Continued from Patient-Client Management Model (Part 1)

Prognosis—the predicted optimal level of functional improvement within a time frame—will also help determine intervention strategies. Predicting the level of improvement guides the intensity, duration, and style of intervention. The combination of diagnosis and prognosis is used to justify physical therapy management. The prognosis for the patient with an ankle sprain will depend on such things as the degree of sprain and the number of previous ankle sprains.

Intervention is the purposeful and skilled interaction between either the physical therapist or ancillary staff and the patient, based heavily on the patient’s functional needs. Decisions are contingent upon the timely monitoring of the patient’s response and progression toward mutually agreed-upon goals. There are a number of issues that guide the type, duration, and intensity of treatment.

If your patient has a chronic case of subacromial bursitis, it will probably take longer to treat than if the patient was in the acute stage, although the latter stage would not tolerate aggressive treatment. The patient’s activity level should always play a major role in the types of exercises as well as the intensity of treatment. If your patient with chronic subacromial bursitis wants to return to golfing weekly, then exercises mimicking the golf swing and even using the golf clubs are a critical component of the plan of care.

Notice patient’s reactions, both generally and locally while treating the patient. Watch the patient’s face; there’s no need to inflict unnecessary pain. Also watch for tissue reaction like swelling and redness because you may be causing too much of a reaction. Too little a reaction is just as problematic. A patient who has a chronic adhesive capsulitis should be showing some gradual improvement with grade-4 joint mobilization. If there is no change during or after treatment, then the therapist must consider whether the technique is appropriate and if it’s being performed correctly, as well as whether the original diagnosis is correct or something else is causing the limited range of motion.

The re-examination is performing selected tests and measures to evaluate the patient’s progress. It is also used to modify or redirect intervention and may require a change in diagnosis and/or prognosis. The patient with adhesive capsulitis should have the range of motion, joint mobility, and functional capacity reexamined regularly.

Outcomes relate to the following: functional limitation/disability, patient/client satisfaction, and secondary prevention. Remediation of impairments is important, but the overriding purpose of physical therapy management is function. If the patient recovering from adhesive capsulitis cannot return to playing golf, despite an increase in range of motion and joint play, then the outcome (even with an improvement in impairments) may not be considered positive.

Of the many procedures used by physical therapists in the continuum of care of patients and clients, therapeutic exercise takes its place as one of the key elements that lies at the center of programs designed to improve or restore an individual’s function or to prevent dysfunction.

Therapeutic exercise is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to

• Remediate or prevent impairments
• Improve, restore, or enhance physical function
• Prevent or reduce health-related risk factors
• Optimize overall health status, fitness, or sense of well-being

Therapeutic exercise programs designed by physical therapists are individualized to the unique needs of each patient or client. A patient is an individual with impairments and functional limitations diagnosed by a physical therapist who is receiving physical therapy care to improve function and prevent disability. A client is an individual without diagnosed dysfunction who engages in physical therapy services to promote health and wellness and to prevent dysfunction. Because the focus of this textbook is on management of individuals with physical impairments and functional limitations, the authors have chosen to use the term “patient” rather than “client” or “patient/client” throughout this text. We believe that all individuals receiving physical therapy services must be active participants rather than passive recipients in the rehabilitation process to learn how to self-manage their health needs.

Buy the Book that holds this excerpt: Techniques in Musculoskeletal Rehabilitation

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