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Every so often an article comes along that really makes you think and ultimately changes how you view your practice. Periodically, an article comes along that sheds the light of understanding to help improve your practice and patient education. “Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Cause More Harm Than Good” by Tim Flynn accomplished all the aforementioned criteria for me. Just read a portion of the synopsis and you can see why it’s an important article.
“The rate of lumbar spine magnetic resonance imaging in the United States is growing at an alarming rate, despite evidence that it is not accompanied by improved patient outcomes. Over-utilization of lumbar imaging in individuals with low back pain correlates with, and likely contributes to, a 2- to 3-fold increase in surgical rates over the last 10 years. Furthermore, a patient’s knowledge of imaging abnormalities can actually decrease self-perception of health and may lead to fear-avoidance and catastrophizing behaviors that may predispose people to chronicity.” You can view or download the article below
Extremely Important Imaging Study
This article is why you may have seen me use the hashtag wrinkles on the inside. There is so much good information in this article to help us educate our patients and to help our patients avoid catastrophizing. There are so many important studies cited in this article that make us think about how we evaluate patients to maximize their outcome. But the real gem of the article is reminding us that imaging is not the end all be all. It is a tool but do not discount your examination. We can’t take pictures of pain. But we can assess how pain responds to movement patterns.
I highly encourage you to read this article no matter the field of physical therapy in which you work. It will greatly benefit your practice and your patients.
Welcome to our new subscribers!! And if you haven't joined the conversation on Facebook, then find us @ptsonmission to continue to receive updates, encouragement, and information.
I am excited today to have my friend and colleague Matthew Bounds on the Blog! He shares some of his thoughts and experiences about the role of his faith working in a spinal cord rehab unit. You will not be disappointed!
Where do you work and describe the patient population in which you work?
I work at the Charlie Norwood VA Medical Center Augusta Ga. My focus of physical therapy is with US veterans who have sustained acute spinal cord injuries. I perform assessments of needs through evaluation and also provide treatment through intensive rehab sessions. Me and my team will then follow these patients for the life of their injury by providing both outpatient and inpatient care as the patient needs.
2. What do you enjoy about working in your field of PT?
The thing that I enjoy most about my job is the fact that I have the opportunity to serve the US veteran population. This is especially important to me because I am also a veteran and have served overseas in defense of our country. I enjoy interacting with and treating these patients because I can relate to so many of their experiences and I think that common bond enables me to build good rapport and enhance their treatment outcome. I like my job because I enjoy teaching new skills to these patients in order to reshape and redefine their new normal and I love the opportunities I have to encourage my patients to become as independent as possible despite incurring an injury that transforms their life.
3. What are some of the unique physical, emotional, or spiritual challenges of working in your field PT?
Physically, my job is very hands on and challenging because I work with patients, who at times, are completely dependent on me and my rehab colleagues to move and position them. My field of work can be demanding because I also teach and demonstrate transfer and positioning techniques to family members or caregivers of my patients. So there is an element of physical demand to my job. Emotionally, my field of PT can have both highs and lows. When a patient of mine learns to transfer independently, recover movement of their arms and legs, or just learns to drive a wheelchair, it is a very positive emotional experience. But this job can also be devastating when my patients are limited and struggling due to a multitude of co-morbidities, their high risk of infection, and the interpersonal strain their injuries place on the patients and their families. Spiritually, though, my job offers an open door to inject hope into my patient’s lives every day. It's easier to start a conversation about God, His love, and spiritual healing when you've hit rock bottom. That being said, many patients deal with bitterness and anger as they transition through their injuries which leaves to more difficult conversations.
4. How does your faith impact your work and how you view your patient interactions?
My faith definitely impacts my approach to patients who have had a spinal cord injury. For each person I interact with, I try to ask what God's purpose is for their situation. Then, I pray that God helps me inject those truths in our conversations during treatment sessions.
