FOTO Rehab Outcomes

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Selena Horner

I believe outcomes data is the new frontier - so many things to learn from this type of data: professionally, clinically and businessly!
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Jul 21, 2017 | Selena Horner

Quick-DASH Requires Caution with Use

The first reference I can find about the Quick-DASH is in 2001. This patient reported outcome measure is favored by many because the DASH is familiar and the Quick-DASH is shorter. Like the DASH it was was originally created as a paper and pencil tool. 

The Quick-DASH has problems.  Even though it is faster to complete, it does not meet Rasch model analysis. Of the 11 items to respond, 2 of the items have a floor effect. Most of the items have a response bias. You can trust the Quick-DASH score.

FOTO has research supporting its shoulder functional status items and computer adaptive testing.  In 2006, the number of items originally tested was 60.  Factor analysis only supported 42 of the items.  The item pool was decreased to 37 items to fit the item response theory model.  

Below you will find a quick view of the abstract about the Quick-DASH.

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Jul 19, 2017 | Selena Horner

Post Op Total Knee Arthroplasty Home Exercise Program

I realize this particular abstract outlines a future study and has no results yet. As I read the abstract it really made me wonder.

So, here in the States, most individuals are discharged from the hospital after a total knee athroplasty day 2 or 3.  In the Netherlands, it appears discharge happens day 3 or 5 post operatively.

The proposed exercise program would begin day 4 or day 6 post operatively.  I don't know about what happens across the country, but I'm amazed at the progression. In my area, if a patient has home health services, the physical therapists won't utilize or even have a patient utilize their stationary bikes or recumbent bikes. So much time and energy is spent on standing on the non-surgical side and doing marches and kick backs and hip abduction with the surgical side.  Patients will typically bring in a booklet of exercises that take the majority of their time to perform.

I need to rethink my progression. I begin to push patients to begin a walking program at the 4 week point and pushing themselves doing stairs. I suppose I'm typically worried about joint swelling. I worry about motion not occurring due to joint swelling. I need to think like the Dutch and begin to be a bit more aggressive in pushing the two activities that I have feared my whole career!

Oh... I appreciated the accelerometer-based activity sensor.  I have a feeling it will help patients be more accountable. When we can find something that gives feedback on their stretches and their progress in that area, that will be hugely helpful also.

Below you will find a quick view of the abstract.

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Jul 17, 2017 | Selena Horner

Persistent Low Back Pain: Case Study 6 visits over 3 months

The beauty of a case study lies in the description of the story.

Although case studies fall low on the evidence scale, there is so much value to be had in the description of the story. We've learned that there is a risk of glaring bias in a case study. Granted, this is a factor to keep in the back of our minds while at the same time appreciating the story and the thought processes shared.

Rehabilitation professionals are going to be challenged about the frequency of patient visits. How is the frequency determined? Because it's just that way or because certain aspects of the individual patient dictates the provided frequency of care.

What I immediately found interesting about this case study was frequency of care. Providing 6 sessions over a 3 month duration is not something typical here in the States. What I find missing is knowing the patient's ability to function prior to initiating services compared to the 3 month. Did the patient's function change?

The study highlights how fear level reduced. The Orebro Musculoskeletal Pain Questionnaire is a tool designed to predict disability and return to work.  I will presume the study used the short form Orebro.  A score of 1-50 indicates a lower risk for work disability where as 51-100 indicates a higher risk.

The take home in this study is in the methods used to address the psychosocial factors and beliefs to reduce fear level and change the risk category for work disability. Based on this case study, it doesn't appear many visits are required for the cognitive changes. Although few visits are required, the patient needs time for change to happen.  It would have been nice to see if function changed. 

Below you will find a quick view of the abstract.

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Jul 14, 2017 | Selena Horner

Yoga, Physical Therapy, or Education to Treat Individuals with Persistent Low Back Pain

Full text of the below study is really required in order to truly discuss the results.

I hope the full text version spends some time addressing the subjects ability to read. I also hope the investigators provide a rationale for 15 sessions of physical therapy. As with most comparative studies, I also expect a description of what "physical therapy" entailed. 

I tend to do better sharing my thoughts if I can review the findings within the full text.  I don't quite understand "noninferiority margins."  I'm not quite sure why the investigators didn't just use the minimal clinically important difference.

Below you will find a quick view of the abstract.

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Jul 12, 2017 | Selena Horner

Knee Dislocations and Outcomes

After most traumas, it isn't easy to know exactly what to expect.

I appreciate that this study shares the amount of knee motion and the typical complications after a traumatic knee dislocation. From a clinical perspective, this helps alert me as to what I need to also keep in the back of my mind when treating these individuals.

Below you will find a quick view of the abstract.

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Jul 10, 2017 | Selena Horner

Motivational Interviewing and Return to Work

The words we use matter. We've been learning this over the past few years, in particular in the pain science world.

 This study focused on individuals and return to work. We already know that a patient who is injured at work has a characteristic that is risk adjusted for fair comparison in outcomes. These individuals may not achieve functional outcomes as high or as fast compared to other patients. Motivational interviewing may be considered within the treatment strategy to improve outcomes.

Below you will find a quick view of the abstract.

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Jul 07, 2017 | Selena Horner

5 Questions Can Determine Degenerative Disc Disease

It's almost like the pendulum is swinging to value subjective history during the interview process.

This study just reached my radar. If we can implement these kinds of studies into our practice (and physicians also), we have an opportunity to reduce the cognitive changes and beliefs that happen after a patient learns and views radiographs and MRIs. 

Below you will find a quick view of the abstract.

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Jul 03, 2017 | Selena Horner

Transitioning to a Total Joint Arthroplasty Bundled Payment Program

More hospital systems will be involved in bundled payments for total joint arthroplasties.  Medicare currently has a bundled payment program for joint arthroplasties. Private payers will also be changing their payment models to potentially include an alternative payment model for joint arthroplasties.

This article focuses on how a private institution transitioned into a bundled payment model. Hopefully the full text provides details that will help you learn ways to negotiate and also be efficient in this type of payment model.

Below you will find a quick view of the abstract. 

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