Impact in MSK Physiotherapy – Part 2: Meso
In this second of the series on MSK Physiotherapy Impact from a micro, meso and macro level, this Clinical Insight looks at the impact on function (meso) MSK practice could have.
Functional outcomes are used widely in research and audit and offer an insight into the potential benefit of intervention (Monk 2006). Many research protocols utilise them when looking at singular modal interventions to attach a functional relevance to the outcomes, or as part of a multi-modal approach that might mimic a more pragmatic approach (Johnston and Shaw 2013).
However, as practitioners in MSK what is the connection between treatment interventions and functional outcomes in the clinical setting?
The question lies firstly in whether there is an assumption, belief or fact that MSK physiotherapy treatments directly impact function, secondly that the treatments are the most appropriate method to improve function, and thirdly that the functional measures do in fact correlate with impactful outcomes for the patient in their own opinion?
For this short commentary, let’s consider whether the treatments provided are the most appropriate method to improve function.
If we consider exercise, by offering stretch, strength and mobility programmes, the practitioner hopes perhaps to gain a carry over from the exercise into task. This is difficult to be sure of and unless the clinician views the actual task in the context of how it is performed, it might be difficult to link.
When it comes to work-based tasks that societally are vital, a physiotherapist working in a clinic setting may struggle to offer task-orientated rehab that really fits the needs of the patient.
Secondly, not every task needs to be “fixed”; it could be modified, and this is a particular skill in say occupational health, vocational rehab or occupational therapy.
How many MSK physiotherapists gain the skills of these professions to enhance function and yet state they focus on function in the rehab that they provide?
Therefore, when looking outside the tissue-based approaches to helping patients move forward, there is potential for a more pragmatic approach to problem-solving through the lens of improving the outcomes of tasks.
This involves the modification not of their movement but of the workplace and occupational set up. This might seem distinct from being taught how to strengthen something, but could see a different outcome when measuring through the lens of function.
References
Johnston, V. and Shaw, W.S., 2013. Helping workers help themselves: empowering physiotherapy clients to manage musculoskeletal problems at work. Physical Therapy Reviews, 18(5), pp.373-378.
Monk, C., 2006. Measurement of the functional improvement in patients receiving physiotherapy for musculoskeletal conditions. New Zealand Journal of Physiotherapy, 34(2).
