EBP and Therapeutic Interventions

• best evidence

• clinician expertise

• patient values

Components of Evidence-Based Practice

problem-based/disease-based healthcare

focuses on the disease/problem and treat based on the cause, pathology, development, and progression

• respect patients’ values, preferences, and needs

• coordinated & integrated

• provide information, communication, and education

• ensure physical comfort

• provide emotional support

• involve family and friends

components of patient centered care

• occupational

• physical

• emotional

• social

• intellectual

• spiritual

Six dimensions of health

• health condition

• activities

• body function/structures

• participation

• environmental factors

• personal factors

ICF model components

• health related quality of life (HRQL)

• functional status

• symptoms & symptom burden

• health behaviors

• patient experience

types of patient related outcomes (PROs)

• generic

• condition/region specific

• individualized

types of MSK PROs

• validity

• reliability

• responsiveness

• acceptability

psychometric properties to know a PRO is good

responsiveness

ability to measure small changes that are clinically important

minimal detectable change (MDC)

amount of change needed to say that it is not due to chance or the variability of the instrument

minimally clinically important difference (MCID)

amount of change that needs to occur to be clinically meaningful

MCID>MDC

relationship between MCD and MCID for meaningful clinical change

> 0.70

strong validity value

0.50-0.70

moderate validity value

< 0.5

weak validity value

> 0.80

excellent reliability score

0.60 - 0.79

good reliability score

< 0.60

poor reliability score

smaller

smaller or larger score preferred for SEM/MDC/MCID?

• can the energy produced by the modality affect the target tissue?

• does the modality produce the physiologic response to promote healing?

• does this improve patient outcomes?

• any contraindications?

questions to ask before using therapeutic modality

absolute contraindications

modality or protocol must not be used under any circumstances

relative contraindications

type of contraindication where treatment can be modified to accommodate the patients’ condition

precaution

identifies how the misuse of the modality may harm the patient

• patient

• intervention

• comparison

• outcome

PICO pneumonic for asking clinical questions

• obtain medical history

• identify activity limitation, restrictions, and impairments

• prioritize the problem

• set treatment goals

• review the evidence

• plan the interventions

• reexamine the patient and establish outcomes

problem solving approach

• relieve

• restore

• return

3 Rs of rehab

• modalities

activities within Phase 1 (inactive) of rehab

• modalities

• flexibility exercises (ROM)

• proprioception and neuromotor control exercises (balance + coordination)

activities within Phase 2 (active) of rehab

• flexibility exercises

• resistive exercises

• proprioception and neuromotor control exercises (agility, progressive plyos)

• functional and performance-specific exercises (easy functional)

activities within Phase 3 (resistive) of rehab

• flexibility (maintenance)

• resistive exercises (isokinetics, diagonal patterns, maintenance)

• proprioception and neuromotor control exercises (progressive plyometrics)

• functional and performance-specific exercises (activity-performance)

activities within Phase 4 (advanced) of rehab

• decrease signs and symptoms

• protect the injury

• maintain cardiovascular fitness

Rehab phase 1 (inactive) goals

phases of healing where rehab phase 1 occurs

homeostasis and inflammation

• pain and swelling minimal at rest

• healing rate of injury

criteria to progress from rehab phase 1 to rehab phase 2

phase 2 (active) of rehab goals

• eliminate signs and symptoms

• improve mobility

• initiate strengthening

• maintain cardiovascular fitness

modalities for pain, spasm, edema

phase 1 of rehab interventions

• phase out modalities use

• ROM and flexibility exercises

• joint mobilization

• isometric strengthening

interventions for phase 2 of rehab

early proliferation

phase of healing where phase 2 of rehab occurs

• no pain or swelling

• full ROM

• complete ADLs without limtiations

criteria to progress from phase 2-3 of rehab

• remain symptom free

• maintain full ROM

• improve strength, endurance, agility

• improve neuromuscular control

• maintain cardiovascular fitness

phase 3 (resistive) of rehab goals

• progressive strength training

• neuromuscular and proprioceptive exercises

• begin functional training

phase 3 (resistive) of rehab interventions

late proliferation to remodeling

phase of healing where phase 3 (resistive) of rehab occurs

• no pain with ADLs

• full ROM and strength

criteria to progress from stage 3-4 of rehab

• maintain symptom-free status

• maintain ROM

• maintain strength & endurance

• maintain cardiovascular fitness

• restore function and performance

phase 4 (advanced) of rehab goals

phase 4 (advanced) of rehab interventions

• functional exercises

• performance-specific exercises

• initiate return to play progression

late remodeling

phase of healing where phase 4 (advanced) of healing occurs

able to participate fully without limitations or pain

criteria to discharge from stage 4 of rehab