I have recently started doing “Utilization Peer Review” work in my spare time. I wanted to ensure that I was acquainted with all aspects of the workers compensation system, and to be honest, I was a little curious to see what other clinics were doing. UPR means that I spend some of my time each week working on a contract basis for insurance companies, reviewing the work of other therapists, and making recommendations regarding the appropriateness of proposed future care.
Well, it’s been extremely revealing, and leads me to today’s post about treatment expectations.
Whose Expectations? What Expectations?
It’s a loaded question: What should you expect from therapy? What should your insurance company expect from therapy? What should your employer or coach expect from therapy?
Well, first of all, each party involved is entitled to straight answers regarding care. Things like “How long will therapy last?” or “Will I be back to normal when I’m done?” are the most basic, but I’d go even further and ask things like “What is this treatment and how does it relate specifically to my condition?”
I started this post today because I was asked to review a worker’s compensation case in the state of Massachusetts. For treatment of injured workers in Texas, we use a document called “Official Disability Guidelines” (ODG) as our starting point. It’s a laundry list of conditions that affect people, and based on the best research evidence published, ODG attempts to make recommendations regarding the number of therapy visits a patient with a particular problem will need. My uncle’s a transmission mechanic, and mechanics have a similar book to estimate the amount of labor needed to complete a given repair. Good mechanics will come in under the estimate, lesser mechanics will take longer than the estimate.
Well, the same holds true in therapy. The first request I received today was for an injured worker. He hurt his back in 2007, and has been in and out of therapy for episodic low back pain since. Basically he’s back in treatment when his pain is such that it prevents him from working.
In this case, his therapy began on 6/1/09 and continued for 22 visits. What was the result? Not much. His therapist says “he’s definitely in pain” but doesn’t have much of an idea about what to do. The solution? Request more therapy visits.
We Begin With an End in Mind
Sometimes physical therapy is the treatment of choice for a given condition. You’ll know because your therapist will tell you that. He or she will explain to you how therapy will address your problems, and what the final result should look like. Your therapist will tell you about when you should see improvement, and about when you should complete your therapy.
Other times you’ll know that therapy is the treatment of choice because you’ll see results before you even complete your first visit. This is common for patients with spinal problems, such as neck and back pain. Part of the therapy evaluation is determining what the best approach is for your problem, and part of that determination comes from utilizing a series of movements and/or tests, and then initiating treatment at that moment, based on your response.
We Will Not Lead You On
Personally (professionally) I have a “two week rule” that means that you should experience significant improvement in two weeks, or physical therapy is not the treatment for your condition. That applies for long term (chronic) problems as well as to more acute problems. In fact, in most cases, I’d shorten it to a “7-10 day” rule or less, depending on how often I see the patient.
So what’s my point? If you’re experiencing a problem, seeing a therapist, not getting answers that you’re happy with and are still seeing that therapist weeks later, you need to make a change.
At Terry Rehabilitation, each patient is expertly evaluated, each treatment plan is customized for that patient, and all treatment occurs with a highly trained professional.
Our rehabilitation programs include:
- Hands-on manual therapy techniques – to quickly correct loss of motion
- Supervised therapeutic exercises targeted to specific deficiencies
- Modalities such as cold packs, heat, and electrical stimulation to reduce pain, inflammation, and to increase flexibility
- Targeted home exercise programs that do not require special equipment
- Restoration of functional strength and stability for daily activities
- Work-specific or sport-specific rehabilitation
Contact us to schedule an initial evaluation. If physical therapy is recommended, we will contact your physician in writing regarding the recommended plan of care, allowing him or her to make the most informed decision possible for the care.