Functional Outcomes
"Until you see
that your experiences are consequences of your choices, you will think
they are just or unjust, good or bad."
Gary Zukav |
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Functional outcomes is a method of working with a client that the insurance
companies are requiring to prove medical necessity and allow massage therapists
to get paid. They are more interested in what is going on in the clients
functional life, rather than what we are doing in a session. It is the
only thing they can measure. They only want to know if the
client can resume normal activity, not whether or not the client is completely
recovered from their injury -which by my definition is the tissue healed to a
pre-injury status.
It involves setting goals with the client to get the client back
to normal functioning assuming that they have limited function. A
functional goal starts with a long term goal such as " resume running 200m
sprints within 6 weeks". It is further broken down to a short term
goal such as " lightly striding 60m sprints within 2 weeks".
Functional Goals, according to Diana Thompson, author of
"Hands Heal", should be charted
in the assessment section of SOAP.
My issues with functional outcomes:
What happens to the people who come in with a stiff neck, but
are still climbing Mt. Rainier on the weekend or riding their bike 120 miles?
They are totally functioning in everyway, but are tired of waking up every
morning feeling stiff.
What about the people who are injured and have loss of ROM, have pain but no
loss of function?
The definition of healing has become one of can the client go
back to work or resume normal activity, not is the tissue actually healed to a
pre-injury/condition state. Insurance companies don't want to be
responsible for total recovery as they think that it may not be possible and
will also increase what they have to pay out in settlements and services.
To be able to make a long or short term functional goal assumes
that the massage therapist has training in determining (diagnosing or
assessing?) injuries and knowing when they are healed enough to resume physical
activity. Physical therapists are highly trained in this and there are
specific textbooks that I assume go with college level Physical therapy class in
physical therapy. Just do a search at www.amazon.com
for functional outcomes.
Functional Outcomes Document for Physical
Therapists
by Lori Quinn, James Gordon, Richard B. Goldbloom
ISBN: 0721689477
Lower Extremity Amputation: A Guide to Functional Outcomes in Physical Therapy
Management
by Linda Karacoloff, Frederick Schneider (Editor), Carol
Stube Hammersley
ISBN: 0834202913
Functional Assessment and Outcome Measures for
the Rehabilitation Health Professional
by Sharon S. Dittmar (Editor), Glen E. Gresham (Editor)
ISBN: 0834209292
Can a Massage therapist learn how to set up functional outcomes
in a 5 hour workshop?
Are we qualified as massage therapists to determine the severity
of the injury and determine when the client should get back to their normal
activity? What is involved in setting up functional goals? We need
to be able to determine if the muscle/joint is capable of sustaining the
movement without further injury or setback. To me this involves having a
diagnosis - how much has the tear healed? To me setting a functional goal is
outside my scope of practice. I would not want to tell someone to go out
and lift their toddler with their rotator cuff tear, just because the pain is
somewhat reduced. What if it isn't totally recovered and able to handle
normal functioning? From what I know, this is in the realm of physical
therapy.
The definition of massage in WA state is:
"Massage" and "massage
therapy" mean a health care service involving the external manipulation or
pressure of soft tissue for therapeutic purposes. Massage therapy includes
techniques such as tapping, compressions, friction, Swedish gymnastics or
movements, gliding, kneading, shaking, and fascial or connective tissue
stretching, with or without the aids of superficial heat, cold, water,
lubricants, or salts. Massage therapy does not include diagnosis or attempts to
adjust or manipulate any articulations of the body or spine or mobilization of
these articulations by the use of a thrusting force, nor does it include genital
manipulation.
The scope of practice for Physical therapy in WA state seems more applicable.
"Physical therapy" means the treatment of any bodily or mental
condition of any person by the use of the physical, chemical, and other
properties of heat, cold, air, light, water, electricity, sound, massage, and
therapeutic exercise, which includes posture and rehabilitation procedures; the
performance of tests and measurements of neuromuscular function as an aid to the
diagnosis or treatment of any human condition; performance of treatments on the
basis of test findings after consultation with and periodic review by an
authorized health care practitioner except as provided in RCW18.74.012;
supervision of selective forms of treatment by trained supportive personnel; and
provision of consultative services for health, education, and community
agencies. The use of Roentgen rays and radium for diagnostic and therapeutic
purposes, the use of electricity for surgical purposes, including cauterization,
and the use of spinal manipulation or manipulative mobilization of the spine and
its immediate articulations, are not included under the term "physical
therapy" as used in this chapter.
So again, my question are:
What do we want to be telling insurance companies
and medical professionals about what we do?
What are we allowed to assess an injury?
What is the difference between a diagnosis and an assessment?
Discuss this issue on my
blog...
