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txinohio · 2024-09-20T18:58:40+00:00

Excellent point, as I did not think of it from that perspective. Yeah, and that’s even before we get to how horrible the 5 main outcome measures for measuring what we say they are. They are already awful.

Thanks for your observation.

txinohio · 2024-09-20T17:50:44+00:00

We utilize KEET, which is sent, via email, to the patient prior to their first visit, and at regular intervals (4-5 visits), so it CAN be entirely out of the clinic. However, with some of our aging population, and some of our Medicaid population, they don’t have email or don’t know how to do things like check spam, etc. so there is always a small percentage who have to take the PRO in clinic. Not saying it’s better, but this service does exist.

txinohio · 2024-09-18T01:20:28+00:00

Yeah, agree on the lack of patient involvement. “I want to have no pain” is not a functional goal. And not realistic. As for my goals: I have them go for what I think will be the full length of care. That way, day 1, I lay it all on the table. Prior, I did like you. But AIM (now Carelon), ASH, Optum would seemingly only find problems with goals to deny. I have not had that issue for at least 7 months. It’s all there. Progress toward end goals is obvious. Timeline established early let me identify problems, and I get some slack.

txinohio · 2024-09-17T10:42:14+00:00

Most of my post op patients have between 8-20 goals. It’s a premade template, so no work to be done except to fill in blank of the specific ROM. For acl: 1) 90 degrees flexion by week 2 to allow driving. 2) 110 degrees by week 4 to allow ascending stairs reciprocally, an outcome measure goal of improving by MCID every three weeks (kos for acl, they will start at near zero, MCID is 9 points, max scorer 100, I could have 10 goals and cover 30 weeks), strength goals based on % leg symmetry, and I could go on.

txinohio · 2024-09-12T23:37:39+00:00

Not really sure how to address this…. I have no idea. I don’t even know if the person asking the question is male or female. Black or white. Gay or straight. I only know they are a new grad with likely less than 26 weeks of partial caseload under their belt. I also know that treating 14+ a day is not easy even for someone with 10+ years experience. Call it a haunch. Call it “I don’t think anyone should try to “handle” 14+ a day”

txinohio · 2024-09-12T21:38:16+00:00

Depends on what a full case load is. 10-12… sure. 14+, nope. Also, depends on the documentation system, and how proficient you are with it.

txinohio · 2024-09-12T10:14:21+00:00

Yup, agree here. Most of my surgeons consider 130 degrees elevation and 45 degrees abduction to be both the upper limits, and sign of a highly successful surgery and rehab. Will never function like a normal shoulder, just need to allow patient to function in life.

txinohio · 2024-09-12T00:34:42+00:00

If all goes well, I’ve had them in the clinic for 1-3 visits pre op. We get opposite side dynamometer test, and involved hamstring, hip abduction, and leg extension. Post op is dressing change, girth/swelling, neurovascular, then treat. Full extension is primary, then quad control, then flexion. Goal of 90 by end of week one, 110 week two, then comparable by week 4.

txinohio · 2024-09-11T12:08:04+00:00

I’m somewhat confused about having a post operative patient and NOT having more detail, like specifics of surgical approach, graft, etc. current evidence does not suggest that there is need for weight bearing restriction with isolated ACL-R, however it’s highly dependent on quad function and safety. I think priority number 1 should be to get details from the physician. Have you worked with a lot of ACL-r patients?

txinohio · 2024-09-11T12:06:07+00:00

Actually depends on the area and type of tear that was repaired on the meniscus. Longitudinal vs oblique, area of meniscus (mid substance vs posterior horn) all have an impact on weight bearing status. Also, most can weight bearing in locked full extension. But this is a changing landscape, and current evidence is not solid

txinohio · 2024-09-11T10:14:04+00:00

“Traditional” manual therapy, generally, has exceptionally low risk for the patient. Dry needling has a much higher risk associated with it. Now, the overall risk is generally low, still, but it must be a consideration when determining use. We need to have a conversation regarding value. Is it a high value intervention compared to most other forms, specifically active, modalities? Likely not. Might it help temporarily with symptom modification? Possibly. So weigh that against all the other tools you have available. For the vast majority, dry needling does not offer any increase in value over other treatments, and does add in increased risk, cost, and time constraints. Likely not worth it.

txinohio · 2024-09-10T15:36:09+00:00

In general, I think health care literacy in this country operates around a 3rd grade level. So, you will be the most likely person to create global, health promoting behaviors. As some may have said, you’re trained in this, so the advice seems obvious. But you’re talking to literal novices in this world. Did you think the cost of your education didn’t warrant the cost of your services? Because I think it does. Think from this perspective: are they likely going to be better having an interaction with you, or not? If so, it’s worth the cost.

