Author: Willette Johnson

Physical therapy can be an effective first line of treatment for severe back and neck discomfort.

A physical therapy-first approach programme called Comprehensive Spine has been launched by St. Luke’s University Health Network to address severe back and neck pain.

According to Aldo Carmona, MD, senior vice president for clinical integration for St. Luke’s University Health Network, members of the network realised back and neck pain was one of the most prevalent diagnoses that presented at the network and that patients were entering the system through different departments. This realisation led to the creation of Comprehensive Spine, which aims to prevent expensive ER visits, radiographs, opioid prescriptions, and unnecessary surgeries.

 

“The method wasn’t always consistent.
The effort to bring individuals where they needed to go was being made by a lot of people, but Carmona said that it was difficult for the network to understand how these patients were being treated since there are so many access points.
“What we have tried to do is basically be a resource for patients and doctors to be routed into a standardised programme where we have researched best practises and started people on early and effective physical therapy as the main aim and avoiding a lot of other complications,” the researcher said. -McMichael, Roberta

 

Delivering suitable therapy

According to Carmona, adopting a physical therapy-first strategy can simplify patient care access by ensuring that patients are treated by the right doctors.
According to him, 50% of patients who visited St. Luke’s University Health Network with acute low back pain went there via the ER or urgent care.

What we want to do is make it possible for patients to go to one of our specialist physical therapy sets, even if they have to go to the emergency room, according to Carmona.

Carmona observed that by offering a single phone number for the Comprehensive Spine programme, individuals may be classified as having a low, high, or intermediate risk of developing important medical conditions through the use of standardised questions administered by a trained nurse.

“We will correctly triage them to the right person, whether that is an emergency department or a surgeon’s office,” Carmona said. “If a patient is high risk for anything, any sort of medical concern, we will appropriately triage them to that person.”

Effective medical care

A multidisciplinary team at the Virginia Mason Spine Clinic in Seattle has improved the care of patients with low back and neck pain by sending them to “the right provider at the right time during their journey of care, with the least amount of cost and the highest amount of effectiveness,” according to Roberta McMichael, PT, DPT, OCS, physical therapist and clinical specialist at the Virginia Mason Spine Clinic. This method is similar to that used at St. Luke’s University Health Network.

She said that by using an educational strategy, patients are given the tools to control their symptoms and are taught the proper exercises and self-care to keep their pain from becoming worse.

According to McMichael, “the physical-therapy-first approach has been demonstrated to be an effective, empowering treatment paradigm or design where patients can get convenient access to high-quality care from a provider who is able to screen them for any more recent medical conditions and appropriately refer them.”

Physical therapy advantages

Studies have proven cost benefits to patients and the health care system with a physical therapy-first strategy vs. typical treatment, in addition to providing the patient with the proper care in a timely way, McMichael said.

“When a patient first sees a physical therapist, the likelihood that they would afterwards have sophisticated imaging, like an MRI/CT scan, is substantially lower.
They are considerably less likely to undergo surgery later on and receive injections that may or may not be beneficial for them, according to the expert.

Carmona pointed out that by offering narcotic-free drugs for shorter periods, a physical therapy-first strategy may also aid in reducing the intake of opioids.

According to Carmona, “[Acute back or neck discomfort is] a prevalent condition that is frequently treated aggressively, perhaps incorrectly.”
As per normal, start with measures that cause the least damage, such as the safest pharmaceuticals, and save the powerful weapons and intensive treatments for when other measures fail.
To be honest, 90% of it should be readily treatable with effective physical therapy, effective short-term medicine, and just excellent education and caring for individuals.

How to put it into practise

Do your research, Carmona advised organisations planning to implement a physical therapy-first strategy for the treatment of back and neck pain.

This wasn’t merely a plan we came up with and wrote down, the man continued.
“You need a huge lot of coordination, a tremendous amount of buy-in, and a significant amount of education for both clinicians and patients if it is going to succeed,” said the author.

The information technology department, the hospital network, and the physical therapy department should all be on board with the implementation, the speaker added.

Physical therapists should establish a connection with other referral sources and have statistics to back up the effectiveness of their treatment approaches, according to McMichael.

The right triage tools are important for ensuring that our patients are treated effectively by the right doctors, according to McMichael.
Casey Tingle

…

Wellness coaching effects are long-lasting, according to a study.

Although it is becoming more and more popular, wellness coaching is still largely unstudied as a method of enhancing health and wellbeing. Despite the fact that people frequently seek wellness coaching for general lifestyle benefits, the majority of published research has focused on results for particular medical issues including weight management and cardiovascular disease.

