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May 2017 Newsletter


Hello,

In this month's newsletter, I'm going to talk about treatment outcomes.

Why?

It's how we judge the success of the treatment process.

Also, when we discuss outcomes, many of my patients will have different expectations to me. Sometimes, they are lower (which I always find surprising), and sometimes they are unrealistic (which doesn't surprise me as much).
 

"Er, I just want to feel better!" - almost every patient I've ever seen

Whenever I ask someone why they have come to see me, most people look a little surprised. As in, isn't it obvious? I'm in pain and I want to feel better.

It's a fair point.

But, as with most things, there is a lot more to a treatment outcome than simply feeling better.

Not sure what I mean? Read on.
For a sprinter, outcomes are clearly defined.

Are you actually better, or do you just feel that way?

When I started practising, I would always ask people how they felt, almost as the first question on follow up.

Over the years, I've started to realise that how people feel is subject to all the beautiful cognitive biases that come with having a human brain.

So now I focus on what they did or didn't do.

Because, usually, what we do reflects how we feel anyway.

If we feel normal, we do our normal things, in our normal way. If we don't, we do things differently, or not at all.

Now, this isn't implying that how you feel is unimportant, only that even when healthy and not in pain or injured, we have good and bad days. We often get caught up focusing on the minutiae and lose sight of the big picture.

Feeling better can be a short term change, caused my many variables. Actually getting better usually involves feeling better, but also improving in functional and cognitive measures.
 

Acute Versus Chronic Outcomes

Outcomes vary depending on the nature of your condition.

For acute issues, the biggest effect comes from time. In many cases, with no treatment, or with treatment, you get better over time.

Does this mean treatment is completely useless? No. Treatment can help modulate symptoms, maintain function and take preventative actions to minimise the risk of recurrence. 

For chronic conditions, often a complete elimination of pain is not a realistic goal. Pain reduction and enhancing quality of life become a bigger focus.

One common theme I see is that most people in pain over react in the short term (they seek treatment and change their behaviours) and under react in the long term (they don't change what got them into the situation in the first place).
 

"Anyone can fix someone for a minute"

A personal trainer said this to me when we were discussing one of those before and after pictures on Instagram that shows a pre-intervention movement, followed by a post-intervention movement with supposedly increased range of motion, indicating effectiveness.

Again, is this really a marker of a good outcome? So many interventions can reduce pain in the short term. This can result in better movement, more range of motion etc.

However, long term, what changes?
 

So What Is a Good Outcome?

A good outcome, to me is:
  • One that meets the expectations of the patient (as long as they are realistic)
  • Manages to reduce symptoms
  • Creates a functional change
  • Creates a cognitive change
The last two points are often overlooked in favour of short term symptom relief, but this is a big mistake. Not because I think it is, because the research around pain outcomes shows that cognitive and functional change are important to making a full and lasting recovery, lest you end up on the treatment merry-go-round.
 

Latest From The Blog (And Social Media)

I didn't have the chance to write any new blogs in April. That's the first time in over a year I've missed a month. Oh well. I still wrote some great (in my opinion) content for Facebook and Twitter and posted regularly to Instagram as well.

Here are a few from Facebook:

A good clinician should...

FREE Initial Consultation!?

Mini-Blog: Performance or Health?

What is your pain story?
 

Updates From The Clinic

Last weekend I ran another workshop teaching health professionals how to use kettlebells for rehab. One of the key points we teach, is that there is more to designing a program than exercise selection and load. You can modify the position of a single exercise in many ways to create a different stimulus. Everyone spoke positively of the content and delivery, so I was pretty happy with my work.

Now that is over, I will be focusing on implementing a few new things in the clinic, to hopefully deliver even better outcomes for all my patients.

At the end of the day, that's my best marketing. Well that and referrals, so if you've had a good experience with me, make sure you spread the word.

Have a great month :)

--

Until next time, stay healthy.

Nick
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Integrative Osteopathy · 191 St Georges Rd · Fitzroy North, VIC 3068 · Australia

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