Give the
patient the responsibility for their recovery
Improve
compliance
Accurate
prediction
Background
Patients,
third party payers, coaches and others frequently want to know how long
recovery will take. This is a very challenging situation for the therapist
because there is very little evidence to draw upon.
"Normal Time Frames
for Recovery"
The
magic 80% in 4-6 weeks rule is at best a mild rule of thumb. This is very
limited since the statistics apply to first time incidents of the injury and do
not include any co-morbidities. The statistics also do not include the well
known high number of recurrences that occur.
"Normal Time Frames
for Return to Work"
Along
with the above comments, this type of prediction is further complicated by
social issues related to income and work psychosocial factors.
"Normal Time Frames
for Healing"
These
link closely with the normal time frames for recovery noted above and are also
very limited. They do provide some guidance for progressing rehab.
Behavioral Factors
These
are moderately useful in giving the clinician guidance if there is a risk of a
prolonged outcome. The accuracy is still limited (Note: In the Behavioral Project we developed a new
screening tool that combines numerous ultra brief screens. This allows the screening
of a variety of conditions from the DSM V. It also provides a novel strategy for predicting outcome).
Experience
This
is obviously critical, but is difficult to quantify.
Specific Motor Control
As
we have already mentioned in previous articles, when Behavioral Factors,
Neurological Factors, Non Mechanical Pain and Medical Co-Morbidities are ruled
out, the response to Specific Motor Control Exercise (specific movement pattern
control, translation control) is highly favorable.
From
considerable clinical, prospective cohort and clinical trial, we have been able
to identify various short and / or long term outcomes from specific motor
control exercise ability from all regions of the body. Depending on the original sub-classification, this is based upon having achieved mile stones in controlling movement and / or muscle imbalance and / or having a level of efficiency of translation control.
This
has proven very beneficial clinically. It is great to be able to say to a
patient something like: "when you can do this (insert specific motor
control exercise) you have a 95% chance of being significantly better".
This improves compliance, reduces uncertainly about outcome and reduces the
stress of the clinician. Further, it facilitates the "ownership and
responsibility" of the condition and recovery process to the patient and
not the therapist.
A
note of caution: to make these statements to a patient, the clinician needs to
be highly competent at sub-classifying movement patterns, prescribing specific
motor control exercises and appropriately progressing the rehabilitation.
Further, as noted above, Behavioral Factors, Neurological Factors, Non
Mechanical Pain and Medical Co-Morbidities must be ruled out for the patient to
have a favorable response to specific motor control exercise.
Sean GT Gibbons BSc (Hons) PT, MSc Ergonomics, PhD (c),
MCPA
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