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I would firstly suggest that this answer could be responded in many different ways and involve a number of factors!  However, the following 3 domains is what I would consider my treatment as an accomplishment:

1. Decrease in Pain (symptom) Rating

This one is obvious but honestly makes a lot of sense.  It is one of the most objective measures a patient can provide you in a quick and reliable way.  Pain is what brings people in to see us so it has to change! I usually inquire about pain in the clinic on a verbal, numeric scale from 0 to 10; rather than on a 10cm visual scale.  It is instant and simply gives me the data I need. A clinically meaningful change is 2 points so I would strive for at least this much improvement (patient arrives with 5/10 pain and it decreases to 3/10 upon departure).

I place ‘symptom’ in parenthesis above as some individuals do not considering their complaint ‘pain’, but numbness/tingling/burning or discomfort, etc.  Also, I have been striving to talk more about symptoms, rather than constantly asking about pain.  It is a better psychosocial approach.

I normally encourage my students to strive for better than 2 point improvement.  Shoot for the stars and try to abolish all pain, but we know this is not always possible.

Another tidbit is that I always assess the pain or symptoms with the movement pattern that was assessed earlier in the treatment.  Absent pain at rest is meaningless if not changed with movement.

2. Patient understands how to manage their symptoms

In short, I feel much better about a treatment if I know the patient can relieve their symptoms independently; rather than rely on me.  Don’t get me wrong, I love giving people relief by something I do and absolutely feel manual therapy is needed in a lot of cases, but I always encourage self-treatment from the moment the patient enters the clinic.  I try to have 1-2 exercises (or activities as I talk to patients as sometimes ‘exercise’ can be perceived as a unfriendly term) that they can perform consistently.  I normally do not try to give more than 3 exercises at the most as I feel adherence rate decreases with a heavily loaded exercise program.

3.  Know that the patient’s money & time was well-spent that visit

This is more of a gut feeling and self perception by myself, the therapist. I want to know deep inside that I gave it all.

Patients come to us for a service.  I encourage my students to think of what we provide is a more of a service but of a product, and we want that product to be of upmost excellence.  I want that patient walking out of the door knowing the co-pay, or self-pay, or 20% that they may owe after insurance was well worth it.  Everyone’s time is valuable too.  Make sure you give in abundance.  Go above and beyond what they would expect from seeing a physical therapist.  If you enjoy what you do, then you will remember ‘if you can satisfy yourself, you can satisfy your patients’.

I have left out many more options!  I would like to hear your feedback on what you think is a successful treatment. 

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7 comments

  1. Hey man! I agree with all your points above, however I think a successful treatment outcome (and I think this is the direction we are heading) should be determined based on whether the patient returns in the relative near future for the same condition…i.e. readmission. Although some private practice owners would love it, I think we haven’t done our jobs as PTs if the patient keeps on returning for the same issues. What gets tricky is whether or not the patient does their part once therapy is over to stay healthy and maintain they’re improved level of function. Just my thought!

    1. Hey Mark! Thanks for your comment. I couldn’t agree more. The post in general was designed as a goal for just one treatment, but yes, preventing reoccurrences or better yet, if they do occur, how much the patient is able to do independently is key.

      I think even private practice owners (I am not one but work in a small private clinic) would agree too. Results will foster relationships and patients will return for another problem (say a knee vs neck issue). I see this day to day.

  2. Function. I am not always as concerned with pain because there are many patients out there who will never be pain free but if you can increase what they are able todo then you have hadsuccess.

    1. I was looking for a fairly recent post that would somewhat relate to what I found to be a very self fulfilling/successful evaluation. I guess and hope it could carry on to each future treatment. Had a middle aged female come in with right neck pain that radiated down into her shoulder and also complaints of pain radiating in the axillary. Onset about a week and she had already been to the chiro for 2 visits who made her worse. She decided to go to her G.P. and was referred to P.T. I asked what made her decide to see Chiro. ( I like to get patient’s mindset when making that decision in hopes of finding out what we must do as P.T.’s to get us as a preferred direct access choice. She had said that co workers had recommended visiting a chiro for relief. I screened her right shoulder for AROM and did empty can (-). All AROM was pain free except combined IR/Ext/Adduction which was also limited by 4 vertebral segments. I then screened neck with AROM. Pain free with exception of flexion which was also limited. I palpated landmarks in sitting and nothing outstanding. I had her go supine and ULTT which were negative. I then asked her what “adjustment” chiro did and set up a mid cervical on her to see if that was correct. She said yes. I asked how long did he spend with you prior to doing the adjustment. About 10 minutes was her reply. I failed to ask if he placed her hands on her at all prior. Based on this patient’s postional faults (head forward/upper thoracic kyphosis) I would expect her to have significant upper T spine hypomobility with spring testing but did not test. So based on this and location of patients symptoms if I were to perform a HVLA thrust movement it would of been at the C/T junction prone and not mid cervical which she received previously! When supine, I did passive accessory mobility testing and then soft tissue. Found a trigger point on the right levator scapula that was not as remarkable in sitting. I asked if that was the type of pain that she has been experiencing (8/10). She replied yes. I did some soft tissue/trigger point release/contract relax for about 5 minutes then sat her up and retested cervical flexion. AROM was now almost full with only minimal pain at end range. She was not only surprised but very grateful of the immediate change. Provided a levator stretch for HEP. This was an eval at the end of a very long day but was very satisfying for several reasons. #1I love to outperform any chiro especially when they made a patient worse. (I realize chiros get patients all the time that Im sure say PT’s made them worse). #2 She got immediate positive results. Pre and post testing. #3 She in turn was grateful for her visit when she may have been skeptical at first. #4 she will probably go back and tell co workers who may then in turn consider PT in the future over chiro! Future blog post what makes a successful eval?

      1. JT,
        Great results! I agree with you that I ask patients why they went to other professionals as it is interesting to get the results.

        Sounds like you did a very sound treatment based on a clinical reasoning framework. Keep it up!

        HNV

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