“People approach Mayo Clinic with the expectation that we will weigh them and prod them to walk more since the wellness coaches are located in the staff healthy living centre, which is devoted to exercise. However, during the wellness coaching process, people’s objectives frequently alter, making it about much more than just stress reduction, restful sleep, and relationships “explains Mayo Clinic campus in Minnesota clinical psychologist Matthew M. Clark, Ph.D., L.P.

Dr. Clark and colleagues conducted a single-arm cohort study of 100 Mayo workers who finished a 12-week in-person health coaching programme to learn more about the possible psychological advantages of wellness coaching.

The study’s main objectives were to look at possible improvements in depressive symptoms, perceived stress levels, physical, social, emotional, cognitive, and spiritual functioning, as well as quality of life (QOL). Examining the enduring effects of future advancements was the secondary goal.

The wellness coaching programme started with an introductory session lasting 60 to 120 minutes when participants’ strengths, problems, and personal objectives were discussed along with the tactics required to reach those goals. Participants and coaches addressed actions taken toward the goals and strategies for effectively continuing them over 11 follow-up sessions that lasted 30 to 60 minutes each.
improvement throughout the board

Results of the study, which were published in Mayo Clinic Proceedings in2014, showed that after 12 weeks, there had been substantial increases in all areas of quality of life, including the overall QOL, the five QOL dimensions, depressive symptoms, and perceived stress levels.

On a scale of 1 to 10, mean QOL measurements varied from 6 to 7.6 at baseline. Physical well-being had the largest impact size at 12 weeks (0.8), whereas spiritual well-being had the smallest effect size (0.4). The mean perceived stress level dropped from 14.3 at baseline to11.0, and the ratings for depressive symptoms were cut in half.

At 12 weeks, the proportion of individuals who had at least one troublesome symptom at baseline on the Patient Health Questionnaire-9 had similarly decreased by half. The gains were still there during the 24-week follow-up, which is crucial.

The findings, according to Dr. Clark, are noteworthy for a number of reasons. One is the statistically notable and clinically significant improvement across all five QOL dimensions. Another is the potential for wellness coaching to contribute to formal stress-reduction programmes and integrated approaches to the treatment of depression.

He makes the point that as wellness coaching becomes more and more popular, so does the need for coach training and certification. The Mayo Clinic Wellness Coaching Training Program, which trains wellness coaches to establish trustworthy relationships, recognise client values and wants, and translate objectives into actions that bring about permanent change, was used to teach and certify all wellness coaches at the Mayo Clinic.…

Is it Finally Time to Stop Employing Rehabilitation Protocols?

Physical therapy continues to apply rehabilitation techniques on a regular basis.
I just conducted a little survey of my readers, and they largely concur.
Most people continue to adhere to protocol:

However, there has been a recent rise in criticism of these rules and individuals who adhere to them on social media.
Even after graduating from college, students are refusing to follow standards.
Over the years, I’ve heard a lot of grievances, including:

Instead of following a piece of paper, we must utilise our minds.

Physiatrists shouldn’t use a recipe book.

Physical therapy is not a binary process.

We must personalise our therapy strategy.

I can at least somewhat comprehend and concur.
We have devoted a lot of time and effort to our education on the workings of the human body as physical therapists (or other rehabilitation specialists).
We’ve put many hours (and money…) into becoming physical therapists and become the best at what we do.
Based on our experiences and the results of our patients, we have spent years honing our talents.

We ought to be using our minds and customising programmes for every individual.

But if we apply rehabilitative methods appropriately, we can do this more effectively.
To best understand how we should be employing rehabilitation protocols in our practises, it helps to break down exactly what they are and are not in physical therapy.

Rehab Protocols Are Not Recipe Books

book about physical therapy

Rehab protocols are not intended to be exhaustive recipe books, so let’s get that out of the way immediately.
When a physical therapist thinks they can’t perform anything that isn’t clearly stated in the protocol, they might frequently feel immobilised by it.

In reality, an effective rehabilitation strategy should explicitly outline the dangers, deadlines, and goals for gradually applying stress to repairing tissue.
These were created using what we know about the fundamental science of how the body heals.

Between what you unquestionably SHOULD be doing and what you unquestionably SHOULD NOT be doing, there is still a lot of grey space.

Consider this an opportunity to create your own sandwich using your preferred recipe.
Bread must be spread on both sides, but the patient, your education, and your experience will all influence what foods you sandwich between the pieces of bread.
Like me, you could have your own tastes.

