Measurements Equals Value for Medicare

Medicare wants measurable data for a compliant physical therapy chart?

Fine.

Here's a new way to measure the strength of the external rotator of the shoulder using the common goniometer.

This measure is easy, quick and reliable (reliability data not published).

It works better than Manual Muscle Testing.

I use this measurement every day in my clinic to document the treat ment of Medicare shoulder impingement patients.

The measurements lend themselves to long term goal setting for the physical therapy chart.

I measure shoulder dysfunction in patients that some physicians don't recognize.

The measurements are accurate enough to gauge the progress of the patient.

This technique will segue to a home exercise program in a heartbeat.

I can diagnose shoulder joint stiffness.

I can diagnose shoulder muscle (ER) weakness.

You can, too.

See more simple measurement techniques at www.simplescore.com

Sign up for the free course - 'Bulletproof Physical Therapy Charts and Notes'.

Regional Interdependence and Finding Normal

Regional interdependence is a concept familiar to physical therapists treating orthopedic conditions.

Regional interdependence is the following:

1. finding hip involvement in patients with primary knee pain


2. finding hip involvement in patients with primary low back pain


3. finding thoracic involvement in patients with primary neck pain


4. finding thoracic involvement in patients with primary shoulder pain
   
   (Wainner RS, Whitman JS, Cleland JA, Flynn, TW. Regional Interdepedence: A Musculoskeletal Examination Model Whose Time Has Come. JOSPT. Nov. 2007;37(11):658-660.)
   

With experience and training a physical therapist will often recognize patterns of movement that suggest regional interdependence. Wainner's article provides peer-reviewed evidence to support the concept.

While regional interdependence may come easily to orthopedic physical therapists, finding normal may not come easily.

For example, how many physical therapists can say to a patient these words...

"I've completely examined you and I can find no evidence of musculoskeletal invovelement. You are completely normal!"

Finding normal is important to regional interdependence because of the large number of potential musculoskeletal contributors to the primary complaint. For example, impairments in strength and range-of-motion at the hip and the ankle may contribute to primary knee pain.

Thomas Goetz writes in Wired Magazine about 'Finding Normal'.

He states the following...

"...we look not for causes of illness but for risks...But for all sorts of conditions , there's often no definition of normal."

Right now, the orthopedic physical therapy community is fascinated with trying to classify every patient into treatable sub-groups.

What happened to measuring patient characteristics and treating the findings?

I may be old-fashioned but I believe that the more you look for the more you find.

What gets measured gets treated.

Regional interdependence is a powerful concept that needs standards to guide physical therapists in making treatment decisions.

One technique that I'll offer up for public consumption and comment is this measurement that I use to assess hip external rotation.

I find that impairments in this motion (using this technique) often demonstrate hypermobile lumbar rotation.

Hip External Rotation measurement

Using data published on my website, I've found that this measurement correlates with functional limitations using the OPTIMAL scale. The correlation coefficient is 0.40.

I will often use this technique to stabilize a weak hip with primary knee osteoarthritis.

Patients with lumbar pain also respond well to strengthening the hip external rotators.

What's especially helpful though, when treating these conditions, I can test the hip external rotator muscles and, if the finding is normal, I can say to the patient the following:

"You are completely normal"

How to Diagnose Rotator Cuff Weakness

View the video to assess rotator cuff weakness. Note that your findings must correlate with the patient-stated functional limitation (eg: cannot raise the involved arm over the head).

The patient may also identify a disability, namely the inability to engage in work or play as a result of the functional limitation.

Please forgive the math error at the end of the video - I was a little nervous.

Tim