Treatment Plan Timeline and Goals

[fozzy40]

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I have a quick question for your guys/gals...

I am very diligent about reading the progress notes of the treating PTs of my patients. I'm trying to get a sense about how you guys determine the timeline of your treatment plan. I.E. sometimes there are patients that are requested 1-2/wk vs. 2-3/wk for 3-4wks vs. 6-8wks. I'm trying to pick up the pattern of how the therapists I work with determine this.

Is there a protocol? If so, can someone cite me a reference?
Is it an insurance thing? Ask for a certain amount of visits based on a diagnosis code?

Thanks for your help!

 

[jesspt]

I have a quick question for your guys/gals...

I am very diligent about reading the progress notes of the treating PTs of my patients. I'm trying to get a sense about how you guys determine the timeline of your treatment plan. I.E. sometimes there are patients that are requested 1-2/wk vs. 2-3/wk for 3-4wks vs. 6-8wks. I'm trying to pick up the pattern of how the therapists I work with determine this.

Is there a protocol? If so, can someone cite me a reference?
Is it an insurance thing? Ask for a certain amount of visits based on a diagnosis code?

Thanks for your help!

Good luck finding a pattern Fozzy. I haven't seen much rhyme or reason as to how many of the PTs I have worked with in the past determine frequency and duration, and we don't have a lot of literature to guide us in that regard.

I'll write more to try to explain my thought process when I get a bit more time.

 

[riseboi]

Setting aside any constraints from insurance, MD orders, and personal finances, I'd say a PT's determination of a patient's individual treatment plan comes from a number of variables such as patient motivation/compliance, and level of hands-on manual work and/or supervised treatment needed initially. I believe all these things come with clinical experience. Maybe you can speak with the therapists with regard to some patients with varying plans to gain insight from them in why one plan is different than the other.

 

[fozzy40]

Good luck finding a pattern Fozzy. I haven't seen much rhyme or reason as to how many of the PTs I have worked with in the past determine frequency and duration, and we don't have a lot of literature to guide us in that regard.

I'll write more to try to explain my thought process when I get a bit more time.

Thanks JessPT!

 

[jesspt]

I think when looking at frequency and duration, I try to first determine what my role will be in interacting with the patient. Will it be primarily one of education and advice, will it be one of providing more "hands-on" treatment, etc. So, if a patient has acute, non-specific LBP, I might see them 2x wk for 1-2 weeks for manipulation/mobilization and instruct them in a general cardiovascular exercise and trunk strengthening program near the end of that time. But, if it's a patient that is a runner with chronic Achilles tendonopathy, the best thing I might have to offer them is isntrument assisted soft tissue mobilization (for which I am unaware of any outcomes data - only some histological rat tendon studies) and Alredson''s eccentic plantar flexor strengthening program. So, I'd probably see the patient 3 time per week for 2 weeks primarily for IASTM, then once a week every other week for advice on return to their running program and to advance the eccentric protocol, with the understanding that the protocol is three months in duration, so I may be seeing them infrequently for a long period of time.

I also try to determine if a patient has primarily chemically or mechanically mediated pain. If it is primarily chemical/inflammatory, I may see them less frequently, and primarily only for advice and gentle ROM HEP instruction as their best friends will be gentle, mid-range motions and pharmacological interventions to reduce inflammation. I would see a patient with mechanical pain more frequently, as their symptoms are likely very ammenable to PT interventions and I should be able to have a big impact at a higher frequency over a short duration (2-3 per week x 2 weeks).

The only patients I tend to see at a very high frequency are those who are post-op and who are struggling to regain ROM.

 

[dg1984]

That is a great question. The best PTs I have seen do a great job of feelingout the patient's compliance which is a huge component of how long a treatmentcould take. I think there are a few major factors.

1. Did you do anything or find anything in the evaluation that would leadyou to believe that the pain will resolve quickly. An example is a patient withan acute lumbar radiculopathy that exhibits a clear centralization pattern witha repeated motion. This is a huge factor in how someone will fair.

2. Who is your patient? Is the patient motivated? What is their joint mobility, muscle length, strength,endurance, or neuromuscular control like? How acute is the injury? Patientmotivation and compliance with a HEP are huge factors for success in PT.

3. Healing time frames and protocols always come into play. A lot ofsurgeries have predictable timelines based on protocols. Some injuries arepredictable, but again a lot comes down to the patient.

I am a student nearing the end of my education, but have seen some veteranPTs provide amazing and accurate prognosis taking into account these factors.If you are working with a trusted and experienced PT I would certainly listento their recommendations.