FOTO Basics
Who is responsible for ensuring demographic information is correct on initial input?
The treating clinician
Which Patient Reported Outcome Measure (PROM) is replacing the mood scale within the FOTO platform?
Patient Specific Functional Scale (PSFS)
Your PC incorrectly entered demographic information for a new IE (body part/impairment). What is the best course of action?
It is the clinician's responsibility to ensure the correct information was input. Close out the FOTO and begin a new status intake.
A clinician is not consistently capturing pain ratings during their visits. The clinician tells you that patients don't understand pain ratings and the pain ratings are often "all over the place" throughout the plan of care so it is not useful to them. How can you coach this clinician from a clinical excellence standpoint?
Based on research, we know that an improvement of 2 or more points on the NPRS is considered meaningful/significant difference.
“Pain ratings are not meant to be perfect. They’re a clinical tool — like strength testing or ROM — that help us monitor change, guide intensity, and support conversations with patients.”
“Pain may not always line up perfectly with function — but that’s part of the story. When a patient’s function improves but pain stays high, it can trigger us to look at psychosocial factors. When pain drops before function improves, we might need to progress more aggressively.”
Based on internal time study data, how long should it take a clinician to walk through the FOTO questions with a patient on IE?
~4-5 minutes
When will the Patient Reported Outcome Measure (PROM) "swap" happen for all clinicians?
July 15
A 20 year old patient and baseball player, Bryce, presents to the clinic with complaints of persistent shoulder pain that started without injury 1 month ago. During the initial evaluation, Bryce reports his pain on the Numeric Pain Rating Scale (NPRS) as "2 out of 10," indicating mild discomfort. However, during clinical observation & assessment, the therapist notices Bryce grimacing visibly while performing simple movements, such as raising their arm to shoulder height.
Further questioning reveals that Bryce has been avoiding overhead activities entirely due to "sharp pain" and has been taking over-the-counter analgesics daily to manage discomfort. Despite the low reported pain score, Bryce's physical presentation suggests significant pain interference with daily activities and functional capacity.
On IE, what action should the clinician take to address this discrepancy?
Reassess pain with the patient by using the NPRS with specific instructions and then relaunch a new status FOTO or make the update before submission.
Pain scores are subjective — but they should still make sense in context.
A clinician voices frustration that the FOTO questionnaire is changing and the PSFS is being added, they express that they can't answer "more" questions with their patients. How can you coach the clinician on this change?
Acknowledge and validate their frustration.
Clarify that the mood questions are being removed and replaced with PSFS so the change is a "net zero"
“The PSFS is one of the most personalized, patient-centered tools we have. It allows patients to define what they want to get back to — and that gives us better clinical direction and stronger buy-in.”
"Let's utilize this tool as a part of our IE, making it easy for us to create 3 functional goals!"
PSFS is a valuable tool in clinical practice that allows patients to identify and rate their ability to perform specific activities that are important to them. By focusing on the individual’s unique functional goals, the PSFS facilitates personalized care and helps track progress over time. This patient-centric approach empowers individuals to actively participate in their treatment, fostering better outcomes and satisfaction. It is already a part of the clinician's IE as they ask patients about functional deficits. Using and tracking the PSFS is just a formal way for clinicians to establish functional goals and include the patient in those goals. Lastly, it provides quantifiable data that can be used to evaluate the efficacy of interventions and make necessary adjustments to the treatment plan.
Explain the SPARE outcome questionnaire and why is it important?
SPARE/OSPRO-YF (Screening for Pain Vulnerability and Resilience and Optimal Screening for Prediction of Referral and Outcome Yellow Flag)
SPARE tool is derived from existing measures in the OSPRO. It includes critical sections on positive affect and coping as well as fear avoidance.
This tool is designed to assess how individuals manage and adapt to pain and discomfort, as well as their tendencies to avoid activities due to fear of exacerbating their condition. Effective coping strategies can significantly influence the overall rehabilitation process and outcomes, while fear avoidance behaviors can hinder progress and prolong recovery.
By identifying these patterns, the SPARE tool aims to tailor interventions that address psychological barriers and promote more effective pain management and functional improvement. At Ivy, we can use this information not only to identify needs for effective pain management, but also to correlate patient engagement, self-discharge, and pain interventions
What timeframe do Ivy clinicians have to complete the Outcomes re-focus education?
July 1-14
Tiger is a 49 year old patient with persistent low back pain with traumatic onset beginning 1 week ago. During the initial evaluation, Tiger rates his pain as 10 out of 10. However, during the exam, he completes all active range of motion, with mild signs of discomfort (slight wince but full motion). No guarding, withdrawal, or verbal cues typically associated with 10/10 pain. He engages in light resistance testing without refusal or breakdown. Has not pursued imaging, injections, or any urgent care for pain relief. Despite reporting 10/10 pain, Tiger demonstrates little functional disability and low physical distress, making his extreme pain score inconsistent with findings.
What action should the clinician take to address this discrepancy?
Reassess pain with the patient by using the NPRS with specific instructions and then relaunch a new status FOTO or make the update before submission.
Pain scores are subjective — but they should still make sense in context.
When a patient reports 10/10 pain yet demonstrates moderate function, it’s our job to clarify, validate, and guide them toward accurate reporting that supports high-quality care and outcomes tracking.
In reviewing your team's documentation, you notice that one of your clinicians does not have realistic or functional goals. They also do not consistently have a FOTO specific goal. How can you coach this clinician?
Use the PSFS --> that will create 3 functional goals.
