The Three Question Test for Exercise Implementation

3 question test

One of the first tasks given to students on clinical rotation is to come up with an exercise flowsheet, or plan, for a patient they have just evaluated. This seems pretty standard in the outpatient orthopedic setting for students.

This task is often hard enough for many students. They work through it and I question their decisions and ask why they picked a certain movement. It’s harder than it sounds to predict how things will go and what they should work on. I always let them work on this independently at first, then we discuss their thought processes.

I’ve started using a Three Question Test for each item on the flowsheet. I’m not sure this originated with me, as I have been mentored by many and have picked up ideas from lots of smart folks. But here is the current question sequence: Continue reading

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This is the person you are trying to help

this-is-the-person-youre-trying-to-help

In walks your 2pm evaluation. Well, not really…they scoot in backwards, sitting on their four-wheeled walker complaining about how long the medical history form is and “why do you need to know all that stuff?” A long past medical history is fine, you can handle that, you can synthesize how 10 years of uncontrolled diabetes mixes with COPD, a back problem they’ve had “since they were 19” and the multiple progressive knee scopes and procedures they’ve had.

During the interaction, however, the person is “off.” They don’t interact with the ease and simplicity that you do with your staff, your friends or the prior patient. You can’t quite describe it well. Continue reading

THE role for Physical Therapists

HomeRun GwynnImage Credit

There is a clash between knowing that biomechanics and structure are not 100% responsible (ie. a 1-to-1 relationship) for pain, and the fact that (from an Example I got from Mike Eisenhart) some one with a poorly moving C5-C6, (as best we can tell the difference and as valid as our hands may be) has a risk factor for future neck pains and problems.

No. Not causative, but a risk factor.

Continue reading

G O A L !

What you perceive today as a struggle is not truly due to the task at hand. It has to do with what the goals of the activity are.

The goal determines how the steps will play out. A worthy goal can bring you through any tough time. If the outcome is not of interest to you, no simple/light task is easy. It’s all a struggle if the goal is not meaningful. Continue reading

The Meaning of Cost in Value

We associate many things with money. One example: If it costs more, it’s better.

Money is not just a physical item representative of some good or service.  It has meaning past trade. Having more money does not just mean that you can accumulate more things. Socially, it states that maybe you have accomplished more, are a better decision maker, make better behavior choices, etc. It possesses status and other cultural attributions. Not a surprise. You know this.

The $15 beer will taste superior to the $1.50 beer. It just does, because we know it’s better. It’s contextual priming. That’s why blinded taste trials are often so interesting, because the context is removed and you are left with a singular sensory organ (taste organs of the tongue and mouth, yes and olfaction). Continue reading

Who is Satisfied?

How are we going to do this?

In other industries customer satisfaction is part of the delivery, but not directly tied to product price. Companies are “paid” by happy customers with more business (referral, word of mouth, etc), or market leverage to increase the cost of service (increased value of product) with customers happy to pay that increase due to increased value, to them.

This works in a market system, where individuals are in charge of their monetary decisions. But that isn’t health care.

In a move towards payment for outcomes, where will customer satisfaction have a role? (we don’t know whether we will be paid better for better outcomes, or paid a set fee for an average expected outcome and it’s up to us to beat that average… who knows)

Is there any talk of adding customer satisfaction directly to payment? Sometimes that’s all we have. No significant change in patient status, but a very satisfied customer with the care, service, advise and input given. Perhaps they leave with an understanding of their condition, ways to manage it and strategies to avoid deleterious effects of their disease/dysfunctional process… but no change in ROM, strength or patient reported outcome measures. Continue reading

Cervical Artery Dissection: Implications for the Physical Therapist A Case Report from a Direct Access Environment

Intro:

You receive a call from your friend and fellow DPT classmate to evaluate her neck… the patient herself is a physical therapist by occupation. A healthy and fit 29 year old female, 5’0″, 115lbs. She reports she is having some cervical musculoskeletal issues going on. She has an achy pain in the bilateral upper traps., levator scapula, and peri-cervical muscles. She is limited by pain with the following cervical motions: right side-bend, right rotation and extension. No signs of central or peripheral neurological issues.

You are an experienced PT and have completed many cervical manipulations on a patient like this and it’s the end of your day. So you are going to do a quick favor for a friend and manipulate her neck, complete some STM, and maybe some PROM/SNAGs/isometrics/METs or whatever your favorite manual therapy technique is. What could go wrong? She’s a therapist herself so she wouldn’t miss anything serious. Being that you are friends you want to do some “magic” giving her some relief of symptoms. So… snap, crackle, manip. You move into some PROM and she reports severe vertigo, nausea, double vision, and you notice hemi-facial asymmetries as she talks about her onset of symptoms. Now what?  Your table, your hands, your patient. Continue reading

Five Days of Fallacies: Day 5, Fallacist’s Fallacy

Five Days of Fallacies: Day 1 here, Day 2 here, Day 3 here, Day 4 here. I have discussed  some common mistakes we humans make in reasoning, in the hope that you can 1) Understand what they are 2) Recognize them when others speak 3) Recognize them when you think this way 4) Attempt to correct your thinking on old, current and future ideas.

The Fallacist’s Fallacy (I like saying that) refers to an argument being refuted, simply because it uses a fallicious approach, not because the content is false. For example: “These old-school classic basketball shoes always hold up better.” (an appeal to antiquity). The argument commits a fallacy (they are old = they are better), but perhaps they are constructed with more craftsmanship or durable supplies, so the content may still be true. (*are we to assume more craftsmanship and better supplies make a better B-Ball shoe?!  Oh my, don’t let me make assumptions here!)

The Gambler’s Fallacy is also a nice one to be aware of…. Continue reading

Five Days of Fallacies: Day 4, Circular Argument

Five Days of Fallacies: Day 1 here, Day 2 here, Day 3 here, Day 5 here. I am discussing some common mistakes we humans make in reasoning, in the hope that you can 1) Understand what they are 2) Recognize them when others speak 3) Recognize them when you think this way 4) Attempt to correct your thinking on old, current and future ideas.

The Circular Argument, or Begging the Question. “Fascia is a tissue in the body that holds one’s emotions. I know this because the research I did indicates that releasing fascia results in released emotions. Therefore, fascia holds our emotions.”  In my opinion, these fallacies are very hard to understand and uncover in conversation. In circular arguments the conclusion of the statement is stated up front, and any statement after that simply restates the presumed conclusion.

Let me give a simple example: “Everyone is using METs at the hip because they are so popular right now!” Did you catch it? Continue reading