Motion Analysis Software

In the clinic I use my iPad and HudlTechnique (basic is free) for showing a patient what I’m noticing in their movement or for me to slow it down so i can see better.  I thought I would pass along a new one I just found that is Windows-based.  I haven’t played with it yet, but it looks like it would be a great resource so I’m passing it along –  Kinovea is open-source.

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Compendium for teaching professional level PT content (neuro focus)

From an email I received earlier this month.  If you are an instructor this is a great resource for neuro-related coursework ideas.

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The Academy of Neurologic Physical Therapy is pleased to announce the
release of the updated *“Compendium for Teaching Professional Level
Physical Therapy Content, v. 2016”*. This compendium is an update of the
previous compendium published in 2000 and edited by Margaret Schenkman PhD,
PT and Kathleen Gill-Body, MS, PT, NCS.

The purpose of the Compendium is to provide examples of high quality
teaching and learning strategies that have been developed and refined by
the contributors. Some activities include detailed patient cases and/or
grading rubrics, which can be difficult and time-consuming to write. These
will be useful for novice faculty who are seeking innovative ways to
deliver content. In addition, experienced educators will find new ideas
and alternative teaching strategies.

The compendium is online, and open access
http://www.neuropt.org/education/compendium. Activities may be searched by
elements of the patient management model, by pathology, or by type of
teaching activity. *Activities can be downloaded individually, and
educators may freely adapt or adopt the learning activities while providing
recognition to the Academy and the original authors*.

The Compendium co-chairs would like to recognize the hard work of authors,
editors, and Academy leaders in developing this resource. We hope you find
it useful in planning your curriculum!

*Jody Cormack, PT, DPT, MS Ed, NCS*
* Sue Perry, PT, DPT, MS*
Compendium v.2016 Co-chairs

I have a bias toward therapy

I’m on a flight to go visit my father in the hospital. He had significant SOB, had a TEE which showed significant mitral regurgitation. We’ve had end of life discussions so know his wishes, and he wanted to have a valve clipping done (given his age and PMH it was recommended he not have open heart surgery, and this was the other option given to him). This is a relatively new procedure and I do have some questions I want to ask (including why no palliative care consult yet, will this reduce readmissions, change mortality, it drastically improve quality of life, and what are the complication rates).
I personally am questioning how much impact will this procedure have on dad’s life – cost benefit or risk assessment I guess; given that I work with sick people, have read Being Mortal, and have seen sad cases, I’m a little hesitant about surgery for him. I don’t want to see my Dad suffer either way. How do surgeons decide when to counsel conservative management, something other than what they are trained to do? ( His previous cardiologist knew of this problem and had recommended managing symptoms, but my parents just moved last month and had to reestablish health care providers, so this is definitely a different take on the situation).

Better yet, do I do any better? As PT’s we hear and agree #getPTfirst or #choosePT – we know we can make a great impact on people’s function and quality of life We talk about avoiding surgery if you can and avoid opioids. I want to bring hope. I hate it when I have to admit that i can’t restore function, return the patient home, etc. Most of the time it is easy – yes or no. But in the gray area, how long do you spend working at it? The patient with a CVA. The patient who has poor motor planning that isn’t responding to everything you can think of to help with mobility. The patient with pain you can’t really touch no matter what you do. These are the things you want to know as a student, and even as a practitioner there are ones that stick in your mind – did I do everything? Would a bit more, or something different help? I want to give hope, and I hate it when I have to say I’ve done all i can and we need to stop. Even therapy can’t fix everything. To a man with a hammer everything looks like a nail – i have a bias toward therapy and I need be aware of that for the sake of my patients, their families, and even myself.

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Sometimes the best teachers are where you least expect

I am clinical faculty for a local PT program for their ICE (Integrated Clinical Education).  During the a student evaluation last month, one of my students recommended that I involve the patient during my instruction and education to students as she felt the patient (who is to be the center of what we do) is left out on the periphery.  Wow.  Best feedback I’ve received thus far.  I came up with an idea how to implement it for next year.