5. Briefly describe a story in which you really felt like you ministered to a patient.
I recently had a patient, Mr. H, who recently was faced with the decision to undergo additional surgery. There was a possibility of the procedure causing additional paralysis. I had the chance to encourage him and remind him that we are all under God's control, and on His timeline. I told him that there isn't a hair on our heads unaccounted for by Him, so we need to pray and trust God with the faith that He grants us in these situations. He agreed and went ahead with the surgery. His fear was gone from that time on and I am pleased to say the surgery went well. Praise God!
Today, I am excited to have my colleagues Tim Wixson on the blog. He was gracious enough to answer a few questions in our new series relating out outpatient/Sports Medicine clinic. I hope you find his words helpful and encouraging.
Where do you work? Describe the patient population in which you work.
For the last 13+ years, I have worked for Augusta University (multiple name changes over the years) in an outpatient orthopedic setting. Our clinic has a very unique variety of patients that we get to provide care for, including post-operative sports medicine cases, post-operative joint replacement cases, post-operative and non-operative trauma cases, as well as non-operative orthopedic patients.
What do you enjoy about working in your field of PT?
For me, one of the most enjoyable parts of being a PT in this setting is the time I get to spend with my patients. Most interactions that physicians and other health professionals have are not afforded the direct time with their patients. Over the years I have learned to really appreciate this difference. Another component of my job and field that I have come love and value is sharing a clinic space with several other PTs, which allows for almost constant collaboration and encouragement.
What are some of the unique physical, emotional, or spiritual challenges of working in your field as a PT?
From a physical perspective, I think the only challenge that stands out to me is the demand to be at work every day due to the nature of being a healthcare worker with my own caseload. Any time I’m out, the patients who are scheduled either have to be treated by a co-worker or rescheduled. So, I see my daily attendance as a service to my colleagues when I’m able to manage my caseload well.
Emotionally, I definitely have experienced more challenges over the years than maybe physical challenges. When trying to implement a plan of care for people who are only in your care because life is not how they want it to be at the current time, there is a certain burden and responsibility to help your patients begin progressing back their desired level of function. Many times, a PT is the first person that these patients see, outside of immediate family, after a significant surgery. Part of our job may be to help them establish healthy ways to combat the sense of being overwhelmed by their current circumstance. Sometimes we see young people who are battling to recover with very poor support systems and broken home lives. I’ve had to learn over the years to check my tendency to feel sorry for them, but rather, to appreciate their resilience and strength. My preference in treatment in general is to focus on the patient’s ability to help themselves, which helps me avoid drifting toward any kind of “savior” mindset of thinking that I am the reason that someone’s making progress.
I guess this is a good transition into some of the spiritual challenges I’ve experienced as a PT over my career. What I mentioned above has become a healthy posture for me to strive to maintain in the clinic. I think it’s pretty easy to meet physical needs for people and become prideful and overly confident in the ability to improve the lives of people under your care, and spiritual pride is a tough pattern of sin to uproot and remove from the garden of our soul.
How does your faith impact your work and how you view you patient interactions?
My faith in Jesus has impacted my desire to be an effective PT, first and foremost. Colossians 3:23 tells us that, “Whatever you do, work heartily, as for the Lord and not for men,” and having this modeled for me in the home I grew up in as well as the therapists I’ve been able to work alongside of clinically has allowed me to establish this Scripture as a daily aim. As mentioned before, learning to be alongside of my patients has also helped me turn to Jesus in intercession for my patients, because I’m less prone to attempt to carry their burden on my own if I can keep the perspective that it was never my burden to carry in the first place. In Matthew 11, Jesus reminds us that He invites ALL who labor and are heavy laden to take His yoke, and exchange our heavy burden for one which He calls light. This is my aim in my workplace, not to overlook the significance of what I have been blessed and gifted to do, but to understand that my patients are not in need of my skills apart from their need for Jesus. A consistent prayer of mine is to ask the Lord to provide opportunities to speak of the uniqueness of how we’ve been created and for Him to make very clear to me when there are open doors for spiritual conversations with patients.
