Is it reasonable to use an individual patient's progress after treatment as a guide to ongoing clinical reasoning?
Systematic assessment of a patient's progress after an intervention is frequently used to inform decision making in ongoing conservative management of patients with musculoskeletal symptoms. Although reassessment of impairments immediately after treatment is commonplace in clinical practice, relatively little research has considered whether this method is reasonable. The history of, rationale behind, and evidence for the use of patient responses to inform clinical reasoning are explored in this commentary. Although the evidence is not conclusive, an argument is presented suggesting it is more reasonable to use a patient's response to treatment to inform ongoing clinical reasoning than to follow predetermined protocols. A methodical approach that considers change in parameters such as patient impairments is likely to be a useful guide for decision making during ongoing patient management but only when the change being reassessed can be directly linked to functional goals. Changes in active range of movement or centralization of pain appear to be better indicators of treatment effectiveness than changes in either pain intensity or assessment of joint position. There is limited evidence to support the use of changes in segmental stiffness to guide ongoing management. Although reassessment of some impairments has been found to be useful, the author suggests that care is required in the selection of reassessments used to guide ongoing management. The usefulness of any reassessment is considered to rely on how well a change in the selected impairment predicts that individual patient's ability to achieve their goals.
Tuttle
Neil
N
School of Physiotherapy and Exercise Science, Griffith University, Queensland, Australia. n.tuttle@griffith.edu.au
D002684:Chiropractic / Q000379:methods; D002983:Clinical Competence; D003657:Decision Making; D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D026761:Physical Therapy Specialty; D016059:Range of Motion, Articular; D016896:Treatment Outcome