In the course of this year, I came across an excellent piece written discussing the concept of patients who fail the physiotherapy. Overall, it’s an excellent piece of writing, but I’d love to further discuss the topic.
In this blog, I address the following: 1. Are your patients struggling with physiotherapy and 2. What can you do to enhance your therapeutic relationship and adherence to lessen the risk of clients who fail the physiotherapy?
Do you know if your patient is suffering from therapy?
It’s easy to believe that a patient’s health isn’t improving even though their condition may change in a day or two of visits. However, before hitting the panic button, think about the following factors:
1) Are realistic goals and objectives set?
This isn’t easy as a few patients will not be satisfied with anything less than a complete cure on day one, but since we’re conditioned to expect physicians to offer accurate expectations about the outcome of any injection or surgery, it’s best to set realistic expectations in advance to avoid unhappy patients later.
In the majority of instances “I can’t guarantee that you’re gonna be pain-free and fully recovered given how long this has gone on for, but I do think you will experience a significant amount of symptomatic and functional improvement.”
2) Do you have a realistic timeframe?
Certain conditions could be able to take an entire year to fully recover from, or perhaps an improvement in the symptoms. It can be a challenge for people to accept and yet you need to remain realistic, or your patients might quit when they’re not fixed within 1-3 sessions.
However, you require timeframes that allow for incremental improvement as you go. From both research and my personal experience will typically range from:
- ROM: mainly session from the session
- The strength of the body is 2-3 weeks, ranging from 3 months
- The pain can last from 1-2 sessions for more than a month (or longer)
Making smaller goals as you go in the course of treatment and having time to monitor this is crucial in order to continue to reinforce patient improvement throughout the process. This approach is a key component of effective physiotherapy treatment in Waterloo.
3) Do you want to look at functions or the symptoms?
There is no doubt that many are influenced by the huge pain scale as well as the percentage of patients who are pain-free as the primary (or perhaps the only) indicator of the success of their treatment. But this is often inaccurate, particularly for those suffering from chronic illness.
It’s not uncommon, particularly in chronic conditions, for patients to experience improvements in their functional abilities (i.e. enhanced strength, increased ability to perform activities) before having major improvement in pain. Also, this should be noted and analyzed. It is also crucial to recognize that certain patients might not have any functional limitations, or limitations, and simply want the pain to lessen. It’s okay as you make sure that the objectives are reasonable.
Be careful not to get too excited, but make time to reflect on these points – and you could find that your patients may be more ahead of schedule than you imagine. At Restore Life Physiotherapy, we encourage ongoing reflection and patient-centered care to support steady, meaningful progress.
What happens if I’ve established realistic expectations, goals, and deadlines and my patient isn’t better?
The 64 million question is whether they are adhering to their plan.
Option A: They’re not adhering to the plans
It can be attributed to many factors, including:
1) A poor therapeutic relationship
It could be due to low confidence of the patient within the clinic; poor confidence of the clinician, and/or a patient being rushed, disengaged, and not being listened to. Sometimes, the environment of the office can contribute to this. Slowing down, paying attention to the client, as well as appearing confident is essential.
2) Treatment approach that isn’t in line with the patient’s needs and requirements
Patients need to understand “why they are receiving the treatment, as well as how it can be applied to the patient’s goals. I love it when my patients inquire about why they choose specific treatments or exercises because it helps me stay attuned to their needs. If the patient isn’t able to comprehend what is the “why” then good luck in adhering.
3) It doesn’t work for the person’s lifestyle
Though I’m certainly an exercise and education-focused physiotherapist, I am astonished when I meet patients who have been to the same provider before who had given them 10 exercises, with no feedback from the patient. For most non-surgical or non-fracture patients, I’m favoring 1-3 goal-oriented exercises that are straightforward to incorporate into (i.e., they can be performed in a standing position or sitting down, without the need for fancy equipment).
A split squat or a lunge that is controlled eccentrically also strengthens your glutes as well as stretching the hip flexors, without having to do two distinct exercises.
4) Does it seem too difficult or is it too simple?
It isn’t always easy to avoid the pain of patients. However, when a patient returns with a complaint that they’ve been suffering from pain for two days following their exercise it is possible that you need to adjust your routine in order to maintain their condition and ensure that symptoms remain within a reasonable limit.
Some clients get irritated by everything regardless of what you are doing or how softly your approach is. Although I do not like that patients are feeling like “I’m in too much pain for physio today”, if a person is sensitive, easy to flare up, and suffers from psychosocial triggers, the possibility is the case that these factors must be dealt with before treatment can be successful. A skilled Waterloo physiotherapist can help identify and manage these barriers to support a more successful treatment outcome.
Option B: They’re staying with the program
In these instances:
1) Is it compatible with the patient’s goals?
It’s great to improve shoulder ROM; however, if the objective is to help the patient get her child picked up, then the patient probably doesn’t require a 180-degree shoulder abduction or flexion. It is better to focus on strength and load tolerance.
2) Does the diagnosis make sense?
Other diagnoses could be hidden beneath the sub-surface. It happens occasionally and was my experience. There was a patient who had an alleged disc herniation that began to regress and was diagnosed (via images) with a cyst which required medical treatment. Though I’m not a huge advocate of using imaging too often, it has an appropriate time and location, especially in cases where the patient’s progress is slowing or if something isn’t normal.
3) Do you have any other obstacles?
One of the major reasons that I’ve witnessed people who have active clients “fail physiotherapy” with other professionals is inattention to things that are done in the outside world. If the neck pain has been aggravated by working for 10 hours to a certain extent, or your client’s hamstring tendinopathy is made worse by the countless miles of running, yet there is no consideration or focus made on modifications to their activities … The result is that you and your patient could hit a wall with no progress. There are times when activities cannot be changeable, and that’s okay.
However, it is important to note that realistic timelines and goals need to be set and adjusted when necessary.
4) Sometimes, clients are surgical patients
If a patient has signs similar to those seen in imaging, doesn’t present any significant barriers for a successful surgical result, and is receiving satisfactory treatments, I’m okay with having the procedure.
5) Sometimes, quite simply physical therapy (even in the right way) isn’t effective!
This blog should provide valuable tips on how to strengthen your therapeutic alliance results and adherence to reduce the percentage of patients who suffer from a failure in the physiotherapy process.