Briefly describe a story in which you really ministered to a patient.
This may seem strange, but this is the hardest question for me to answer. Every day that I get to be in the clinic, I attempt to speak of God’s Word and how it shapes my thought processes and convictions. In my life, moments of significant ministry have been some of my greatest temptations of pride, so I have made efforts to share what the Lord has given me to speak and at the same time I pray that He protects me from seeing the impact it may have for that person. I know some may read this and wonder how someone would maintain this thought process without questioning whether their efforts have significance, but this is a pattern that has helped me abide in Jesus as we are called to do in John 15. His promise to those who abide in Him is a life that bears much fruit for which the Father is glorified (vs. 8).
Good morning PTs on Mission community. I wanted to make you aware of several newsworthy updates.
ICYMI: My new book “Rehab the World” is now available. I encourage you to check it out and order a copy if it intrigues you. I really enjoyed sharing my story regarding working faithfully in the clinic and how that applies to our international outreach. I think you will find it encouraging, insightful, and challenging as well. It would also make a great gift! And for those that like to read books on their devices, the Kindle eBook version is now available! Both link are below.
Rehab the World: A Physical Therapist's Guide to Medical Mission (Paperback)
Rehab the World: A Physical Therapist's Guide to Medical Mission (Kindle eBook)
New Blog Series! In the coming weeks, I will be releasing a new blog series entitled “Faith at Work.” This series will highlight personal thoughts from other physical therapists that work in different therapy settings. I am excited to share these stories and testimonies with you and I think you will find them helpful and interesting! And if you have a unique story to share (whether it be a local ministry story or an international medical mission story), contact me and I would be happy to review and publish it. We need to encourage each other and learn from each other!
Spread the Word! If you are enjoying the content of this platform then please tell a friend or a colleague! Students are also welcome as they are so close to beginning their career. We can help them start off on the right foot! So like, share, join the Facebook group, and spread the word.
Welcome to our new subscribers! Thank you for joining the conversation. Also, a friendly reminder that you can continue the conversation on Facebook @ptsonmission. Go visit Facebook and "Like" the page to receive more updates and encouragement!
Also, welcome back for another Journal Club meeting! Much of the content in recent days has been related to orthopedic rehab, largely because that is my background and what I am most comfortable discussing. However, I work hard to make sure that I cover many different topics and since I occasionally work PRN in the acute care setting, I wanted to include a helpful article to motivate those of you who live and work in the daily grind of the hospital setting.
When I first started working PRN at the hospital several years ago, I was a little nervous and slightly terrified. My only experience in acute care was for 2 months way, way back when I was a PT student. Fortunately, I had a wonderful mentor who helped me understand the flow of the hospital. I soon became very comfortable with general medical floors and even some of the specialty floors! But one area really petrified me. I dreaded receiving a consult to the ICU.
Part of that dread was the reality that I didn't really know what could be done with a patient in that type of condition. The other part was the unfortunate error in my thinking that exercise or positioning was probably not even useful for a patient, much to the dismay, I'm most sure, to my acute care professor in school. But since I was working on the weekends it was a very real possibility for me to end up visiting the ICU wing of the hospital.
Fortunately, my attitude has changed in large part to my interactions with acute care therapists who see the positive impact of engaging a critical patient. It has also changed because of many articles like the one that I have linked below. There is definitely value engaging the critical patient in physical therapy services.
Rehabilitation and Early Mobilization in the Critical Patient
In this review, the researches highlight several important advantages of mobilizing a critical patient. Some of these advantages include improved muscle strength and walking ability. Another advantage was that patients who were engaged early had a better health perception of their quality of life. So, before you think to yourself that visiting the ICU is a waste of your time, remember this article and others that highlight the significance of early intervention of the critical patient.