With my patients, I frequently take actions that are not expressly stated in a protocol but which I am certain are consistent with the objectives and safety measures of the protocol.
ACL rehabilitation’s early stages can benefit from core exercise, as can treating the soft tissue of the traps after rotator cuff surgery.
You can still conduct them even if they aren’t listed in the protocol expressly.

The cornerstone of your programme is rehabilitation procedures, which should be modified in light of:

The distinct objectives of each person

the precise wound or operation

Any simultaneous injuries, which are frequent

Following an injury, rehabilitation protocols serve as guidelines.

Beckett, Mike

It’s a prevalent misperception that procedures are suggestions rather than rigid laws.
All of the nonoperative rehabilitation regimens that we have developed over the years are meant to serve as a roadmap for you as you take patients back from injuries.

Many of them really have stages rather than hard deadlines with criteria for advancement.
For instance, the following would be some of each phase’s objectives while treating a baseball player who has had a Tommy John injury:

Phase 1: Promote healing, increase range of motion, establish a foundation of strength, and improve proprioception

Phase 2: Maintain flexibility, increase strength, and improve dynamic stability

Phase 3: progressively add strain to tissue and advance to vigorous sports activities

Phase 4: Progress toward a return to sport

You may use these rules to decide what is and isn’t acceptable for each of the aforementioned phases by taking a look at the phases listed above.
Your own tastes may be relevant in this situation.
You like yellow mustard, I enjoy spicy mustard with my ham and cheese.
I’m not going to pass judgement.
They are both suitable.

For nonoperative cases, you should apply a procedure in this manner. Postoperative cases are different, and we’ll cover it in more detail below.
Nonoperative rehabilitation protocols are utilised to break the rehab sequence into manageable pieces for nonoperative injuries, yet there are situations when you may wish to restrict an exercise or activity for a certain period of time.

After Surgery, Rehabilitation Protocols Are Required

procedure for knee rehabilitation

The unquestionable requirement for post-operative rehabilitation programmes is one area in which I have strong opinions.
Physical therapy after surgery includes several crucial components called rehabilitation regimens.
To ensure that patients recover from surgery and go on effectively, a set of standards of care must be established and disseminated.

Many of them can be surgeon-specific, i.e., individual surgeons may want you to move more quickly or more slowly according on their expertise.
We as physical therapists must adhere to the operating surgeon’s instructions.
They are more familiar with the interior of your patient and their procedure than you are.

Following surgery, measures are utilised to ensure that the wounded tissues are protected, healed, and loaded progressively.

The least probable scenario is that you will return the individual as swiftly and securely as possible if you just wing it and don’t follow a routine.
For instance, having too much or too little shoulder range of motion after an anterior labral surgery can both be harmful.
The patient will have the highest chance of success with a postoperative rehabilitation regimen that is properly thought out.

It might be challenging for a novice practitioner to prioritise the precautions and limitations of challenging patients.
For instance, our rehabilitation programmes offer 16 different ACL reconstruction protocols and 13 different rotator cuff repair treatments.
Based on a number of variables and concurrent injuries, we modify the rules.
This is essential.

Is it Finally Time to Stop Employing Rehabilitation Protocols?

I sincerely doubt it; in fact, I firmly believe that, when used properly, rehab regimens are effective.
To reject protocols as unimportant to our profession or as something we are above adopting is, in my opinion, really naive.

A protocol, on the other hand, only outlines what you CAN and CANNOT do.
Your “options” are not limited to what is allowed by the protocol.
Consider these as precautions to ensure that you are not moving too quickly or slowly.
A protocol often does not cover all of the treatments and exercises that must be done.
Your knowledge and expertise will be useful in this situation.
While determining whether the chosen intervention can be safely carried out within the protocol’s constraints, you must also consider what additional interventions you can safely carry out to assist the patient.

A rehabilitation plan that is not “skilled” physical therapy should not be blindly followed.
But we must recognise that treatments and healing tissues frequently have timetables.

A truly professional doctor is aware of this and integrates their considerable knowledge and personal therapeutic preferences with the recommendations of a rehabilitation regimen.

Do You Wish to Use My Protocols?

procedures for physical therapy rehabilitation

We just changed and enlarged all of our protocols and put them entirely online and downloadable if you’re interested in adopting the protocols that I co-developed with Kevin Wilk and Dr. James Andrews.
Our procedures, which are based on decades of study, empirical data, and experience, have been published in a number of journals throughout the years.

They are now the most popular and well-regarded rehabilitation methods.…