Physical Therapy Integration Pilot Program at Windward CBOC

One of the services that can be extremely beneficial is physical therapy. Veterans who access physical therapy after an injury or when they have mobility limitations are more likely to have positive outcomes. Right now, a pilot program is taking place at the Windward Community Based Outpatient Clinic (CBOC) which will integrate direct access to physical therapy into primary care appointments where appropriate.

“In cases where a Veteran is having musculoskeletal complaints that are impeding their way of life, early intervention from a physical therapist can be extremely beneficial,” Air Force Veteran and Board Certified Orthopedic Clinical Specialist in Physical Therapy Grant Tong. “The Physical Therapy profession has deep roots within the military. The concept was born out necessity from the aftermath of injured service members from World War One.”

Physical therapy is a type of treatment that helps improve movements after an injury, surgery, health condition, or other challenge. For Veterans with an acute injury like a sprained ankle, having a physical therapist send them home with exercises, crutches or another mobility aid could help them to heal more effectively and avoid re-injury. Other Veterans may come in for a routine primary care visit, but then end up wanting to discuss musculoskeletal complaints or mobility challenges like struggling to get down onto the floor to play with their grandchildren or having difficulty reaching above their head. A primary care doctor would normally write a consult to see a physical therapist. The process of integrating a direct access Physical Therapy into the primary care appointment can avoid this referral process, saving time and health care cost while also improving the care experience for the Veteran.

“We don’t see many situations where we can truly say that a program benefits everyone involved, which includes our primary mission to improve the Veteran’s access to care, outcomes, and satisfaction,” said Tong. “This process of having a physical therapist accessible to a Patient Aligned Care Team (PACT) has already been implemented in VA locations across the country, and it really has been successful for staff, Veterans, and health care cost. This type of program is what separates us from most other outside health care systems.” 

Due to space considerations, direct access to PACT PT will be limited to providing physical therapy services where it is appropriate and teaching Veterans exercises and movements that they can practice recovering mobility after an injury or other health setback. For in-house physical therapy appointments Veterans will still need a consult by provider. Later reorganizations could allow for expansions of the program, but at this time, starting with consults in primary care appointments and giving basic support is a good beginning to prove the concept and get everyone on board.

“I was injured in High School, and I went to physical therapy,” said Tong. “I found it really helpful, and I realized I’d like to do it as a career; I realized I’d like to be able to help others heal conservatively from my knowledge of how the body works.”

Tong attended Pearl City High School before going to Oregon State University for his Bachelor of Science (BS) and Creighton University for his Doctor of Physical Therapy (DPT) degree and becoming board certified. He has 12 years of experience as a physical therapist, and eight years as an active-duty physical therapist with the Air Force. Tong is excited to be heading up the new PACT PT program for VAPIHCS. 

“I joined the VA a few years ago because I wanted to serve my community and share effective programs and skillsets from my training and experience while in the Air Force. Also, it feels good to be able to help other Veterans,” Tong said. “With this program, I hope we can eliminate some steps for them and remove some barriers to care, so Veterans can have access to PT with little or no wait times. I am very grateful for VA leadership, the windward CBOC, and our Veterans for allowing me to pilot this program. The skillsets of physical therapist have drastically increased since its beginnings. The goal is to have physical therapists use their entire scope of practice to advance the Veteran experience of care.” 

As an added benefit, the PACT PT program ties back into the VA’s culture change towards Whole Health. Whole Health is a program that seeks to ask a Veteran what matters most to them, and then direct their care accordingly. The Whole Health program seeks to bring in health coaching, spiritual and cultural considerations, complimentary treatments, and lifestyle changes that fit into a Veterans life and help them improve their overall wellbeing. From recreation therapy to Tai Chi classes, Veterans can find a wide array of treatments at VA to address each aspect of their health and lead them towards the best possible life. Physical therapy is just another treatment that can improve a Veterans ability to do what matters most to them, from Pickleball to gardening.