PDR Clinics – HealthPartners Innovation Award Participant

Todd Ginkel, DC, Laurie Applebee, PT and Jennifer Missling, PT at the 2017 HealthPartners Innovation Awards

Innovation is the heart of PDR Clinics’ vision of being the best non-surgical solution for neck and low back pain management.

As part of our continued investment in innovation PDR took part in the 2017 HealthPartners Innovation Awards.

As a Innovations in HealthCare Recognition Participant, PDR submitted an innovation on using predictive indicators to improve outcomes.

The poster content is provided below.


In contrast to a biomedical model that emphasizes treatments based on physiologic structure of the spine (i.e., joint, disc, or muscle injury), the biopsychosocial model addresses a broader spectrum. Cognitive Functional Therapy (CFT) is a behaviorally targeted intervention that combines normalization of movement while discoursing pain behaviors by reconstructing maladaptive thoughts about pain.


We studied patient activation and its relationship to neck and low back pain therapy outcomes and program adherence and its relationship to other routine inventories performed in our office. We also wanted to determine if there is any opportunity to better triage patients for improved completion rate and outcomes.


  • Using predictive indicators for poor outcome may allow providers to triage care earlier in the process, offering a more targeted approach to obtain higher outcomes.
  • PAM-13 measure for patient activation and Keele STart Back measure for psychosocial risks factors allow providers to understand patient psychology and employ coaching for activation and motivational interviewing skills appropriately with care

    The results demonstrate that regardless of the level of activation or severity of disability, patients get similar outcomes. This validates that patients completing a CFT-based rehabilitation program achieve outstanding results in function, pain, and psychosocial outcomes.


    Understanding the relationship of patient activation and psychosocial barriers to recovery and adherence helps provide some preliminary knowledge moving forward into health care payment reform.

    Star Tribune names PDR Clinics a 2017 Top 150 Workplace

    A Top 150 Workplace

    Edina, MN June 25, 2017—Physicians’ Diagnostics & Rehabilitation (PDR Clinics) has been named one of the Top 150 Workplaces in Minnesota by the Star Tribune. A complete list of those selected is available at StarTribune.com/topworkplaces2017 and will also be published in the Star Tribune Top Workplaces special section on Sunday, June 25.

    Produced by the same team that compiles the 26-year-old Star Tribune 100 report of the best-performing public companies in Minnesota, Top Workplaces recognizes the most progressive companies in Minnesota based on employee opinions measuring engagement, organizational health and satisfaction.  The analysis included responses from over 69,000 employees at Minnesota public, private and nonprofit organizations.

    The rankings in the Star Tribune Top 150 Workplaces are based on survey information collected by WorkplaceDynamics, an independent company specializing in employee engagement and retention.

    Physicians’ Diagnostics & Rehabilitation Clinics (PDR Clinics) was ranked 51st on the small company list.    

    “It is an honor to be selected as one of the Top Workplaces again this year. Living out our six Core Values of excellence, innovation, optimism, modesty, seeing the potential in everyone, and leading with grace makes this a wonderful place to work! It is also incredibly rewarding to see the patients we serve thrive in our program and get the relief they deserve from chronic neck and back pain. I feel incredibly blessed to be a part of such a great organization!”, said Tracy Rheineck, Administrator of PDR Clinics.

    Star Tribune Publisher Michael J. Klingensmith said, “The companies in the
    Star Tribune Top 150 Workplaces deserve high praise for creating the very best work environments in the state of Minnesota. My congratulations to each of these exceptional companies.”

     To qualify for the Star Tribune Top Workplaces, a company must have more than 50 employees in Minnesota. Over 2,000 companies were invited to participate. Rankings were composite scores calculated purely on the basis of employee responses.


    This is an image of a Calendar Hanging Up on a Wood Board.

    Looking at Our 2016 Patient Outcomes

    PDR differentiates itself from other rehabilitation programs by specializing specifically in neck and back treatment. We are experts at what we do because that is all we do – and have done for over 23 years. We help treat the “whole” person by looking not only at the physiological issue but also at the psychosocial barriers that may exist as a result of chronic neck and back pain. Our Road To Recovery combines MedX rehabilitation with Cognitive Behavioral Coaching (CBC) to ensure the greatest opportunity for overall, long-term recovery.