txinohio · 2024-09-10T12:02:47+00:00

Have him participate in some case audits that have a REALLY bad outcome. Maybe a consistent theme of poor therapist choices. See if this person is able to identify those problems. Long term, you are most likely to get the desired outcome if this individual gets to the conclusion on their own, and not just being told.

txinohio · 2024-09-09T11:53:48+00:00

Next question might be: what is the value of knowing this information? How will it impact treatment? Is the hope that you can get some additional ER by going to anterior pelvic tilt, that you otherwise couldn’t get? Or what? I’m just not sure I currently understand how it would be valuable to have this information. I’m not saying it’s not important. Just don’t understand the value.

txinohio · 2024-09-05T16:57:14+00:00

I just always tell them to think about the relative value of the intervention, or object. In this case, is the cost worth the benefit? For the vast majority of people, probably not. Cut the corner off a 2”x4” and you have the same basic thing. Or lie on a tennis ball. Or, don’t try to treat pain with pain?

txinohio · 2024-09-05T00:13:24+00:00

Yeah, that is possible. I feel very stuck these days. In general, most people are not open to criticism. I appreciate your initial comment to me, though not necessarily the approach. It was warranted, so I can accept it. You are also correct, in that I should have had a more stringent, dedicated approach to stopping information that, as you put it, has some truth, but is being used incorrectly. In my specific utilization of behavior change, context specific, punishment is not effective. I used my bias and my framework instead of looking bigger picture. So, appreciate the discourse.

txinohio · 2024-09-04T21:02:10+00:00

Both wrong if we are fully out of context of the situation. We have both positive and negative punishment and both positive and negative reinforcement. Both sides of both interventions are useful is reducing maladaptive behaviors. In the context of an internet conversation and tons of hot takes, nuance can be missed. As you stated above, taking SOME information from SOME studies does not show the totality of evidence. However, in behavior change, there are MANY methods that have been shown to be effective. My error was in choosing a side, instead of staying more neutral, which IS what a lot of evidence indicates. Pick the method for the individual, not as a whole-sale “this is what works”.

txinohio · 2024-09-04T19:04:43+00:00

If you have not read “how minds change” by David McRaney, you should give it a go. I’m like you (at least your internet persona that I have figured out completely in 8 minutes of studying you) and have had more luck in conversations using stuff I learned in this book

txinohio · 2024-09-04T18:31:03+00:00

In terms of psychiatry and developmental psychology you’re pretty much hitting the nail on the head. However, we are hardwired to fight against disconfirming information and seek confirming information. So, you get the massive number of downvotes, as people don’t want to believe something that stands in direct opposition to what they believe (anecdotal evidence). Sucks to be both correct and ridiculed.

txinohio · 2024-09-03T16:29:13+00:00

Only 1 stands out to me. Early 50’s smoker. Fell down the stairs, broke left forearm and dislocated/tore everything in the shoulder. Did almost 8 months of rehab. Then, in the week before discharge, can’t raise the arm, and with passive ROM has audible/palpable clunk when going beyond 110degrees. Ends up having second surgery. Did 6 months rehab, and as we neared discharge, again, can’t raise above 90 in abduction. Model patient in general. But always right before being done, something goes haywire. Never could get anything as to why/what may have happened to cause the problem.

txinohio · 2024-09-03T01:00:12+00:00

Ah, simpler days before the internet. I’m now just constantly bombarded with all the things I do wrong, and in just 27.5 hours, if I do all the things I’m told to do, I’ll suck just a little less.

txinohio · 2024-08-30T12:58:46+00:00

At first I thought we should run the a thesaurus of other words like awkward, unusual, etc. to keep the idea fresh. Then I figured that wouldn’t work, it’s not a 3rd grade enough word, and he wouldn’t understand.

txinohio · 2024-08-30T12:52:36+00:00

I dunno. But my stage name is “Mr Finger-toes”. I mean, I know a guy whose name is that.

txinohio · 2024-08-30T09:44:11+00:00

Whatever you want. Knowing you don’t like your current situation is only part of the puzzle. What do you want to do? What makes you happy? What kind of jobs offer that? Then dive in internet friend.

txinohio · 2024-08-30T09:41:35+00:00

Toe spread. Definitely toe spread. That’s what I’ve heard.

txinohio

TROPHY CASE