Developing Protocols for Physical Therapy
Robert Taylor United States
This is a frequent request that I receive in person, mail, phone, and e-mail. I would like to address how one assesses the patient and develops a protocol that matches the need of the patient and client with the capabilities of the rehabilitation provider.
Step 1: Statistics
Develop a sense for your “statistics of repair.” If you operate on 10 cruciate patients, what is the outcome of these patients in your hands, not what has been published? Where are they at one week, six weeks, twelve weeks, and one year?
Step 2: Outcome goals
Based on the injury, diagnosis, and technique of repair establish outcome goals. For example, I want my TPLO patients to be ready for all activity and competition by 12 weeks post-op.
Step 3: Capabilities and resources
Look at your capabilities/resources. Who will provide the rehabilitation therapy? What resources can I commit? (Purchase U.S., E-stim, therapy pool?) How do I achieve patient/client compliance? How can we be paid?
Step 4: Patient assessment
Patient assessment. The post-operative status of patients undergoing the same procedure is always different. One needs to have a good working knowledge of the repair used and the temporal aspects of wound healing.
A. Extra capsular vs. BTB allograft
C. Limb circumference (muscle mass)
D. Scar assessment
G. Published recovery details for given procedure
H. Demeanor of patient
I. Willingness of owner to be part of the solution
Step 5: Patient/procedure specific protocol.
Patient: 7 year “hunting” female Labrador
Acute CCL tear < 2 weeks old
“Job dedicated” vet tech.
Post-op patient assessment—first week
Left rear leg (repair)
i. PROM Q.I.D.
Ice packs Q.I.D.
ii. 2-3 weeks
iii. Reassessment—Phase II P.T. 3–6 weeks
iv. Reassessment Phase II 6-12 weeks
T.E. –muscle specific
With this stepwise format, one can design and implement a treatment protocol designed specifically for your patient, your clinic and PT capabilities.
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