervention. Clinical trial registration: (clinicaltrials.gov): NCT02362243.
Found here: https://pubmed.ncbi.nlm.nih.gov/32796259/
Objective: This study assessed worksite exercise delivered by on-site supervision (supervised) or telehealth to reduce lost work time (LWT) related to low back pain (LBP) in firefighters. Methods: A cluster randomized controlled trial assigned 264 career firefighters to supervised (n = 86) or telehealth (n = 95) back and core exercises 2X/week for 12 months, or control (n = 83). Results: 58.0% (153/264) of participants reported LBP and 7.6% (20/264) reported LWT related to LBP (control n = 10, supervised n = 5, telehealth n = 5). Participants in the control group experienced 1.15 times as many hours of LWT as the supervised group, and 5.51 times as many hours of LWT as the telehealth group. Conclusions: Worksite exercise, delivered by on-site supervision or telehealth, can reduce LWT related to LBP in career firefighters.