While this chat is sound in principle and this patient centric focus is great, there are a wide range of generalisations made here. Can you site any (or many) diagnoses that are typically slow or unresponsive in the acute phase (0-6 weeks)? A mark of a truely good practitioner is one that can relay the fact that in some cases the road can be long and the natural history (even with evidenced based / excellent management) will show that even minor changes in baseline objective outcome measures will take longer than 2 weeks. Moreover, depending on the temporal nature or severity of the diagnosis a practitioner may have to reveal to the patient that they may in fact ‘feel’ worse before they get ‘better’. Love the stuff you touch on about digging deep with a patient’s history. That is key to paving a way forward! Some of the best wins I have had in practice are where the patient has come to me frustrated with their lack of progress with another practitioner asked for another opinion or management option and I have sent them back to their original practitioner as I felt they were on the correct path all along. It was just they are unclear about or incongruent with the goals and instruction laid out. Even with good EBP many people that have symptoms of dysfunction may require multiple inputs and levels of reinforcement before they are convinced or settled on a road ahead.
Further to this, I would add that a fundamental requirement is your the patient completely understands their issue(s) from the outset, as well as the management and prognosis of their specific diagnosis. The problem arises when the goals and outcomes between practitioner and patient are not initially aligned and at each check point along the way. This can cause discourse with the patient when they present with 2 separate problems that feel similar. For example, they present with a straight forward ankle sprain that resolves within 6 weeks (which is fair and reasonable). The same patient presents years later with multi-region spinal deconditioning syndrome with subclinical advanced osteoarthritis that presents with late and recent onset pain and dysfunction that feels similar to their previous ankle issue. This is a common presentation in practice. They may expect the same timeframe for resolution for their spinal complaints as the ankle sprain. However, it may be unrealistic to expect a 6 week resolutions as they do not understand the complexities of and subclinical history and chronicity of this particular issue.
Thanks for listening Jim and for such an awesome well thought out comment! First to mind where there is slow improvement in the first weeks of a rehab would be degenerative diseases such as MS or other chronic issues that occurred a while ago. Orthopedically, post operatively the rehab will likely take longer than 6 weeks ie. ACL repair or total joint, but there should be positive improvements and change in each 2 week span unless complications exist (ie. total joint put in off balanced or rotated). I have not personally ever had the experience of a patient having to get worse before they get better in Orthopedic Physical Therapy, but that is not the first time I have heard that saying and it certainly would apply in the world of cancer treatments and others. TOTALLY AGREE that communication and making sure the patient owns what is going on from a total understanding standpoint is HUGE! IF they do not understand, the buy in will be poor and that is on the clinician 100%. Thanks again for listening and if you have specific ideas for topics from the clinician standpoint that you'd like us to get out to our viewers and listeners please let us know!
While this chat is sound in principle and this patient centric focus is great, there are a wide range of generalisations made here. Can you site any (or many) diagnoses that are typically slow or unresponsive in the acute phase (0-6 weeks)? A mark of a truely good practitioner is one that can relay the fact that in some cases the road can be long and the natural history (even with evidenced based / excellent management) will show that even minor changes in baseline objective outcome measures will take longer than 2 weeks. Moreover, depending on the temporal nature or severity of the diagnosis a practitioner may have to reveal to the patient that they may in fact ‘feel’ worse before they get ‘better’. Love the stuff you touch on about digging deep with a patient’s history. That is key to paving a way forward! Some of the best wins I have had in practice are where the patient has come to me frustrated with their lack of progress with another practitioner asked for another opinion or management option and I have sent them back to their original practitioner as I felt they were on the correct path all along. It was just they are unclear about or incongruent with the goals and instruction laid out. Even with good EBP many people that have symptoms of dysfunction may require multiple inputs and levels of reinforcement before they are convinced or settled on a road ahead.
Further to this, I would add that a fundamental requirement is your the patient completely understands their issue(s) from the outset, as well as the management and prognosis of their specific diagnosis. The problem arises when the goals and outcomes between practitioner and patient are not initially aligned and at each check point along the way.
This can cause discourse with the patient when they present with 2 separate problems that feel similar.
For example, they present with a straight forward ankle sprain that resolves within 6 weeks (which is fair and reasonable). The same patient presents years later with multi-region spinal deconditioning syndrome with subclinical advanced osteoarthritis that presents with late and recent onset pain and dysfunction that feels similar to their previous ankle issue. This is a common presentation in practice. They may expect the same timeframe for resolution for their spinal complaints as the ankle sprain. However, it may be unrealistic to expect a 6 week resolutions as they do not understand the complexities of and subclinical history and chronicity of this particular issue.
Thanks for listening Jim and for such an awesome well thought out comment! First to mind where there is slow improvement in the first weeks of a rehab would be degenerative diseases such as MS or other chronic issues that occurred a while ago. Orthopedically, post operatively the rehab will likely take longer than 6 weeks ie. ACL repair or total joint, but there should be positive improvements and change in each 2 week span unless complications exist (ie. total joint put in off balanced or rotated). I have not personally ever had the experience of a patient having to get worse before they get better in Orthopedic Physical Therapy, but that is not the first time I have heard that saying and it certainly would apply in the world of cancer treatments and others. TOTALLY AGREE that communication and making sure the patient owns what is going on from a total understanding standpoint is HUGE! IF they do not understand, the buy in will be poor and that is on the clinician 100%. Thanks again for listening and if you have specific ideas for topics from the clinician standpoint that you'd like us to get out to our viewers and listeners please let us know!