Today, I wanted to give you a little prayer guide. This is not an original prayer that I thought up and wrote down but it is actually framed on one of my colleague's desk. It is just a really great, encouraging prayer to think about and actually pray before our work day starts. I hope you find it encouraging!
Heavenly Father, with your tender care and guidance, I pray you fill my heart with your love and help me pass it on to each person I may touch. Use me, through my knowledge and understanding of the injured human body, to help those whom you have given me the ability to heal. May I do this by the strength of you Holy Spirit within me.
Be with me Lord, to direct my patient care and to do no harm to those I serve. Let your will be done to each person in need.
Father, speak through my words and actions as I interact with fellow healthcare workers and my patients to further your kingdom.
Lord, I pray you give me the strength to encourage my patients, a heart to care for them, patience to understand them, knowledge to serve them, and love to extend to them. Help me to do your will only as you wish it to be done.
And Lord, I thank you for the gift of education you have given me. You have carried me through to the end and are now allowing me to use what you've given me toward your glory. I ask only that you guide me in the proper use of this education with love, strength, and compassion.
These things I pray in Jesus Christ's holy name.
First off, a very warm and heartfelt welcome to our new subscribers! Thank you for joining the conversation. Also, a friendly reminder that you can continue the conversation on Facebook @ptsonmission. Go visit Facebook and "Like" the page to receive more updates and encouragement!
Second, I am super excited to welcome another friend and colleague to the blog today! Alyson O'banion is a PT with extensive experience with CVA rehab. Today, she is gracious enough to share three important keys that she and her team utilize to maximize the functional outcome of a patient who has suffered a CVA. I hope you enjoy it!
"I have been working with stroke patients for many years and have witnessed first hand the importance of interdisciplinary care for the success of rehab for patients who have had a CVA. CVA can be, and often is, a life altering condition that has significant impact on not only the patient but also the patient's family. According to the CDC, stroke is the leading cause of serious, long-term disability in the US and that is why an interdisciplinary approach to rehab is so important. So what is an interdisciplinary approach? It is using all forms of rehab specialists to provide a complete plan of care to maximize the function of a patient post CVA.
An interdisciplinary approach is crucial to assist in restoring cognitive function, ADL and iADL skills, and safe mobility/gait in order to return patients to the the highest level of independence. In our clinic, we often work to return the patient to the type of work the patient participated in prior to the CVA. But the bottom line is that we want to limit the need for care-giver assistance or any other additional burdens on other family members. Memory, attention and concentration, spatial awareness, executive function, driving, weaknesses in extremities, ability to dress, feed, toilet, grocery shop, handling finances, handling own medication, as well as negotiating stairs, may all be affected by a stroke, and only a skilled interdisciplinary team can address all of those needs. It should be noted that although PT, OT, and SLP are essential during the recovery process, the team would not be complete without the MD, social worker, nurse, dietitian, and neuropsychologist assisting in other areas of need for most patients. So how do we manage the diverse array of medical providers to ensure the most successful outcome? For me, it comes down to three key things.
Identify the Barriers to Learning. One key area for multidisciplinary care is for each therapist to know what the barriers to learning (cognition vs physical limitation) the patient may have in order to help assist in the performance of a task during a session. Meeting together to discuss barriers, as well as successful tips, can benefit each therapist and make the patient perform at the maximum potential during each session and to follow through with home reproduction of those same tasks.
Set Proper Expectations. Another key area is for the patient and caregiver/family to all have realistic expectations of the rehab process and also the expectations of the amount of dedicated time that is necessary to work on the interventions given by the therapists. The patient and family must be willing to spend many hours a day practicing the activities to stimulate neuroplasticity - the ability to learn skills through a new neural pathway. A minimum suggestion of practice is 60 hours to begin making the task more automatic. The patient and family must also understand that neuro-regeneration is a slow process, so reaching goals or making improvements can take much longer than the patient or family may realize. The interdisciplinary team will assist in the motivation and provide the repetition required to help that patient meet his or her goals but it is so important that the patient and family understand the rehab process will take time and effort. Setting the proper expectations will assist that process.
