Patients per hour. What’s your speed limit?

 

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The topic of one-on-one care vs a double-booked/overlapping/>1 care model is one of great emotion and opinion in the physical therapy community.

So, I am a huge fan of the one-on-one treatment model and it really seems to suit me.  Bias warning, I am drawn to this style of care.  This model is not pushed or addressed in school other than to say that most out-patient ortho clinics are >1 treatment model providers.  My experience has been as follows: I was a PT Tech in a clinic for two years that saw 3 pt/hour/PT and I have interned in a clinic with one-on-one care and am currently in a clinic that does 2-3 pt/hour/PT.  I recently posted on Twitter about not feeling I could ask as much from my patients in a >1 care model, since I was wasn’t giving them as much of myself.  I felt (and still feel) that if a patient comes in and I give them divided care, and not my full attention, that I could only expect the same in return from them.

I got some responses that were quite positive for the >1 model of treatment and it got me thinking about some of the pros and cons.  First off, I was happy to get the insights since I may be in a situation in the future (actually, as I am now in this internship) where I am practicing under the double-book model. Also with future health care regulations and changes, a double-book model may be the only way to operate and I want to be able to think positively about it.  So let’s take a look…

Dry Needling, the JOSPT, and BiM

Last June JOSPT released a systematic review and meta-analysis of trigger point dry needling (TDN) (1); and during this past year, some classmates and I reviewed it.  There was indeed mixed feelings about the review and the topic itself.  I know this is a hot/touchy topic in PT right now and it’s a very “sexy” treatment idea, but I think if we are continuing to push towards an evidence based field (i.e. science based)…we should pump the breaks a bit with TDN.

What are you teaching? Balance?: Motor Control Series

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Ah yes, time to go to the parallel bars and do some balance training.  As we all know, because we are super nerds, Balance is made up of a few major sensory components.  The visual system (just written about by Spencer, here) proprioception from the joints

Visual Dominance: You have it…and so does your CVA patient.

I just recently finished 8 weeks at an excellent neuro-rehab facility.  During my time there I presented an inservice proposing visual dominance as an indication for mirror therapy, but as I suggested during my talk–I think this sensory preference could go much further than indicating the use of a mirror during stroke rehab if we take advantage of it. 

Aquatic MIRAGE

Oh man!  I had a great day today.  So my current clinical experience is made up of 40% aquatic physical therapy.  I think it’s fine, the research on it, from what I can find, seems to support its efficacy and validate it’s use.  But that’s not what I’m excited about.

Have you heard of the MIRAGE arthritis study from Univ.  Nottingham?

Contextual Priming

As humans we are experts in making associations.  We cannot help it, it is subconscious, intuitive thinking and comes to the forefront of our brains faster than we think it does.

As has been studied (elsewhere) and discussed here by PTBT, and here by Joe Brence PT DPT, and here by Harrison Vaughan PT DPT, experiences shape our current thought patterns.  A wonderfully awesome example of this association power is the concept of ‘Priming.”  Priming demonstrates how an initial thought pattern, through environmental context or communications, effects the outcomes of subsequent thought patterns. Here’s the example:

Anchoring Expectations.

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Patients are making decisions about you and your treatment all the time.

Clinical Practice Algorithm: Motor Control Series

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More of this Motor Control business.  See the previous Background and Learning post to get caught up.

“Science is built up of facts, as a house is built of stone; but an accumulation of facts is no more a science than a heap of stones is a house.”-Jules Henri Poincare

Practice is built upon theories, as a house is built of stone… Let’s put these theories into practice. Time to build a house…..

Background and Learning: Motor Control Series

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Working the late-shift at the Nerdery- more research based musings…