I’m also a CI this summer with a 2:1 model for first-year students.  As I was asking a student what he observed about a patient transfer, explaining what I saw, and working on ideas of what we could do, the patient said “hey, I’m right here – talk to me!”  Ouch.  So now I’m prefacing my interactions with students to the patient saying I’ll be talking PT jargon to the students, but they will be explaining it back to you in non-technical terms.  In doing this a) we are involving the patient (and they know what is going on) and b) the students get to practice patient-friendly language (if you ever get stuck try the rubber ducky idea).

I love being a physio and a teacher, and also a student.  While I do miss academia, you can learn anywhere if you are open to it, and bettering yourself and others in the process.

 

Telehealth, tech, and the older adult

64946580_88fb60c7f4_qI received a tweet this morning – “Telerehab+fall predict platform= Game changing. Effective?” (I tried to embed it but it wasn’t working).  The American Telemedicine Association is having their meeting in Minneapolis this week, and it will include telehealth platforms for seniors.  Two quick thoughts about the idea before I get ready for work (I’d love your comments and thoughts in the comments or on Twitter).

First, I agree with the author of the article that cost will be a huge issue.  Those on a fixed income are not going to have much wiggle room, and those who are poorer and rely on SS definitely will not.  This will be an increasing concern with the Baby Boomers given the data out there on their savings (or lack of) for retirement.

Second, will THEY want to wear it/ use it?  There is a great section of dialog in Jurassic Park where the grandfather is defending all he has done to the scientists, that he spared no expense, and Ian (Jeff Goldblum’s character) says something to the effect of your scientists were so busy asking if they could they didn’t ask if they should.  In the same vein, are we so busy asking if we can do all this great tech we aren’t asking whether they want it? Yes, there are those who love tech and will embrace the idea, but are those the ones that are having the falls, experiencing incontinence, not eating well, etc?  It reminds me of the Fitbit – those who use it are often the ones who are already fit.  Will they view it as an invasion of their privacy, of one extra step closer to an ALF or a nursing home, despite assurances that the tech is “to keep them as independent as possible for as long as possible”?

I think the technology has the potential to be effective, and to be a game changer for many.  But I think that for many others the financial cost and the resistance against the tech intrusion will require continued personal monitoring and involvement by family and the home health community.

 

Photo credit: “Old and New” by Sparky

How Can You Improve Patient Interactions?

153570089_bb99d7108c_mHave you ever been a patient (for any provider, not just PT) and had a really great or a really bad experience?  What was the key to that experience for you?  For me, it was the interaction with the provider.  I’ve contemplated switching providers because of an interaction where I felt like a number, that my concerns were minimized and derided, and that his time was much more valuable than mine.

I received the most recent PTJ yesterday.  A few articles grabbed my attention, including “What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis” (O’Keeffee M, Cullinane P, Hurley J, et al; Phys Ther 2016; 96: 609-622).  It reminds me a lot of the PTJ article by Hush and colleagues from 2011 entitled “Patient Satisfaction with Musculoskeletal Physical Therapy Care: a Systematic Review” which is one I have my students read.

The authors identified four themes in their review: PT interpersonal and communication skills (active listening, empathy, friendliness, encouragement, confidence but not overconfidence, and non-verbal communication), PT practice skills (patient education – a big one for patients, and PT expertise and training), individualized patient centered care (individualized, and taking patient opinion and preference into consideration) and organization and environmental factors (time, flexibility).

The results aren’t all that surprising, but they bear repeating to ourselves as providers; I would argue while both articles examine this in light of musculoskeletal PT, it very likely applies across all specialties and settings. Do positive interactions enhance adherence and give better outcomes?  No evidence on this yet, but it would make sense especially for self-efficacy. I think I do pretty well in my interactions, but I think I’ll focus on my listening and patient education.  What can you work on to improve patient satisfaction and possibly their adherence and outcomes?

Photo credit: X-Factor by Pierre Metivier.

Research on Attire for Physical Therapists

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I’ve seen some recent discussion on Twitter about attire for PT’s (including #NoPolo before and after CSM), and my employer is facing a possible change in requirements (we are allowed to be business casual or scrubs, with jeans on Fridays, but are now opening up a TCU within a hospital where the staff will be required to wear black scrubs).  I thought I would pull up whatever research is out there for attire for physical therapists and briefly summarize each (there isn’t much!).

