BraceLab Clinical Clues

May 2021 No. 21

Do You See Patients One Year Post Discharge?

Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

Asking a patient to return one year after discharge may seem strange but could prove to be a valuable learning experience. I started this approach early in my career and it has allowed me to better recognize how the body changes over time, and to understand that the result at discharge is not the final result.

The varying health care rules and regulations will determine the best way to incorporate such visits into your practice. Perhaps you will need to conduct a social visit like Judy Colditz, OTR/L, CHT, FAOTA described in our Clinical Pearl 24, where you can quickly learn how time contributes to tissue maturity and range of motion. Or you may be able to conduct an hour-long billable re-evaluation. Valuable insight can be gained when re-testing a patient’s functional strength at the one-year visit.

E.J., a 61-year-old female who is an avid gardener, injured her back when lifting a 10-pound bag of topsoil. At her initial therapy visit her back pain was 7/10, radiated into her right hip, and she was unable to lift 10 pounds from the floor to her waist without increasing symptoms. She responded well to six weeks of therapy. At discharge she could lift twice the load for ten times the duration as the same lifting task that caused her injury. She had achieved her functional goal of pain free lifting of 10-pound bags of compost.

E.J. returned for a one-year follow-up visit because soon the weather would allow her to start gardening again. She had not been very active during the winter and was worried about re-injury.

One year following discharge her 10-repetition maximal functional lift was 5 pounds but had been 20 pounds at discharge. She admitted she had not been doing her home exercises and yet a typical day in the garden would demand lifting 10 pounds from the ground to her waist multiple times. Her current strength levels put her at risk for re-injury.

E.J. decided to re-start her home exercises and return in four weeks to be retested at which time her retest improved to 12 pounds. This improved lift strength made us both more comfortable with her return to gardening.

Strength testing at E.J.’s one-year follow-up visit demonstrated how a patient can gain or lose functional strength which may not be easily detected by manual muscle testing. The results of retesting the patient’s strength motivated the patient to commit to performing the home exercises and to work toward prevention of a re-injury.

 

 

Download Clinical Clues No.21, Do You See Patients One Year Post Discharge?; May 2021

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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