Communicate. This cannot be stated enough. As a patient moves through each rehab discipline, new observations will be made, new problems might be discovered and new successes will surface. All parties involved in each patient's rehab need to know all these new developments so that each therapist and modify the therapy session to maximize function. You must communicate frequently to each other throughout a rehab session. But we also hold rounding meetings every week to discuss all the patients we are currently seeing with all the other rehab specialists. These meetings are always fruitful to maintain high quality care.
I hope you found these three keys helpful to you especially if you work in the stroke rehabilitation world!"
Alyson O’Banion, DPT
First off, a very warm and heartfelt welcome to our new subscribers! Thank you for joining the conversation. Also, a friendly reminder that you can continue the conversation on Facebook @ptsonmission. Go visit Facebook and "Like" the page to receive more updates and encouragement!
Last time we discussed Ephesians 5:15-16 and challenged ourselves to assess whether we were using our time with our patients wisely or unwisely. Click here if you need to get caught up. I hope that you spent some time reflecting on that passage and that discussion and began to pray about what to do. Today, I want to provide a few general ideas to help us redeem all the time we spend with our patients.
Listen to Your Patients. We probably already do a significant amount of listening but I often don’t listen with intent to absorb and process non-therapy information. I may have other things on my mind like what another patient is doing in the gym or thinking about documentation or planning treatments or preparing for meetings, etc. The list goes on and I know you feel that too. But, if time allows, I think one way to redeem our time is to really listen and process what patients are telling us. There is usually a lot more than meets the eye and patients are often surprisingly honest if given the opportunity. This is a great way to minister to a patient.
“Know this, my beloved brother: Let every person be quick to hear, slow to speak…” James 1:19
Speak a Word of Encouragement to Your Patients. We live in a time of seemingly endless negativity, outrage, and frustration. These sentiments are often expressed generally or specifically. Rarely do we hear many words of genuine encouragement. We may speak encouragement to a patient in regards to the rehab progress but I am talking about encouragement that impacts an individual’s character. I think one way we can redeem our time with patients is to give them encouraging words. Look for and listen for opportunities to speak a kind word to a patient and watch the demeanor and attitude change.
“Therefore encourage one another and build one another up, just as you have been doing.” 1 Thess. 5:11
Pray for Your Patients. This is a habit that I continue to try and build. We know as we listen to our patients, hard situations, worries, fears, anxieties, concerns, frustrations are all going to surface. What a great opportunity for us to show God’s love by interceding for them. This may take the form of writing the prayer request down and praying later or stepping aside and praying for the patient right then if the patient grants permission. I try to perform the latter just because I know in the busyness of the clinic and daily life I may not remember to actually pray for the patient. Oswald Chambers poignantly said, “Don’t just say you will pray about thing; pray about it.” I think most of the time patients are incredibly grateful and appreciative.
“I urge that supplication, prayers, intercessions and thanksgiving be made for all people…This is good and is pleasing in the sight of God or Savior...” 1 Tim. 2:1, 3
Serve Your Patients. This is probably the most time consuming and difficult idea to redeem your time with patients but likely one of the most impactful. As we listen, encourage, and pray for individuals we interact with, God will show us ways in which we can serve them. I have had opportunities to not only pray with patients as a way to serve them, but also anything ranging from providing a meal, volunteering time for yard maintenance, providing a small birthday gift, or showing up at an event for support. There are probably infinite number of ways to serve your patients in and out of the clinic. We just have to be creative.
“For even the Son of Man came not to be served but to serve, and to give his life as a ransom for many.” Mark 10:45
These are four general ideas to help us walk and work as wise and not unwise utilizing all the time that God grants us with our patients. Look for these opportunities this week. How else do you redeem your time with your patients? I would love to hear from you!
