FOTO Rehab Outcomes

Jun 26, 2017 | Selena Horner

Effects of Myofascial Release for Patients with Nonspecific Chronic Low Back Pain

This conclusion needs to be stated more strongly than it is.

When it comes to outcomes, a result will have meaning to the patient if the difference in scores falls outside of the minimal clinically important difference of the tool. Without reading the full text and seeing the actual scores and the data, it appears (based on the language in the conclusion) that myofasical release is no different than sham. Neither had clinical relevancy from the patient's perspective.

Below you will find a quick view of the abstract. 

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Jun 23, 2017 | Selena Horner

Physiotherapists Managing Patients with Musculoskeletal Complaints in Emergency Department

Physiotherapists managing patients with musculoskeletal conditions arriving by ambulance immediately had me thinking, "no way."

Here's another study done in Australia. Now the key for sucessful interpretation and implementation of physiotherapists in the emergency department... triage. Physiotherapists were not involved with every patient. Physiotherapists were involved in the care of patients in Categories 3-5. That makes sense and offsets my gut response. Australia has Advanced Musculoskeletal Physiotherapists practicing in their emergency departments.

Hospital systems may begin to shift emergency department personnel so that the skill level and knowledge level required to care for someone admitted into an emergency department matches the care required. Here in the States, the role of the physical therapist may be dependent upon state practice acts and scope of care.

Below you will find a quick view of the abstract. 

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Jun 21, 2017 | Selena Horner

Claims Data Outcomes: 90 Days After Lower Extremity Joint Arthroplasty

This study brings more questions to my mind.

Nonelective hip arthroplasties would probably be mainly due to a patient falling. Clinically it makes sense that the mortality rate is higher and that these individuals would be more likely to receive skilled nursing facility services.  Without knowing the relevant factors, it seem reasonable to me that 72% of these patients receive skilled nursing facility services. 

How low is a reasonable complication rate? I mean, 0% is unrealistic. What is realistic?

I'm also curious the reasons for readmissions. I would assume there would be overlap with complication rates. 

I wonder how much change will happen with bundled payments.... and with that change will patients really receive the appropriate care even if it costs more and reduces the amount of profit.

Below you will find a quick view of the abstract. 

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Jun 19, 2017 | Selena Horner

Necessity of Immobilizing the Metacarpophalangeal Joint in Carpometacarpal Osteoarthritis

Thinking of occupational therapists right now.  This study may not be completely realistic because I'm not sure if in real life treating carpometacarpal osteoarthritis solely hinges on a splint.  What may be more relevant is whether or not to splint the thumb. Then again, this only looked at results after one week, which may not be horribly helpful clinically.

Below you will find a quick view of the abstract. 

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Jun 16, 2017 | Selena Horner

Physiotherapists Managing Patients with Acute Low Back Pain in the Emergency Department

The idea of having physical therapists practicing in the emergency department is growing globally.

With the growing need for high quality and efficient care, there will be changes in practice models. I don't what is different between an advanced musculoskeletal physiotherapist and a physiotherapist. Although I am not familiar what happens in Australia, I do find this study as an opportunity to help promote changes in care delivery.

Below you will find a quick view of the abstract. 

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Jun 14, 2017 | Selena Horner

App vs Goniometer

It seems that you hear, "there's an app for that" quite frequently. 

This study looked at a smartphone app vs a goniometer for measuring knee motion. If your clinicians want to whip our their smartphone, it appears the measurements obtained should be adequate for documentation.

The only question I have: what is the appropriate procedure for cleaning a smartphone between patients?

Below you will find a quick view of the abstract. 

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Jun 12, 2017 | Selena Horner

Characteristics of Therapeutic Alliance

I appreciate the buzz that continues to grow around the topic of therapeutic alliance. I dislike that often times discussions focus on empathy.  Empathy has a role, sure, but empathy isn't the main factor. 

The study I am sharing is fantastic in really creating the big picture about what a therapeutic alliance really is. Table 4 has 8 core themes that are part of a therapeutic alliance. Then, the table shares 44 additional aspects within the core themes. Therapeutic alliance includes roles for not only the clinician, but also the patient. A therapeutic alliance obviously includes creating a relationship while at the same time agreeing on goals, good communication skills, measuring outcomes, and individualizing sessions based on how the patient presents for the day.  I like how roles were defined and the prerequisites that are required by both the clinician and the patient.

