Physical Therapy in the Home Setting: A Q&A with Lynn McKinnis, DPT

In recognition of National Physical Therapy Month, we wanted to take a moment to thank physical therapists at Concordia and around the world for the work you do to help your patients – in any setting – achieve their goals. Your drive and ability to motivate and strengthen those you serve does not go unnoticed. THANK YOU for all you do!

In this article, we are taking a look at the primary goals of physical therapy, common misconceptions and the benefits of providing physical therapy in the home setting. Helping us unpackage and understand this information is the accomplished Concordia Visiting Nurses physical therapist Lynn McKinnis. In a Concordia blog published in 2014, we featured a story on Lynn and how she helped a home health patient recover from two knee replacements from the comfort of his own home.

Lynn McKinnis, DPT, was the first physical therapist hired by Concordia and celebrated 24 years with the Concordia family this past April. She is the author of two books, “Fundamentals of Musculoskeletal Imaging,” the most adopted imaging textbook in DPT programs in North America, and “Musculoskeletal Imaging Handbook,” a guide for all allied health clinicians including physician assistants, nurse practitioners, and anyone who would be ordering imaging. She was the recipient of the 2009 American Physical Therapy Association’s (APTA) Helen J. Hislop Award for Outstanding Contributions to Professional Literature, an achievement that she cites as her sweetest recognition ever because it was from nominations by her peers and educators within the APTA.

Q: What motivated you to pursue a career in physical therapy?

Lynn: My Dad, an elementary school principal, picked it out for me. I was only 18 and he had me apply to a freshman placement program. I had no idea what it was about, then luckily found out it was a good match, just like my dad thought it would be. I am forever grateful he steered me in that direction.

Q: What are the primary objectives of physical therapy?

Lynn: To help restore physical function so that people may live and move as freely and as painlessly as possible, all the years of their lives.

Q: Your book “Fundamentals of Musculoskeletal Imaging,” originally published in 2005 and currently in its 5^th edition, is widely considered to be the golden standard in medical imaging, praised for its ability to present a complex subject matter in an accessible way. Why was it important to you to write this textbook?

Lynn: When the physical therapy profession advanced to the clinical doctoral level, imaging was added to all curriculums, but no textbooks were available. Physical therapy book publishers cast a wide net searching for someone to fill the gap. I always found the radiology fascinating and mystifying during the 10 years I worked in a hospital, so I got hooked! It was challenging, and I admit, fun, to have a reason to get all the answers to all the questions I had about radiology.

It is still fascinating to see our “internal pictures.” It gets more fantastical all of the time, too. The imaging field has progressed from 2 dimensional radiographs to 3 dimensional CT and MRI images to 4 dimensional images that rotate.  Also, physical therapists are now using diagnostic ultrasound in their clinics to get immediate answers to soft tissue pain.

Q: You were the first physical therapist hired by Concordia and have worked for our home health agency, Concordia Visiting Nurses, for 24 years. How has in-home therapy treatment evolved over the course of your career?

Lynn: What’s changed the most is charting, not only moving from paper to digital, but from physician-driven care to insurance regulation and the amount of data entry that entails. And of course, we are seeing a much higher level of acuity now that hospital stays are as short as possible. Home care now reminds me of my 10 years in acute hospital care.

Q: Our patients are often surprised that they can receive physical therapy in the comfort of their own home. Can you summarize what in-home physical therapy looks like and how it is modified to include exercises that incorporate household items?

Lynn: One of the most common interventions we do is to try and get patients to accept equipment that will immediately make them safer in their home. After all, we cannot change their strength overnight, but we can help enable them to go from falling to safe independence overnight with the use of a walker, a bedside commode, a tub chair, a few well-placed grab bars, etc.

One of my favorite pieces of equipment in the home is using the kitchen counter for balance exercises, kitchen chair stand-ups for leg exercises, and soup cans for weights for arm exercises. I love good weather so we can walk outside on uneven ground to practice “real life” balancing and the practical need to get to the car or mailbox.

Q: A common misconception about physical therapy is that an injury and/or surgery has to occur in order to receive rehabilitation services. How else can patients benefit from receiving in-home physical therapy?

Lynn: The overarching mission of home care is to keep people in their homes, safely. As our bodies age, that usually becomes progressively more difficult. If a patient or family member notices this decline starting, it is a wonderful idea to ask their PCP for a therapy evaluation.

We can come provide a home safety assessment as well as a physical assessment. We look for risk factors that are modifiable. That is, what exercises can we teach to optimize balance, strength, and endurance? What equipment would allow them to move more without fear of falling? We want to “flatten the curve” of functional decline so that falls and fractures do not happen, and if they do, a person will recover much easier if they are as fit as possible to begin with.

Q: How does physical therapy positively influence a patient’s overall wellness and health?

Lynn: Since the government began tracking our populations’ health factors in the 1960s, several things have become clear and validated with decades of research. Most significantly, obesity increases a person’s risk of developing heart disease, pulmonary disease and diabetes. However, just as significant is the positive finding that moderate intensive exercise and general physical activity will decrease the risk of developing these same diseases.

Physical therapy can help address the problems that prevent a patient from being active. For instance, I often hear a person say they can’t walk because they have arthritis in their knees. Well arthritis affects all old knees! It will not go away! But, if you strengthen your quadriceps muscles enough, the muscle will unload the painful joint surfaces up to 30 percent, reducing pain to a tolerable level. And sometimes other muscles need addressed, or stretched, or even the correct brace, or perhaps a pair of trekking poles, will allow a patient the freedom to start a walking program. Everybody needs to move, and if pain is stopping you, let a physical therapist help.

Q: Is there anything you would like our readers to know about in-home physical therapy that we may have not addressed in this interview?

Lynn: When we come to your home, or the home of your loved one, to do a physical therapy assessment, one of the most important things we discuss together is what goal the patient has. We want to design the treatment plan to work toward whatever is important to the patient. It may be as modest as getting to the bathroom by themselves, or as grand as returning to shopping at the mall again. And insurance will pay for the evaluation, and any further visits as long as the visits require our skills to achieve the goals we set together!

If you or a loved one receive doctor orders for in-home physical therapy services, ask for Concordia Visiting Nurses and experience high quality care provided by experienced physical therapists like Lynn! For more information, call us at 1-877-352-6200 or contact us any time via our online contact form.