FOTO Rehab Outcomes Blog

When Negative Change Happens

Written by Selena Horner | Mar 16, 2015 10:30:00 AM

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.

Until next time,