As I was catching up with the end of 2016 online material, I happened upon an interesting article in Harvard Business Review. I just received a referral from CORE Institute and was going to look into learning more.
I'm disappointed in this research design.
I have patients who ask me which is better: a total knee arthroplasty or a unicompartmental knee replacement?
There is a time and place for self-report measures. For this situation, there needs to be more. The questions I want to ask include:
I continue to have these questions....
Rehabilitation outcomes are one category of outcomes. Health care considers big picture outcomes also - especially when it comes to surgical procedures.
It appears that if a 65+ year old acquires a femoral fracture, it's okay if the surgical repair is not immediate due to having to wait for the surgical procedure. Low-volume hospitals have about a 2 day longer wait for the repair to happen. Although this seems like it could increase the risk for things like death, 30-day re-admission, pneumonia, embolism or ulcers, it really doesn't.
I have a casual question. When a self-report outcomes measurement tool is being validated, is it reasonable for the subjects to complete only one tool? Meaning, in the below study, all subjects completed a legacy tool, the DASH. (Legacy tools were the first self-report tools used prior to computer adaptive testing.) The researchers then carved out the responses within the DASH and created a QuickDASH score. I don't quite understand how validation can actually happen because we really don't know if a patient completed the DASH, and was then required to complete the QuickDASH 20 minutes later if the patient would truly exactly match the reponse indicated in the DASH.
See what you think...
I don't suggest we begin supporting the value of smoking for individuals who are wondering how to prevent osteoarthritis.
Let's think about this.... although this study seems to indicate that smoking may be associated with a reduced risk of osteoarthritis, I think the researchers were missing other pieces of information. What if the real reason that smoking seemed to be associated with less joint replacments had to do with lifestyle choices? What if the higher the number of cigarettes smoked per day was a direct relation to the amount of joint loading that occurred in a day? When smokers are smoking they are not performing any activities at a high level of intensity.
It's always interesting for me to compare FOTO's prediction process with outside research that highlights factors that predict outcomes. Although FOTO does not predict return to work, I find this current abstract interesting. Just like FOTO, the below abstract indicates: the higher the severity of the injury, the longer the road of recovery. Interestingly, the research in this study points to a factor I haven't considered as a variable in return to work: occupational skill level. The lower the skill level, the longer for the person to return to work.
On the flip side, the positive factors associated with a quicker return to work revolved around good pre-injury health and working full-time prior to the motor vehicle accident. As more and more musculoskeletal research is finding, a person's expectations play a role in outcomes. In this study, the individuals who expected to return to usual activities within 90 days had quicker recovery.
I wonder why legal representation didn't affect the time to return to work? Maybe the system in Australia is different than here in the United States.
More and more rehabilitation specialists are addressing the growing need to help individuals who have non-communicable diseases, such as obesity and diabetes. Often times, physical activity plays a large role as a recommended intervention. Does physical activity have an impact? And, more importantly, how can the targeted individuals be motivated and engaged in long term commitment? Can we learn from this study and extrapolate the ways individuals can be motivated to each of our patients?
Occupational therapists work with quite a few individuals who have rheumatoid arthritis. I find it interesting how what occupational therapists provide can at times appear similar to what physical therapists provide. As you can see, there is growing evidence of the value of exercise, educating patients, and promoting self-efficacy. All clinicians should include components of these interventions with their patients to help improve results of care.
Comprehensive Care for Joint Replacement Model focuses on reducing the cost of care for individuals undergoing this procedure. Although rehabilitative services are not the biggest cost factor, they are included in the model. One of the most immediate aspects that you can address as a rehabilitative provider, either during a pre-surgical visit or post-operatively, are your patient's expectations. If a patient's expectations affect utilization, isn't it imperative to spend some time addressing expectations?
As Veteran's Day approaches next week, I think of quite a few veterans I've treated. I remember their stories. War - it seems to be a messy topic with many angles and components that can be discussed. The various topics that can be discussed include strategies, money spent, number of soldiers, technology, winning, losing.... Veterans, when they do share stories, keep it very simple: those living, those that lost their lives and the relationships they made.