Creating a Functional Image of the Patient - Part III
Over the years, I've used a variety of outcome tools. I've consistently played a mental game in creating a functional image of the patient. This functional image was based on the functional score of the tool. Obviously, if you've used the Oswestry or the Lower Extremity Functional Scale or the Neck Disability Index or the DASH, you know I'm talking about a score. I'd guesstimate the score I'd think the person should have based upon clinical observations and my gut. Kind of a crazy game because it wasn't based on any solid evidence.
I remember many years ago arguing with Dennis Hart. I literally hated the scores. I loved playing the mental game of guessing the score, but the score really had no concrete meaning to me. A score is a number... what does 25% functional deficit mean? What does 50% deficit mean? What does 65/80 mean? On September 8, 2010, I emailed Dennis my excitedness to see the above figure in the Physical Therapy Journal. I congratulated him on this awesome work.
I know the outcomes world revolves around the score and the change in the score. This girl focuses on the patient and what that score means to the patient and what the score means to their actual functional ability. I honestly don't connect with a number. I do connect with the concept of functional staging. Functional staging brings relevance to the score for me.
So, for all patients, after I review the graph with their score, the FOTO risk-adjusted score and the prediction (my thoughts are in Part I)... my eyes jump to the top of the page and review the risk-adjusted factors (my clinical thoughts are in Part II). I then spend some time learning the patient's level of function. What are they able to do... what do they need to be able to do?
Do you attempt to create a functional image in your head of how your patient is functioning?