Use the FOTO --> "Let’s say a patient has a predicted FOTO improvement of +12 points. A solid FOTO-informed goal might be: ‘Patient will demonstrate 10-point increase in functional score (FOTO) in 4 weeks through independent stair navigation and self-care.’ That ties together measurable improvement with meaningful activity.”
FOTO automatically loads the expected benchmark goal --> If you do a FOTO before you load your template, the template might erase that goal. Coach your clinician to download the FOTO questionnaire again and click SAVE. It will appear on goals.
Why is it required to perform outcomes/FOTO status updates every 14 days?
Improved the patient experience.
Boosts the accuracy and strength of your outcome profile.
***Also to be performed if there is a change in patient status, engagement concerns, physician follow-up, or as required by federal, state, or payer regulations.
Why is this 'Ivy Outcomes Re-focus' important to clinical care? Must have 3 of 5 correct answers.
*Establish patient-centered care and goals
*Adjust and modify treatment plans as needed
*Demonstrate the Value of therapy services
*Support reimbursement and payer negotiations
*Evaluate treatment effectiveness and efficiency
AND We need to improve the way we are capturing successful clinical care.
You are seeing a new patient, Serena, for balance and gait deficits. Serena completes her initial FOTO survey and does not disclose her diabetes or history of falls. You are made aware during your clinical assessment/subjective. Consequently, her functional status score is benchmarked incorrectly, placing her in a category for healthier individuals without comorbid conditions.
What should the clinician do to address the discrepancy?
Close the FOTO as Incomplete/Incorrect. Create a New FOTO and ensure Serena provides accurate information, including comorbidities, for proper benchmarking.
Serena is incorrectly categorized as low-risk.
Her predicted functional improvement score is inflated. This can make your actual care appear less effective, even if Serena makes great progress
By capturing correct risk factors:
The care plan is more clinically justified.
FOTO scores better reflect the real challenges Serena faces.
If Serena needs more visits or progresses more slowly, the data supports your reasoning.
One of your clinicians has poor outcomes scores (<65%) but you determine that they are collecting at the appropriate time frames, and they are reviewing the questionnaire with patients. What is the best course of action?
Reinforce the “Why”
Strong outcomes aren’t about hitting a score — they’re about ensuring we’re truly making a difference in our patients’ lives. You’re already doing the hard part by successfully utilizing the tool. Now let’s make sure the clinical decision making is driving the outcomes we want.
“You’re doing a great job integrating FOTO into your workflow — that’s a huge first step. I’ve noticed your outcome scores are trending below target, and I’d love to explore that with you so we can figure out what’s behind it and how to support your success.”
Ask reflective, open-ended questions:
Are goals and interventions aligned with the patient's functional limitations?
Are we dosing the plan of care (frequency, intensity, duration) in a way that supports outcome improvement and is evidence based?
Are there common themes in patients with lower scores (e.g., chronicity, fear avoidance, low engagement)?
Look for:
Under-dosing (too few visits)
Late discharge planning (overextending care after goals are met)
Lack of progressions or delayed progression of interventions
Review Specific Cases Together
Pick 2–3 recent patient cases with poor outcomes.
Walk through the clinical decisions, outcome score trends, and any roadblocks to progress.
Set a Targeted Action Plan
Shadowing a peer with high outcomes
Utilizing Medbridge for specific clinicla reasoning or body parts based on FOTO scores
Doing a weekly case review together
Setting a 60-day check-in to review new cases and outcome trends
Why is it considered best practice to walk through the FOTO questionnaire with your patient (especially on IE) vs. letting them fill it out solo?
Patients often misinterpret questions when filling them out alone. When the clinician is present, they can clarify what’s being asked, reframe questions in simpler terms, and guide the patient to provide the most accurate response.
It sends the message: “Your responses matter.”
This is not a basic intake form that you quickly fill out like they might have experienced with other providers.
It is an easy step to build therapeutic alliance.
List the question categories within FOTO as they appear in order to the patient.
PROMs Questions (i.e. LEFS, DASH)
Comorbidity Questions
Pain Scale
SPARE Questions
PSFS
A patient calls and says they are pleased with their progress and ready for discharge but they have not filled out an updated or discharge FOTO. What is the recommended next step?
Discuss a DC visit with the patient first. If unable, send the FOTO questionnaire via e-mail and ask them to complete. This needs to be captured!
One of your clinicians in struggling with a patient who seems to be plateauing. Taylor is a 25 year old post op ACL repair. It is visit number 12 in week 6 of their POC. The FOTO Intake FS Score = 42 and the current FS Score = 44. Predicted Improvement = +18. Patient reports there is still "mild pain present and tightness." They have attended all their appointments so far.
Reassess Intensity & Progression of Interventions
is 2x per week an appropriate dosing?
At 6 weeks post-op, Taylor should be entering more dynamic and strength-building phases.
Review current interventions:
Are exercises still low-load or passive?
Is quad strength being aggressively targeted?
Are you integrating multi-joint movements and single-leg tasks?
Update Goals
Evaluate the Home Exercise Program
Ask: Is the HEP too easy, repetitive, or not progressing in parallel with clinic work?
Taylor may benefit from:
Higher challenge level
More frequent updates
Use FOTO as a coaching and re-engagement tool:
Pull up the patient’s score trend in session.
Say something like:
“You’ve been doing everything right — showing up, staying consistent, and putting in the work. But your functional score hasn’t changed in two weeks. That tells me it’s time to shake things up a bit and give your body a new challenge.”
Why this works:
It validates Taylor’s effort.
It creates shared ownership of progress.
It uses objective data to explain the clinical need for change.