Last month I told you of a patient who came to me after about a month of therapy elsewhere. If you recall, she wanted to get better, faster. She wanted to get back to work. She also told me she wanted her broken wrist to look and move exactly like her unbroken wrist. That was what she wanted. But did she need it? Would having 100% of the motion get her back to her life? How about 80%, or 75%, or even 50%?
Now, I used to work for a doctor who told patients when they asked if their moderate to severe injury would be the same as their uninjured arm. He always came back with a story: “You buy a new car and drive it off the lot. You accidentally drive it off a bridge. They tow it back to the dealership and fix it. It looks great. But…is it a new car anymore?”
Most people say no. I explain it as once we mess up what God put together, it can’t go back to perfect. Now, what did that mean to this patient? Was she upset? No. I explained to her that 1 st visit, that she may not get 100% of the range of the motion, but that she will get 100% of the function. I would get her back to work and she will be able to do all the tasks of daily living.
I was involved with an outcome study while I worked at the University of Wisconsin Hospital and Clinics hand therapy clinic. What we found, was that once a client achieved about 50% of their motion, they could do all of their activities of daily living. There were some exceptions who had specific work tasks or hobbies. But the majority could do everything with only 50% of normal range of motion (ROM). At UW, we saw some injuries that we were ecstatic to get 50% motion. Once someone achieved 50% ROM, we began focusing more on strength. Patients normally continue to improve their ROM while strengthening. In fact, improvements can be made up to a year after an injury by performing normal activities.
I still follow this philosophy. With insurance co-pays increasing as well as insurance companies decreasing the number of visits allowed, speed is of the essence. People need to understand what they are doing and why. I find that if I explain what and why they are doing something, they are more likely to follow my recommendations. They need to understand what is expected, both of them and what the outcome will be. I know I don’t do everything that I am told to do, unless I understand why I am doing it. Explanations help a patient understand that needs are more important than wants. Sometimes that want is the same as the need. Sometimes they aren’t. Our job as therapists are to differentiate need verses wants and get the patient to understand the difference.
I am happy to report that the patient in this series is back a work without restrictions. She is performing all activities that she wants to. She got back about 75% of her normal ROM. She knew she wasn’t getting what she really needed so she made the effort to find someone who would. Remember that if you are not getting what you need in therapy, you don’t have to stay there. Call around. See who else is out there. Who else takes your insurance? What is their experience? Get what you NEED, and it may get you what you want.