Clinicians using the FOTO system for individual patients expect positive change in function. What do you do if a status score indicates a negative change in function? During my first visit with patients I share my expectation of a positive sloping line. What do I do when the status indicates a negative sloping line?
Sometimes the rehabilitation journey feels like an old pasture fence. Want to know how I handle negative change?
The first question I ask myself: does this negative change in score surprise me?
If it doesn't surprise me, I don't worry too much because I was already anticipating a poorer score. This may be due to a variety of reasons:
Patient's presentation had been worsening.
Patient was beginning to progress self with daily activities or higher level activities a bit quicker than his/her body was tolerating.
Patient was recently ill.
Services were being provided on a trial basis.
Patient had a change in medication.
Patient had an attorney involved.
Patient continued to have a high level of fear and anxiety.
If the negative change in score does surprise me, my red alert antlers begin buzzing.
Why does the score indicate a worsening when I had anticipated an improved score?
Patient over-exaggerated self reported assessment of function.
Patient reported accurate perception but didn't realize the quality of function was not normal.
Patient erroneously reported and didn't realize reality until clinical reality was exposed.
Condition is changing and I hadn't been asking the right questions or observing accurately.
Objective findings are not correlating with self-report assessment for whatever reason - more often than not some sort of secondary gain is a factor.
Stay tuned for how I clinically address the negative change in function.