    This is an image that displays the patient outcomes for 2016 for PDR Clinics patients.
    Click to view full-sized image

    We are proud to present our patient outcomes for 2016. The results of this data is the culmination of years of refinement to our program, and the talent and dedication of our staff. Our data shows that patients that treat at PDR Clinics report reduced pain, reduced use of medication, and more.

    For those looking for a short-and-sweet overview of our 2016 outcomes, we’ve created a handy infographic to read. If you want a more detailed look at our data, continue reading.


    Patient Outcomes – 2016

    The following information has been made publicly available by Physicians’ Diagnostics & Rehabilitation. It allows patients and physicians to learn more about the world-class neck and back pain treatment provided at PDR Clinics. Healthcare providers can request physical copies of our 2016 Outcomes & Quality report by emailing IT@PDRClinics.com.

    Total Perceived Recovery

    Definition: Patients report overall recovery on a scale from 0-10 (0 = no improvement, 10 = complete recovery).

    Outcome: Patients rated their recovery at 7.5 out of 10 on average. This demonstrates therapy to be effective and yet assumes that patient will continue ongoing recovery with home exercise. This is the desired outcome level to ensure cost-effectiveness and reduce over utilization of services. (N = 1212).

    In a six month follow up survey, 48% of patients reported continued improvement.

    Reduced Pain

    Definition: Patient reported reduction of pain at discharge.

    Outcome: 74% of patients rate their reduction in pain between 50 – 100%. (N = 1053).

    Reduced Medication

    Definition: Patient reported reduction of medication use at discharge.

    Outcome: 66% of patients rate their reduction in medication use between 50 – 100%. (N = 506).

    Reduced Headaches

    Definition: Patient reported reduction of headaches at discharge.

    Outcome: 70% of patients rate their reduction in headaches between 50 – 100%. (N = 396).

    MedX Spinal Function

    Objective: Objective spinal strength and range of motion testing using standardized test procedures on MedX spinal equipment. PDR collected data over 12 years.


    Cervical Flexion & Extension – Improvement 132.1%. (N = 3929).
    Cervical Rotation – Improvement 164.9%. (N = 5022).
    Lumbar Flexion & Extension – Improvement 107.1%. (N = 5219).
    Rotary Torso – Improvement 121.5%. (N = 5662).

    Psychological Metric – Keele STarT Back Tool

    Definition: The Keele STarT Back inventory stratifies patients into a low, medium, or high risk of poor outcomes based upon fears, catastrophization, and anxieties about pain, mood, and motivation.

    Data suggests that a reduction in Keele Scores can be a long range indicator of one’s ability to cope effectively. Addressing psychosocial effects of chronic pain can lead to improved recovery and over-all reduced downstream healthcare costs.1


    Initial High: 87% converted to Medium or Low Risk
    Initial Medium: 78% converted to Low Risk

    Functional Oswestry Low Back Pain Disability Index (ODI)

    Definition: Standardized inventory of functional abilities. Inventory scores (0 – 100) compared of final and initial averages, and within disability category.

    A 10-12 point and/ or 30% improvement in ODI scores is determined to be clinically significant.2 (N = 1105).

    Outcome by Category:

    Moderately limited – improved an average of 14 points
    Severely limited – improved an average of 21 points
    Crippled – improved an average of 27 points


    Definition: PDR provides patients the ability to participate in a Maintenance Program to maintain the gains they made during rehabilitation. It is recommended patients come in one time every three to four weeks for MedX Core training. A study was performed to measure the effectiveness in maintaining gains made during rehabilitation.3

    Outcome: Participants involved in the Maintenance Program were able to maintain their recovery scores, pain levels and dynamic strength at a reduced frequency.4


    1  Hill J.C., Dunn K.M., Lewis M., Mullis R., Main C.J., Foster N.E., A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632-641.
    2  Ostelo RW, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain. Spine 2008; 1:90-94.
    3  Tucci J, Carpenter D, Pollock M, et al. Effect of Reduced Frequency of Training and Detraining on Lumbar Extension Strength. Spine 1992: 17:1497-1501.
    4  Narveson M., et al. Recovery Scores and Dynamic Strength of Patients Participating in a Decreased Frequency MedX Maintenance Program. Unpublished study: 2009.