There are many theories about what is happening when someone’s body malfunctions (mechanisms), many theories about how best to remedy the problem (treatment), and, to my chagrin, also many theories about what successful outcomes entail. I enjoy educated debate about the first two, but don’t fully understand why there is so much disagreement over the final piece, optimal outcomes. (Yes, financial gain is a contributing factor in the American medical system.) The interesting point is that if all clinicians align with regard to best outcomes, the first two should more easily fall into place. Optimal orthopedic patient outcomes entail:
1. Meeting the patient's goals. If they are not realistic, input from the clinician is appropriate.2. Fostering patient independence at every turn. Patients need to be educated in regard to every facet of their care and be given control over their recovery.
3. Efficiency regarding time, cost, and risk mitigation. (Experienced MDT clinicians average around 6 visits with patients.)
4. Ensuring full/maximal musculoskeletal system health (eg range of motion, nerve extensibility, strength, etc.).
5. Teaching prevention strategies. Patients must understand how to keep their problem from returning and how to self-monitor for recurrence to minimize reliance on the medical community.
If we get these things right - no easy task - then I don’t care if you got there because you believe the joint moved and therefore uninhibited a muscle or because you stretched a muscle and subsequently the joint improved (mechanism). I don’t care if you had the patient do 20 calf raises 6 times a day or 100 calf raises 2 times a day (treatment approach). But if one outcome takes longer, costs more, relies more heavily on clinician assistance, or doesn’t achieve full range of motion, then that is a suboptimal outcome - and a better approach is necessary. -- Laura
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