Optimizing Therapeutic Intensity
- mmayer178
- 7 minutes ago
- 4 min read
By J.R. Burnett, BBA, DPT
Director of Outpatient Rehab UMMC,
Regional Clinical Director Mid South Rehab
Team, it is hard to believe that we are already halfway through 2025! What a journey this year has been! From handing off my wonderful N MS teams to Jordan and Lewis, to moving my amazing family from Oxford to Clinton, to meeting and starting new UMMC partnerships in addition to our longstanding UMMC partners, and to being re-joined with my beloved 360 Total Rehab facility, I have gotten to experience a whirlwind of emotions so far this year. Most years see a lot transpire in a 6-month period, but I do not know if I have ever experienced 6 months with so much change!
Some of the changes have been wonderful, but with all changes, there is difficulty. Change is a part of life, and it is trying to all of us whenever we go through it. I am thankful that the rock of ages has been an ever-present source of security and comfort to me and to my family as we have gone through all of the changes, and now, I believe we are in a place of trying to move forward in the new season of life we have been blessed to take part in.
As I have been enriching myself in new relationships, especially new work relationships, I have been delighted to see so many positive changes. Our 360 total rehab team had a complete facelift to our facility! New paint, new floors, new equipment, and our gym is looking better than ever! In a very similar way, the largest of our UMMC outpatient clinics also just experienced a lot of change! We moved from the UMMC Pavilion in downtown Jackson to a brand-new building at UMMC Colony Park South. The building is stunningly beautiful. If you have not been by but have the opportunity, please do come see both 360 and UMMC CPS clinics. You will love what you see!
I truly do believe in the build it and they will come mentality with many aspects of our business. When we transitioned to UMMC Grenada’s standalone OP clinic, providing a beautiful new gym in a joint venture with UMMC, we saw VAST increases (over 3 times the patient volumes) in our OP department. We have all of these beautiful facilities, and indeed, we have been getting more and more referrals. As I have been helping our therapists grow in the provision of care to these patients, I have noticed some drastic differences in treatment approaches as I have examined the therapists’ documentation. This has begged the question, how much therapy is the right amount of therapy? While the typical PT answer, “IT DEPENDS,” certainly does apply here, I believe we need to consistently apply certain overarching principles to our care approaches to see the best outcomes and best operational excellence across our company.
At the end of this article, I have included several different articles that I would encourage ALL of our therapy partners to read, especially our therapists in the field. Once you have reviewed the clinical data and research, I believe you will land in the same place that I have in my conclusion. We MUST be sure that when we do everything, we do to bring patients to us (new equipment, new facilities, marketing, prior-authorization, scheduling, etc.), that we provide the proper amount of intensity to the patient necessary to bring about tissue changes that will achieve our patient’s goals. I agree with the systematic review of Ed M. Bice, which says, “a six‐week therapeutic exercise program, three times a week for 30 minutes was ‘insufficient’ in frequency, intensity, and duration for geriatric patients with cognitive disabilities. “ I agree with the APTA that says if we want to provide care to a patient that will benefit their aerobic capacity, their strengthening, their flexibility, and their balance, we must provide enough intensity to address each of these items of therapy intervention, and the time required cannot be less than what is necessary to bring about these changes! If it takes 90 minutes a week for balance changes, 60 minutes a week for flexibility changes, 60 minutes a week for strengthening changes, and 150 minutes a week for aerobic capacity changes, then we need to help install and carry out a plan that will include ALL of these requirements with the appropriate effort levels to bring about the tissue changes we want to see. These tissue categories and organ systems that our treatment plans are built upon are not and CANNOT be either or; they MUST be BOTH AND. We need to decide what we are going to try to improve, and then, as skilled therapists, we must tell our patients openly and honestly what intensity it will require of them to reach these improvements.
Too many times I have seen our therapists fall into terrible habits of 2 times a week for 45-60 minutes of treatment, when the patient really needs 3 times a week of 60+ minutes of treatment with another 1-3d days of a vigorous HEP to bring out patients where we want them and where they want themselves to be at their day of discharge from our services. As we lead, they will follow!
I believe some therapists are afraid of being overbearing, but when our patients know that we know what it takes to get them to where they want to be and we will help fight for them and motivate them to put in the sweat equity that is required to be there, I believe we will see more patient buy in than ever, higher patient satisfactions than ever, and higher reaching of outcomes than ever. Recently, I was shown FOTO data from one of our busiest therapy clinics, and in the data, the therapist who routinely had the highest frequencies and most intense therapy sessions with their patients had far and above the best outcomes and was well above the national average in this nationally standardized assessment. And while that is one very limited case study in our company, it is a real picture of what this data and these articles are all showing.
Our patients need more of us, not less of us. Please go out there and be the motivator and plan of care creator that gets people to their functional goals, and do this in the name, power, and love of Jesus.
J.R.