Achieving optimal patient outcomes

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Authors: Ron Feise and Jaroslaw Grod
Date: July-August 2013
Publisher: American Chiropractic Association Inc.
Document Type: Article
Length: 1,593 words
Lexile Measure: 1500L

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Patients in pain often diminish normal physical activities to avoid further pain, thereby becoming deconditioned. This "deconditioning cycle" contributes to a cycle of physical disuse and neuromusculoskeletal weaknesses, which has been recognized as a major factor in the perpetuation of chronic pain. (1-3) Once chronic pain is established, it can be difficult to improve. Rehabilitation of the neuromusculoskeletal system is a vital part of good clinical care with treatment aimed at the recovery of optimal function. Passive therapies should be offered for a limited time in the acute stages of care, and active rehabilitation should comprise the next phase.

Effective spinal rehabilitation is predicated on appropriate assessment. How can a DC know if a patient needs active care or if the spinal exercise program the patient has performed for the past 3 months was successful? Without a dependable measure, it is impossible to know if treatment is needed, a recommended intervention is effective, or when to stop care. (4)

Physical performance measures are appropriate to use with deconditioned patients. These assessments provide information about distinct domains of interest that are not detected by physical examination or self-report measures. (5-8) They also help predict patient outcomes. (5-8)

Practitioners must select physical performance measures that have good measurement qualities because erratic physical performance data can lead to poor clinical decisions. Even some of the most widely used tests lack these qualities. For example, although cervical strength is a popular test, researchers have found that it has inconsistent reliability and validity. (9-11) Another popular measure, the functional movement screen, has demonstrated reliability, but it has failed to demonstrate predictive or discriminate validity and it lacks responsiveness. Practitioners should avoid these measures because they fail to provide accurate assessments of patient status.

There are two key issues to be aware of in selecting physical performance measures:

* The measure should come from good research.

* The reported statistics should meet and/or exceed reasonable standards.

Good physical performance measures come from quality research studies designed and implemented with reasonable scientific rigor. Determining the quality of a study is seldom easy because health care literature suffers from inconsistent quality, which complicates assessment and distorts conclusions. It is erroneous to assume that professional journals publish only "sound studies" that are properly designed and implemented. In an analysis of 53 published studies, Sonis et al. found the mean quality of articles to be 35%, and Rubinstein et al....

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Gale Document Number: GALE|A353753381