  • 1999 masters thesis by Angell, Glaspie, and Winters – Physical Therapist Characteristics and Practices That Affect Patient Willingness to Comply With Home Exercise Programs.  “The results of this study demonstrate physical therapist personality traits and clinical practices were perceived by patients to be more influential than appearance and role modeling behaviors.”  Interesting conclusion and I would agree that it is more influential. Appearance, specifically professional dress and casual attire, did not reach a level of significance (the majority of respondents said it made no difference), but that is not to say that it might not matter.  Table 3 appears to show a preference for professional>casual>lab coat, and professional attire and lab coat make gains with the older subjects when the subjects are separated into two age categories.
  • Ingram D, Fell N, Cotton S, Elder S, Hollis L. Patient preference, perceived practicality, and confidence associated with physical therapist attire: a preliminary study. PTJ ‐ PAL. 2011; 2‐8. I don’t have access to this paper, but their paper is included in Dr. Ingram’s NSC 2013 presentation What You Wear to Work: Appropriate Attire and Professional Image for Our Doctoring Profession.  The most preferred attire by patients was scrubs, though OP’s and college educated patients preferred collared polo and khakis.
  • Finally Mercer E, MacKay-Lyons M, Conway N, Flynn J, Mercer C. Perceptions of outpatients regarding the attire of physiotherapists. Physiother Can. 2008;60:349-357. In ranking photographs of professionalism and preference of attire for a male model, for professionalism it was lab coat>tailored dress>scrubs>jeans, and for preference of attire it was tailored dress>scrubs>lab coat>jeans.  For appropriateness of attire, it was tailored dress>scrubs>lab coat>jeans.  Interestingly “in comparison to their younger counterparts, more respondents aged 56 years and above perceived scrubs on the male model as appropriate.” (note – appropriate, not preferred or professional).  Also, “In contrast to the findings from medical literature, which indicate the lab coat as both most professional and most preferred, respondents in the present study unambiguously preferred tailored dress, despite regarding the lab coat as most professional.”  Also, “Extent of exposure to this therapeutic interaction appears to influence patients’ perceptions of the appropriateness of attire.  The study found that perceived appropriateness of lab coat and scrubs decreased and perceived appropriateness of jeans increased with increasing number of physiotherapy visits.”

So where does that leave us?  First of all, you obviously have to follow the employer requirements.  If you are in a hospital, you have no choice – scrubs are the standard, likely color-coded nowadays.  Some of the large corporate OP clinics have a standard polo/ khaki combo.  But if you are in a TCU/SNF or smaller OP clinic and there is just general guidance, what should you wear?  I have chosen to wear professional attire (khakis and a button-down shirt) for two reasons – for the patient, and for me.

I would agree with Angell et al that it is more the characteristics of the therapist, not the clothing, that makes a difference for (at least) the HEP, but probably even from the moment we first meet. Still, I think that clothing does play a part in the interactions, for me and for them.The literature hints at patients preferring professional clothing (Angell), or certain segment of the population preferring it (Ingram), or they consider it to be more professional and preferred (Mercer).   I also believe in dressing the part so to speak, and I think that is what Roush hints at.  I know that I felt different Monday-Thursday than on a casual Friday when I used to wear jeans.  Am I a better practitioner M-Th in professional attire than on casual Friday or M-F if I wear scrubs?  Absolutely not!  For me, I take my profession and my job more seriously than I do if I wear scrubs or jeans, and I feel more engaged.

I leave you with this from Mercer that I found interesting – “professionalism is a multifaceted construct that, in the health care field, encompasses the traits of competence; engagement (e.g., communication skills and empathy); reliability; dignity toward patients, peers, and self; placing the patient above self; and concern for quality of care.  In more practical terms, it is ‘an image that promotes a successful relationship with the patient,’ such that the patient feels confident in the capabilities of the health care provider.  Although professionalism is the single most important trait that can be enhanced by dressing appropriately, professional attire is only one means of achieving a successful relationship.”  Personality traits and interactions play a significant role in the PT-patient relationship, and I want to use professional attire to help me maximize the interaction, for them and for me.

Picture is from Otis Historical Archives