Keeping Patients Well
Group exercise for wellness and prevention—a business opportunity to lead.
By Patrice Hazan, PT, DPT, GCS, MA
Our nation is facing a health care crisis: How do we provide optimal health care for the increasing number of elderly persons with chronic conditions? Physical therapists can take action and use this crisis as an opportunity to expand services to keep patients well. Private practices are in a unique position to innovatively help patients and improve profits and sustainability.
Personally, I was discouraged practicing with the current medical and reimbursement model. I felt as though I was failing my patients. I was growing tired of the all too common scenario of discharging a patient with a home exercise program and recommendations for community programs only to see them again a few months later because they lost all of the progress they had made. I decided that I could do something about this through the use of group physical therapy exercise classes to promote wellness and prevention.
While the motivating factor for designing and creating classes was to provide a needed service, I had no idea what an unbelievable cashed-based business opportunity this service provided. Word spread quickly as this type of service was not being offered anywhere. The feedback I received from patients further strengthened why I had gone this route. For example, they did not want to exercise in a gym environment, they needed their balance challenged, they were afraid of injuring themselves, senior center classes were not appropriate, and/or they did not know what exercises to do or how to progress. This showed me that my risk was paying off—the need for these unique, distinct, evidence-based classes focused on wellness and function was evident.
As a result of filling this need, not only are patients choosing use our service, but they are telling their friends about it. Physicians are also choosing us for their choice of physical therapy because of the unique transition to group classes. All of our referrals have come directly or indirectly from the fact that we offer group classes for wellness.
Wilma and Lou are perfect examples of how critical and beneficial group physical therapy classes have been in patients’ lives.
Wilma had just completed her second episode of physical therapy in less than a year. Her daughter, Barbara, was disheartened and concerned at a discharge plan consisting of a home exercise program and recommendations for community programs. She had tried both options before with poor results. Wilma needed help to perform the exercises and her daughter knew Wilma would quickly become bored doing the same program every day. Without the physical therapist present, she would not be able to adequately challenge Wilma’s balance. A few community programs existed, but nothing that met Wilma’s needs. The chair exercise program at the senior center appeared to be better than nothing, but it did not challenge Wilma’s balance or endurance. Wilma could not do any standing exercise program since her balance was impaired and she could fall. Barbara was concerned Wilma was not going to be able to stay at home much longer at this functional level. When she heard of a physical therapy clinic offering small group exercise classes, she knew it was just what she and her mother needed.
Lou had just completed eight weeks of physical therapy for arthritis and pain in her knee. Her knee was better, but she was still concerned about her balance and lack of stamina. She wanted to improve her overall health. She came to us because she wanted the expertise of the physical therapist to assist with her wellness program. She went through the initial assessment and was placed in the appropriate classes. She states her experience has been life-changing.
We need to ask ourselves, as movement experts, are we acting as leaders in health and wellness? Is it enough to recommend community services and a home exercise program on discharge, or with our knowledge and experience, could we do more? Are we offering our very best or could we use our expertise, knowledge, experience, availability to current research, and creativity to create and deliver superior services to keep our patients well?
Creating group wellness classes has been challenging and there has been an interesting evolution. Initially, I did a lot of research to develop disease-specific exercise classes such as Parkinson’s, osteoporosis, arthritis and balance/fall prevention. I thought patients would like a class full of physical therapy knowledge to address their condition/disease. What I found was completely unexpected—no one wanted this. Instead, patients preferred the fun classes that were based on functional capabilities, not condition specific. Because of this, we offer a wide range of fun and rehabilitative classes: StrengthHab, Strong and Steady, DanceHab, Well and Fit, Rehabilitative YOGA, Core Strengthening/Spinal Stabilization, and simple step. With these classes, it is not just about the disease or the condition and there are no labels, just fun classes with aerobic conditioning, strengthening, balance, and flexibility that are safe, progressive, and enjoyable.
What makes this approach to wellness unique is a detailed physical therapy initial assessment with identification of patient goals, individualized instruction in precautions, modification, and adaptations, and recommendations for the appropriate class based upon functional capabilities and, of course, a wide variety of class offerings. Classes are designed by a physical therapist to meet different functional levels using evidence-based practice, theory, and exercise principles. The initial physical therapy assessment and reassessments contain the individualized disease-specific education and instruction, which is then incorporated into the class.
There are so many patient stories that I could share. In many cases, I feel as though I have been able to accomplish more with group therapy than individual therapy. These group exercise classes allow for a holistic approach to patient wellness, improving endurance, strength, flexibility, balance, and posture while providing a place where patients can have much needed social support. Discharge plans from individual therapy contain a transition to the cash-based group classes.
The model of physical therapy-led and supervised group exercise classes for wellness and prevention is working. Patients are making excellent progress, staying well and from a cash based business standpoint, we are thriving.
Patrice Hazan, PT, DPT, GCS, MA, is the owner, founder and chief executive officer of GroupHab Physical Therapy and Wellness. She can be reached at GroupHab@gmail.com.