Please note: this is a guest blog from Kieran Richardson from Global Specialist Physiotherapy
“I’d like to see you again in X days/weeks’ time for these reasons….”
This may (or may not!) be a common phrase we use in clinical practice as physiotherapists dealing with patients who have musculoskeletal pain and injury – I want to persuade you as to why this is an incredibly useful strategy to ensure better long-term outcomes with them.
I was at the Australian National ACL symposium in Melbourne in 2017, when I recalled hearing an elite athlete detail her rehabilitation post the injury. She made the comment:
“The physio said at one point that they ‘didn’t want to see me for quite a few weeks’ – I didn’t like this. I wanted to keep touching base with them regularly. I wanted to know that the exercises I was doing were accurate, and that I wasn’t doing anything that would make me worse.”
I work fulltime as an Independent Consultant for multiple health care practices in my local area, as well as interstate and internationally, often being called upon for second opinion as well as specific staff tutorial training in treatment dosage and appointment frequency concepts, through treatment management plan implementation.
3 common frustrations of mine (and the consultants that work for Global Specialist Physiotherapy) are:
• Patients aren’t seen frequently enough initially, say in the first 1-2 months, to help ‘dial-down’ their signs, symptoms, and fears
• Patients are spaced out to fortnightly or monthly reviews too soon, with the therapists assuming they are ready to self-manage, when in reality they are still trying to understand how their body is recovering, if they are doing the exercises correctly and are looking to be helped on their pain journey
• Patients are discharged way too early, when they could be hardened up with heavier exercises, have lifestyle issues addressed and build in preventative routines
My experience in these ideas came about around 12 years ago, when I joined a clinic with an employer whose policy was to give a Treatment Plan with every patient. Having started on a post-graduate qualification journey, I was also conscious to give the most research-based information and recommendations to clients I was seeing in-clinic.
I then embarked on a Fellowship at the Australian College of Physiotherapists, where much of the emphasis was predicated on translating the best available evidence to clinical practice, and so hoped to find research and clinical evidence to justify appropriate dosage and frequency.
This Specialist training allowed me to be mentored and educated by some of the World’s preeminent researchers and expert clinicians, who all in fact advocated for clear, concise, and confident communication of when to see a patient again, and why! When completing our ‘mock’ and final exams, we were also encouraged to see patients the next day, so we had to justify to them why this was necessary.
Since being as definitive as possible with my recommendations of dosage and frequency of appointments, I have found that it:
• Improves patients’ understanding of my communication
• Improves therapeutic alliance
• Presents a clear outline and plan for management to the patient
• Gives room for flexibility if their condition gets worse, or better
• Reduces the likelihood of cancellations
• Means I don’t discharge patients too soon
• Actually empowers the patients more to self-manage and prevent relapses!
• Leads to better long-term outcomes
• Gets more new patient referrals
I’m going to burst everyone’s bubble straight off the bat – I don’t have a one-size-fits-all approach to rebooking patients in private practice. And from a research point of view, it would be impossible to support ‘recipe’ style booking strategies:
“Further research is needed to find out the optimum frequency and number of the sessions offered to obtain and maintain the best desirable effects” (Senna and Machaly 2011)
So, we can’t homogeneously book patients 3 x a week for 12 weeks for every condition; equally patients can’t be seen once or twice for a condition where more regular and sustained therapist input would see them improve faster overall and in less pain, with a view to building capacity in their body to avert similar issues reoccurring.
Here are some simple questions I ask myself, and often affirm the corresponding answers to the patient out loud, when I am about to rebook:
• Will they be better overall in 1 week if I see them in 1 or 2 days?
• Could their ROM improve with manual therapy, to assist their ADL’s?
• Could a mobilisation or taping technique provide a neurophysiological ‘pain-free window’ to help the patient feel more comfortable, safe, and assured to move normally?
• Does their level/frequency/type of pain lend itself to receiving hands-on/specialised education/exercise techniques sooner?
• Is there more to assess that I haven’t covered?
• Does this patient need clarification of my education soon rather than later?
• Is there more that I can build into their home exercise program that will see them get better quicker?
• Will seeing them sooner help to consolidate the Treatment plan we have already discussed?
• What does the patient want?
• What are their beliefs, goals, expectations, and preferences for physiotherapy management?
• What does this patient need?
• Is there empirical, high-level evidence that seeing them sooner will be harmful, create dependence or give the patient the impression I’m trying to fleece them? News flash for this one: No.
The whole mantra of physiotherapy is to empower patients towards self-management and improving their quality of life – this is something we can all agree on.
By confidently and specifically communicating our recommendations for when we want to see patients’ again and why, we can build trust with them, allay their fears, physiologically reduce their pain, and ensure that they move towards a better version of themselves, continuing to build the reputation of you as a clinician, your clinic, and the profession.
Mr. Kieran Richardson is a Specialist Physiotherapist and the Director of Global Specialist Physiotherapy, a consultancy company offering ongoing Formal Mentoring, Professional Development and Second Opinions.
Go to globalspecialistphysio.com/treatmentplan for a Free Treatment Plan example, Webinars with a renowned business coach, interprofessional Treatment Planning lectures and Full Treatment planning Workshops for clinic owners and clinicians; Kieran is also available for live Treatment Planning Tutorials over Zoom.
KIERAN AND JAMES SCHOMBURGK ARE HOSTING SOME EXCELLENT LIVE AND ZOOM EVENTS IN 2021 FOR PHYSIOS IN PRIVATE PRACTICE AND FOR PHYSIO CLINIC OWNERS SO STAY TUNED FOR MORE DETAILS!
