Using Video to Improve the Patient Experience
November 2014 Issue
With access to a growing body of online resources and technologies, O&P patients are not only more educated about components than in the past, but they are more involved in the selection and fitting of their devices. As practitioners, we have an opportunity to engage the patient in the fitting process and, therefore, facilitate the patient's proactive participation in his or her healthcare. Video observational gait analysis (VOGA) can be used as a central aspect of integration and coordination between the practitioner, the patient, and the patient's other allied healthcare professionals. Advancements in cameras and technology have made video a user-friendly, cost-effective assessment tool. We can use the video function on our smartphones and tablets to gather information to improve the patient experience, provide feedback for gait training, prepare for and document the patient visit, supplement observational gait assessments, and facilitate treatment planning.
Improve the Patient Experience
In my experience, patients enjoy seeing their progress, particularly if you are making recommendations to improve a movement that they can't see, such as sagittal plane motion. Record videos of the patient across several visits so you have a visual history to review with your patient during subsequent appointments. This is effective to use when a patient expresses discouragement about the lack of improvement in his or her rehabilitation. By showing the patient the video of his or her progress, it can turn that appointment around to be positive, productive, and fun.
Provide Feedback for Gait Training
The majority of people with lower-limb amputations who use prostheses walk with at least one gait deviation.1 Because these deviations are often signs of compensations, VOGA can help the practitioner pinpoint areas in the body where these efficiency losses originate. For example, consider the patient who might not realize that he or she isn't performing the arm swing because of the focus required simply for walking. Take a baseline video to demonstrate the deviation. Because the patient has now been made aware of the problem, he or she will likely swing his or her arms for the next walk cycle that you record. You can then show the patient any asymmetry in the arm swing and continue working on the deviation. At the end of the session, compare the baseline video and the final video to see the progress. Your patient will walk out of your clinic feeling accomplished and motivated to keep improving.
Back pain, osteoarthritis of the sound limb, osteoporosis on the amputated side, and sound side foot breakdown are common secondary conditions in individuals with lower-limb amputations.2 Use video to explain how reducing strain on the sound limb can reduce the risk of secondary conditions. For example, stride length variability has been linked to a risk of falls.3 Record the patient at his or her self-selected walking speed. Play the video back to show the patient any stride variability, and ask him or her to practice making each step symmetrical. Linking to a specific task is invaluable.
Taking video of a patient who uses a prosthetic device for recreation is crucial to maximize fit and function. It is especially important if the recreation involves high-speed motion, because our eyes cannot observe a motion that lasts for less than 60 milliseconds.4 The video can be replayed at a slow speed to allow you to observe the motion. For example, using video to observe the dynamic hip level during running is essential to fitting a running prosthesis that won't lead to back pain. Once you have used the video to maximize the fit of the device, the next step is to use the video to train the patient for gait improvements.
Again, replay the video at a slow speed and explain the motion you see, compared to what it should look like, so that the patient can practice changing his or her pattern.
Prepare for and Document the Patient Visit
One of the best practices for using video in your clinical care is as a tool to prepare for the patient's next visit. Review the patient's most recent video immediately before his or her next appointment. You will be able to identify changes much quicker with video than by reviewing your notes.
VOGA is also an excellent way to help you document the patient visit in your chart notes. Without video, once a patient leaves your facility, you have to rely on your notes to remember what transpired during the visit, which can be difficult when you have back-to-back patient appointments. However, if you review the footage while completing chart notes, it will help ensure thorough documentation.
Supplement Observational Gait Assessments
Visual diagnosis of a patient's gait in real time is subjective, lacks accuracy, and relies on the clinician's training and experience.5 You can use video in conjunction with an observational gait score to increase the reliability of those scores; in fact, gait scores are often tested for reliability using video.6 Possible measurements to use include the Edinburgh Visual Gait Score (EVGS), Rancho Los Amigos System, Rivermead Visual Gait Assessment, and Prosthetic Observational Gait Score. The EVGS is a comprehensive video assessment tool that has been found to be sensitive enough to detect changes in gait due to a change in intervention.7
Facilitate Treatment Planning
VOGA is an easy-to-use and cost-effective method of improving the patient experience by establishing a visual history of your patient's progress. Not only will recording video complement your documentation of outcome measures, but it will help you create a plan for reducing gait deviations. It can also benefit the other members of the patient's healthcare team. For example, the results of the gait score and video can be shared with the physical therapist to facilitate treatment.
Cara Negri, BSME, CP, is the director of PnO Data Solutions, Los Angeles, California. She completed her prosthetic education at Northwestern University Prosthetics-Orthotics Center, Chicago, Illinois.
- Nolan L., A.Wit, K. Dudzinski, M. Lake, and M. Wychowanski. 2003. Adjustments in gait symmetry with walking speed in transfemoral and transtibial amputees. Gait & Posture 17 (2):142-51.
- Norvell D. C., J.M. Czerniecki, G.E. Reiber, C. Maynard, J. A. Pecoraro, and N.W. Weiss. 2005. The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees. Archives of Physical Medicine and Rehabilitation 86:487-93.
- Hausdorff, J. M. 2007. Gait dynamics, fractals and falls: Finding meaning in the stride-to-stride fluctuations of human walking. Human Movement Science 26(4):555-589.
- Kirtley, C. Clinical Gait Analysis; Theory and Practice. (Philadelphia: Elesvier Churchill Livingstone, 2006).
- Toro, B., C. Nester, and P. Farren. 2003. A review of observational gait assessment in clinical practice. Physiotherapy Theory and Practice 19 (3):137-49.
- Rathinam, C., A. Bateman, J. Pierson, and J. Skinner. 2014. Observational gait assessment tools in paediatrics-a systematic review. Gait & Posture 40 (2):279-85.
- Gupta, S., and K. Raja. 2012. Responsiveness of Edinburgh Visual Gait Score to orthopedic surgical intervention of the lower limbs in children with cerebral palsy. American Journal of Physical Medicine and Rehabilitation 91 (9):761-7.