DOCUMENTING TREATMENT PROGRESS
Both subjective and objective measures are important to track treatment results, progress and to more accurately forecast prognosis.
Subjective or self-reported information such as pain and fatigue are the most widely recorded treatment measures in day to day practice. When there is involvement of a third party payer, such as Comcare, TAC or within the Workers Compensation Act, objective outcome measures are important.
You may be requested to complete a report for a third party payer justifying your clinical treatment approach, results of treatment and to outline your treatment plan including the proposed number and frequency of treatments. Being able to support your clinical rationale with objective results such as those from outcome measures strengthens your case.
Outcome measures should be implemented as soon as possible when commencing treatment, at the initial appointment would be ideal. Often the largest gains from treatment can be captured during these early stages. Outcome measures should be used on a 4 – 6 weekly basis throughout treatment to effectively gauge progression.
There are a wide variety of outcome measures available, and selecting the most appropriate one depends on a number of factors including the type, nature and location of the injury, ease of use of the measure, the scoring method and its sensitivity and specificity. However, it is good to familiarise yourself with the basic outcome measures that can be applied to a variety of conditions. These may include Visual Analogue Scales and The Patient Specific Functional Scale.
Visual Analogue Scale (VAS)
A (VAS) requires a person to mark a place along a 10cm line between two extremes, such as extreme pain and no pain, to reflect their current position. You may wish to measure pain levels or the ability to perform an activity of daily living or the ability to sit for more than 30 minutes. The questions will of course be determined according to the client and their condition.
The score is the distance in millimetres from the left hand end to their mark.
The Patient-Specific Functional Scale
This measure is another great tool as it requires the Massage Therapist and client to determine at least 3 activities, and to assign each activity a score out of 10 where 0 means unable to perform the activity and 10 means able to perform activity at the same level as before. The total score = the sum of the activities / number of activities.
By discussing and defining specific goals, this not only creates motivation for the person to achieve them, however provides much greater insight into treatment progress.
For low back pain some commonly used outcome measures include The Oswestry Disability Index and The Quebec Back Pain Disability Scale which are easily downloaded online, straight forward to score and considered quite specific and sensitive.
The Neck Disability Index and Whiplash Disability Questionnaire are commonly used for cervical injuries and again are easily downloaded online and straight forward to score.
There are many region specific questionnaires you may opt to use including The Upper Extremity Functional Index, Shoulder Pain and Disability Index and the Lower Extremity Functional Scale.
Outcome measures provide the required feedback for third party payers and also allow you, as a Massage Therapist, to assess and appraise the success of your treatment. You may also like to consider using these measures for clients outside of these third party payer schemes.