On clinical approaches

mind-tricks

Image Coureousy of Theo Lister lifehack.org

 

Do we often over complicate things with our approach to the rehab of MSK disorders? I, likely more than most, firmly believe in the concept “the truth defies simplicity”; however often the causative factor for a problem is rather apparent with an equally simple solution. Too often do I observe approaches based on loose scientific principles or over extensions of human physiology. These behaviors often obfuscate thinking and make treatment more complicated than it should be. The understanding or perception regarding the attributed mechanism for an intended therapeutic effect is important; for both provider and patient. In short, why is as important as what is done or chosen for treatment. Granted there will be variability in approaches based on one’s training and knowledge base; but are our thoughts often too scattered and random when they should be more focused and directed? Does this uncoordinated way of thinking impact our outcomes? Does this matter? Let’s hear your thoughts (pun intended).

2 thoughts on “On clinical approaches

  1. Agrees.

    I believe it is the human need to reconcile what is unknown and demystify it by using arguments that sometimes based on sketchy science or even not true at all. Not always foul play is the reason, most often I think it is the combination between the need to explain and insufficient clinical thinking that creates this vacuum of knowledge. (KT, FMS, Fascia research, Visceral fascia manipulation, promoting “Fear avoidance” etc… ).

    I recently had a presentation for Physiotherapists and Physiotherapy students where In regards to the treatment plan I advocate using “KIS” principle (Keep It Simple). I stole that from the “Sports Physio” – Adam Meakins.

    Either because our knowledge is not sufficient to fully explain said problem, or that is does not matter that much the actual mechanism at every point of the rehab, keeping it simple from explaining to the patient to the program prescription works wonders for me.

    1 suggestion of using this principle is prescribing the patients 3 – 4 home exercises, from the understanding that the best exercises is the one the patient does.

    Hope it helps someone,

    Or.

  2. “…there will be variability in approaches based on one’s training and knowledge base; but are our thoughts often too scattered and random when they should be more focused and directed? Does this uncoordinated way of thinking impact our outcomes? Does this matter?”

    In short, I think you’ve identified some important issues. Our way of thinking and approaching clinical care likely affects our clinical decisions and possibly outcomes more than we realize.

    I think the lack of a foundational philosophy to our profession, lack of hard science education, and lack of understanding of philosophy/logic contribute to such issues. But, more locally the lack of a process with a focus on interventions definitely contributes to the uncoordinated way of thinking.

    It’s imperative that we develop thinking models, clinical processes, and approaches to integrating new clinical research that are not fractured. Currently, a lack of such robust skills creates a gap whereby various schools of thoughts, gurus, and approaches creep into professional vogue and clinical practice.

    http://ptthinktank.com/2014/12/15/should-we-all-do-the-same-thing-perceivable-vs-conceptual-practice-variation/

    http://ptthinktank.com/2014/01/06/metacognition-critical-thinking-and-science-based-practice-dptstudent/

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360492/

    http://ptthinktank.com/2014/12/13/measuring-outcomes-outcome-measures-and-treatment-effects/

    http://ptthinktank.com/2015/03/01/do-you-have-the-resources-to-perform-your-job-sportspt/

    http://ptthinktank.com/2014/05/04/dptstudent-you-dont-need-clinical-experience/

    Kyle Ridgeway, PT, DPT
    PTThinkTank.com

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