For some reason, clinicians tend to focus on the patient behaviors such as attending services and performing home exercise programs. We skip over our behaviors. Let's take for example my clinic day the other day. I was just about to begin a session with a gentleman who recently underwent elective surgery for a total knee arthroplasty. It isn't going as should be expected at this point in time... when in through the doors walks in a previous patient I hadn't seen in about a year. He stopped in to give me a hug, introduce me to his daughter and let me know his wife is in a home for individuals with dementia (so I could pop in and visit her) and that he was just diagnosed with bladder cancer. Of course, I spent a bit of time with him and then went on to treat the patient waiting for me. Then, with that patient, for some reason, the surgeon did not use a drain tube after the procedure. I have a feeling the reason that we aren't making gains (even though he's working his tail off) has to do with joint effusion. I contacted his surgeon's office to provide an update and request the patient have a follow up visit to have a potential joint aspiration. I engaged in about 4 phone calls after that due to misperception and a patient who wasn't having his expectations met due to previous conversation with the surgeon on a follow up visit. And then, toward the end of my day, the son-in-law of a previous patient stopped in to introduce me to his grandchildren (a 4 year old girl and a 2 year old boy). A few years back I had emergency services whisk his father to the hospital. His father had presented with a change in condition that had me concerned.  And then, the last patient of the day (a young 35 year old female) wasn't indicating a level of improvement I would have expected. Thankfully, right after I said, "I'm missing something. I really need your help. You aren't responding as I had anticipated. We need to talk to figure out why," she immediately stated, "what about ticks?" She moved to Michigan a few years ago, but prior to that she lived in Delaware and removed ticks daily. About 5 years ago, she had one festered and infected in her shoulder blade region. So... another call and differential diagnosis recommendations for diagnostic testing.  What's really sad: she had been treated for a bit over a year with no results. 

Please take a look at the full study. You'll learn that therapeutic alliance is far more than just patient's being motivated and attending their scheduled visits. You have a role and certain behaviors that influence therapeutic alliance.

Below you will find a quick view of the abstract. 

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Jun 09, 2017 | Selena Horner

A Case for Clinician Confirmation Bias

Although I would like to entertain the idea of confirmation bias as having a positive aspect to contemplate, I think it is also best to remember that this study focused on pain-free individuals. In my mind, pain-free individuals are different beasts than the patients that we treat.

What I'd like to do is just pretend that this study had subjects who were patients experiencing pain. It appears that our beliefs about what we do, how we do it and the anticipated results may have an effect on our patients. How do we determine the treatments we choose? I do tend to think that some amount of confirmation bias enters into the picture.  There has to be a reason that we prefer the choices that we make when determining clinical interventions.

Beware of clinicians that do not have a preference. The other positive news... even if a patient prefers something different than your preference, you still have the opportunity to improve outcomes. 

Below you will find a quick view of the abstract. 

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Jun 08, 2017 | Nikki Rasmussen

“Mirror, Mirror on the Wall...” Reflecting on Outcomes


Every morning, we look in the mirror while we comb our hair, brush our teeth, and ready ourselves for the day. Once we are satisfied with our reflection, we head out to face whatever the universe has in store for us. Sometimes we are satisfied with a clean t-shirt and a baseball cap, and we are on our way quickly. Other days, we need to spend more time on a more formal appearance. But no matter what the day, we all check the mirror at least once.

For as often as we do that with our personal appearance, how frequently do we reflect on our professional one? Of course, we know how to do this exceptionally well with individual patients. While the patients are with us in the clinic each day, we measure their range, their strength, use special tests and our evaluative skills, and of course, ask them how they think they are doing. We interpret the results of this information to determine if they are progressing toward the goals that we have agreed are appropriate.

Consider this, though. How frequently do we step back, look at the combined results of all of our patient data, and assess how we are performing and give ourselves the “once-over”?

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Jun 07, 2017 | Selena Horner

Can Clinical Effectiveness be Measured without a Randomized Controlled Trial?


Effectiveness: Randomized controlled trials are used to determine if an intervention has any benefit(s) or risk(s). With randomized controlled trials there are at minimum two groups: a control group and a test group. 

Effectiveness: The degree to which something produces the desired result. The desired result is defined and the performance is evaluated as to whether success occurs.

Quite a few individuals in the rehabilitation world are cognitively challenged by their own bias of what effectiveness is.  The context of the discussion is quite relevant when determining which definition is the definition to use when debating effectiveness. From the two definitions, it is relevant to take into consideration what is being asked.

Some clinicians full-heartedly believe that there is no way to determine if a clinician is effective without a randomized control trial. The reason is because they do not believe the natural course of history can be taken into account. Another reason is because there is no control group.

What do you think? Can clinical effectiveness be determined? Continue below if you're interested in my thoughts.

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