Justifying the on-going physiotherapy management of long-term patients

Abstract

Clinical justification for long-term musculoskeletal patients receiving regular, on-going treatment is an important issue for the physiotherapy profession. In many cases there is no end point and there may be no rationale for continued physiotherapy treatment. The purpose of this paper is to present musculoskeletal physiotherapists and their patients with a flow-chart which may help to determine when on-going physiotherapy treatment is indicated in the management of long-term patients. The common belief that musculoskeletal physiotherapists will rehabilitate all patients to pain-free independence may have contributed to the development of the situation where some patients receive what could be described as excessive physiotherapy. An aim of any physiotherapy plan should be to help patients achieve an end point with an optimum level of function. Not all patients will achieve an end point of rehabilitation to pre-injury function or have no ongoing pain. Work by Waddell on low back pain describes the need for health professionals to focus on function, rather than pain in the management of long-term conditions (Waddell et al. 1992). However, a proportion of patients may require on-going physiotherapy treatment to maintain a functional level that is optimal but below their pre-injury status. Without this intervention, the patients’ functional condition will deteriorate. This type of treatment is referred to as maintenance physiotherapy (Flanagan & Green 2000). A clinical framework which focuses on function, rather than pain, and utilizing validated functional outcome measures to guide the objective management of long-term patients, is presented for consideration (Fig. 1). The flow-chart provides the treating musculoskeletal physiotherapist with a means to assess the efficacy of on-going physiotherapy management. It illustrates the distinction between rehabilitation and maintenance physiotherapy and describes a process to indicate an end point in physiotherapy management in long-term patient care.