Ron,
You say "I don't take ROM or muscle strength measures." In my
setting (chronic pain management/functional restoration), I can't get
away with not doing that. I do a complete Physical Performance Test,
including ROM and static and dynamic strength testing, before,
during, and after the program... because the insurance companies I
deal with demand them.
Just this week a patient was denied an extension of services because
their increases in ROM and strength, and their decrease in pain
levels, were minimal... despite the fact that this patient had
significantly improved in function. The peer review dr was totally
disinterested in function, despite that returning patients to work
was one of the insurance companies main goals. The dr said he
wouldn't approve more days because they didn't benefit from the days
they already had, despite all my concrete examples of how they HAD
improved. All they cared about were the numbers.
The ODG guidelines require baseline measurements (I don't know if
that is just a Texas thing, or not), yet they deny coverage for
intake testing (to GET the baseline measurements) as being medically
unnecessary! They force us to do the initial eval for free, and then
base the number of days they get in the program strictly on the
numbers, and if and how they change. (Scores on the BAI and BDI and
pain scales are numbers we also use). Fortunately, they do pay for
the subsequent PPTs.
Despite the fact that they only "cover" specific body parts, it is a
"full body" program, both physically and psychologically... but we
can only document the covered parts.
I am certain that what I do at work would be not be considered to be
"true" OT, and certainly not "best practice" as you define it. All I
can do is MY best to help my patients regain as much function, in the
form of occupation, as possible.
I think "best practice" is meaningful only to us, as OTs. If we do
our best we darn sure aren't going to get paid for it!
Pat
At 04:23 AM 10/10/2008, you wrote:
Then adaptation and education might be indicated.
Joan, in using the approach I outlined, there isn't a difference
between treating people with cog deficits and phy deficits. In fact,
that's the beauty of the approach; The focus is occupational
performance, not underlying issues. And because the focus is on the
universal phenomena of occupation performance, it applies to all
people having occupation deficits.
Of course, that does not mean we don't treat those underlying issues,
it simply means that issues aren't our measure. For example, I don't
take ROM or muscle strength measures. To be sure, I range limbs and do
manual muscle testing, but I almost never record measurements. Why?
Because improving these measurements is not my goal. However, I may
assess range and strength because these may be barriers to occupation.
In practice, however, I usually have patients attempt desired
occupational goals or preliminary steps to those goals. My observation
of the patient's occupational performance gives me a much better
picture of occupation barriers than simple strength/rom measurements.
In summary, using the outline I provided, really serves to unify OT
across its diverse treatment spectrum. Peds, adults, gero, neuro, etc.
can all use a similar approach. As I was typing this another example
of this model popped into my head.
I just started treating a man with what is essentially fatigue. He's
had lots of medical issues and was hospitalized for a long time. He
just came home and I picked him up on home health. During my eval, the
patient presented with Parkinson's like symptoms; slow speech,
tremors, flat affect, etc., however, there was no neuro diagnosis. I
wanted a better idea of his cognitive status, so I whipped out my
trusty MMSE. Surprisingly, he scored 27/30, which is normal. So, why
did I do the MMSE?
Simply put, I wanted to see if cognition was a possible barrier to his
occupational performance. In this case it wasn't. But if it were, I
would have probably use his goals as treatment. Again, the goal, and
hence the measurement, is not remediating the underlying issue but
improving occupation.
So, an occupation-based approach applies to OT working in phys-dys,
cognition, pediatrics, neuro, etc. But unlike other approaches, an OT
using an occupation-based approach has one single purpose and reason
for being, and that is improving occupational performance.
Thanks,
Ron
--
Ron Carson MHS, OT
----- Original Message -----
From: Joan Riches <[EMAIL PROTECTED]>
Sent: Friday, October 10, 2008
To: [email protected] <[email protected]>
Subj: [OTlist] Best Practice and OT expertise
JR> .........and if cognition cannot be remediated?
JR> Joan
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