May 26 2017

Recovery Timelines in Physical Therapy

General Recovery Timelines and Long-Term Outcomes in Physical Therapy

Every new physical therapist, armed with the latest research knowledge and standing on the shoulders of PT’s before them, has almost delusional expectations of achieving biblical therapy results for their patients when they begin their careers.  Unfortunately, after only a short time, we realize we are not having the kind of successes we expected.  So, what do we do?

Many therapists (myself included), have been drawn to gurus who preach of breathtaking results utilizing a brand new manual method or tool.  Armed with this new tool or method, our excitement returns and we eagerly treat our patients despite the limited research to support this new approach.  Again, after some time, we become discouraged as only marginal results are achieved.  From here, the path of the PT can go two directions:

  1. Convince oneself that they are inadequate with this new treatment method and take the advanced courses
  2. Become disenchanted with this new method and become callused

This process can repeat itself many times during our careers.  David Butler, a Physiotherapist from the NOI group, wrote a succinct article describing this rollercoaster of professional development and it’s definitely worth your time.

The Dinosaur PT

We have all have worked with the ‘dinosaur’ PT’s who utilize outdated modalities and treatment approaches.  We snicker about how out of touch they are as they talk about bone setting and pull out their bucket of leaches for treatment.  We are later shocked to learn that these ‘dinosaurs’ achieve the highest therapy outcome scores with raving fans as patients.  What the hell is going on?!?!

The answer, amongst other contextual factors, is Therapeutic Alliance (defined as the working rapport or positive social connection between the patient and the therapist).   The PT Inquest podcast episode #30 does a great job describing this phenomenon.  Fuentes, et al. has shown that therapists utilizing Therapeutic Alliance while providing sham treatments had similar therapy outcomes as therapists providing actual treatments who utilized poor patient communication.

Therapeutic AllianceThe 5 E’s

To maximize Therapeutic Alliance, the PT Inquest podcast crew have discussed what are called The 5 E’s to help therapists maximize their Therapeutic Alliance.  I recommend this article on the nonspecific treatment effects in pain medicine that discusses The 5 E’s and I believe it should be a required reading for all new grads.

Many of these E’s can be achieved with proper education of the patient.  And the best way to get buy-in from patients is to educate them on the expected timeline of their recovery.  As a new grad, I got tired of mouth breathing with a vacant look in my eyes whenever patients would ask me “how long before I get better?”.

So, I created a cheat sheet for my own use and provided the updated version below.

DISCLAIMER

Most of the data are on athletes as I feel it’s easier to use them as a reference when talking to the general population.  The provided charts are GUIDELINES ONLY.  Recovery is dependent on countless factors, so use your clinical judgement.  We did our best to reference systematic reviews/meta analyses when available.  Finally, most of the data were pulled from physician journals who compared surgery to ‘typical physical therapy’.  Whatever the hell that means.

We hope that by you utilizing these forms you will improve your Therapeutic Alliance and more importantly, become more confident with your current skill-set as you create your own raving fans in your community.

 

General Recovery Timelines and Long-Term Outcomes

Please click on the links below to download the pdfs:

Surgical Conditions

Non-Surgical Conditions

References

 

By: Chris Hart, PT, DPT, CSCS, USAW


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