How to Ensure the Best Therapy Outcomes Using a CPM

Sponsored by: KLC Services, Inc.

• By Joseph Duffy
• Jul 01, 2011

Continuous Passive Motion (CPM) machines were pioneered by Robert B. Salter, M.D., a Toronto orthopedic surgeon who saw that the immobilization of joints after injury or surgery was unhealthy. He theorized that if intermittent movement is healthier for both normal and injured joints, then perhaps continuous motion is better for healing. Since patients cannot be expected to move their own joints for hours at a time, the concept of the CPM machine was created, with devices being developed for most of the major joints of the upper and lower extremities.

“CPM machines are used post operatively after total knee replacement and ACL repairs, predominately,” says Troy Marshall, sales manager for J&J Medical Inc. “They are used occasionally after micro-fracture surgery and other repairs, as well, depending on the physicians protocol. CPM therapy has many advantages.”

CPM machines are considered advantageous for post-surgical treatment to promote the healing and regeneration of joint cartilage. Specifically, they generate increased blood flow and nutrition to the injured site wile moving the limb or joint, prevent stiffness and soreness, reduce pain and swelling, reduce scar tissue formation, and increase range of motion and flexibility.

Physicians prescribe CPM machines to be used in accordance with their prevailing protocol. Each physician serviced by J&J Medical has a protocol for total knee replacements. As an example, one may start a patient at 0 to 60 degrees at set-up and increase flexion 5 to 10 degrees per day, using the CPM machine two to three times per day for one to two hours per session. ACL protocol will differ slightly with the starting range, somewhat lower at 0 to 40 degrees to start and then progressing as you would with the total knee regimen.

According to Marshall, CPM is typically used for two to three weeks after discharge from the hospital. Most CPM therapy is started in the hospital and then continued at home, using a CPM machine on a rental basis. Medicare and most private insurance companies will rent the CPM postoperatively for total knee replacement and ACL repairs, while other types of surgery are covered on a case-by-case basis. A good practice for providers is to verify the insurance coverage before set-up to ensure that patients are fully informed of their benefit package.

“Regarding patient education, we get actively involved with our physicians with pre-operative information packages on CPM use,” says Marshall. “Most hospitals have a total knee education program for patients to attend or review online and we supply literature for them to use. When J&J sets up patients, they receive a CPM brochure explaining the therapy and why it was prescribed and, if necessary, a help guide on how to program the CPM once we measure and set them up.”

Some basic tips for providing the best therapy outcomes include:

• Use CPM as frequently as possible during the day and, if convenient, while you sleep, as well.
• When using the lower limb CPM unit, it should be firmly positioned on the bed or floor.
• Use the CPM unit in a clean, dry place.
• The CPM machine settings should only be adjusted in accordance with the instructions provided by the doctor, therapist or provider.
• Do not allow children near the machine
• Stop CPM treatment if unusual pain or discomfort occurs and immediately notify your doctor, therapist or provider.

Follow up is extremely important. J&J Medical provides comprehensive follow-up with all patients once the set-up has been completed.

“Our program is called Outcome Driven Care [ODC],” says Marshall. “Once patients have been recorded in our system we have a follow-up department that calls patients periodically during their use of the CPM. We have physician-specific questions that are asked so that we can maximize the patients’ use of the equipment. This helps to monitor compliance and also to address any issues that might come up during the treatment time. We follow-up within 24 hours of set-up and then weekly throughout their use.”

A follow-up program such as J&J Medical’s ODC should involve delivery and setup of the CPM machine, full instructions on use and observation of the patient using the machine. Physicians’ goals are reviewed with the patient, including the range of motion they will ultimately need to achieve.

To help with compliance, weekly follow-up questions should include:

• How often do you exercise?
• Have you made each physical therapy appointment?
• How often are you using the CPM machine?
• What is your current active and passive range of motion?

The relationship that company representatives have with patients’ physicians is extremely important, says Marshall. Reps need to know each patient’s treatment protocol for each indication and what the physician expects of patients during the time they are using the machine. Reps must report back any compliance issues and also any issues that might need to be addressed medically.

This article originally appeared in the July 2011 issue of HME Business.