"Hurry, time is running out!" "I don't have the time." "Time marches on." "Time is just flying by!" There are so many expressions that we have in our language to try and capture the reality that our time is limited and constantly, perpetually converting the future into the past. And while there are obviously huge implications when we think about the time each one of us has living on earth, there are also huge implications for a faithful physical therapist to consider.
I have now been a physical therapist for 8 years. That time has passed in the blink of an eye because I have examined and treated hundreds upon hundreds of patients. While I have seen all these people in my clinic, the reality is not only have I treated them, but that I’ve also spent time with them. I spend countless hours of time with patients. You spend countless hours of time with patients. And it all adds up.
I figured out one time that I spend on average about 7 hours with a patient. 7 hours! Some of you may spend even more time with your patients depending on the setting you work in and some of you may spend less time on average because of your specialty. But the common denominator is we spend significant time with one person. What would you do if you knew you were going to be spending hours with one person? Would you have the same conversation over and over again? Would you have hours in silence? Would you seek to learn about that individual?
“Look carefully then how you walk, not as unwise but as wise, making the best use of the time, because the days are evil.” Ephesians 5:15-16
This verse speaks to me and I hope it speaks to you. What if we replaced the word “walk” with “work” or “care for patients.” The call here, then, is the time we spend doing anything really matters in a broken, hurting world especially when it comes to our vocation. We need to use our time wisely in all facets of life and we need to use our time wisely with our patients.
I would encourage you to reflect on this passage and the amount of time you spend with your patients. Ask yourself introspectively if you are using the time God gives you with patients wisely or unwisely. If we are using that time wisely, we will have more meaningful conversations with our patients during the 7 hour rehab adventure and hopefully include applicable faith gems that point to our hope in Christ in a world where the days are evil.
It’s not too late to begin! Pray that God would show you how to use your time wisely. And also stay tuned for the next blog which will give you some practical ideas how to use your time wisely.
I spun the wheel of Journal Club topics and it landed back in the orthopedic/sport rehab world. Today, we will be dealing with the infamous ACL reconstruction! Now, if you have been in the orthopedic/sport rehab field for any duration of time, you will recognize that this is a common surgical procedure and you have most likely treated several patients who have had ACL reconstructions.
There are so many types and ways to repair the ACL from using hamstring grafts to patella tendon grafts to even cadaver grafts. Each surgeon you work with will have his or her “go to” surgical technique and rehab protocol to guide the recovery process. Generally, though it’s a rather lengthy process with certain milestones across the months ultimately ending with a functional return to sport test.
I’m sure you administer functional return to sport testing when the time comes just as I do. We want to make certain that our patients are strong, stable, and ready to return to their respective activity objectively. But what about mentally? What about psychologically? Are we assessing the psychological readiness of the patient to return to sport alongside the objective data?
We don’t want to miss this aspect of recovery and this was the discussion of our recent journal club meeting. We discussed a psychological tool to administer to our patients who are recovering from ACL reconstruction. That tool is the ACL Return to Sport after Injury Scale (ACL-RSI). Below you will find the actual questionnaire along with 2 articles that provide more information about the tool and factors affecting psychological readiness.
ACL-RSI Tool Factors Associated with Psychological Readiness Progression of Psychological ACL-RSI Score
I think the main takeaway from these articles is being able to identify overconfidence or under-confidence in a patient. That will enable us, as the clinicians, to spend time educating the patient appropriately. If a patient tests really well objectively but displays anxiety or timidity with full return to sport or activity, we can talk to the patient and coach them to see they are, indeed, ready. Likewise, if a patient tests poorly during the objective measures but has a really high confidence index and thinks they can do more than what their knee can actually handle, we can educate on the importance of continued strengthening and activity caution.
I hope you begin to utilize ACL-RSI in your practice. I think it will only improve your outcomes as you consider both the objective and subjective aspects of ACL reconstruction rehabilitation. Let’s go change the rehab world!