Goal Setting for Patients

Goal Setting can be awkward…”What do you mean what do I hope to get out of coming here today?”

I am trying to have a more Patient-Centered Approach to Athletic Training Services, but I have not found a good way for me to ask the questions that the students understand.

As a licensed AT and practicing PT Daria Oller knows the value of goal setting. She joins Ray Olivo and John Ciecko to try and make me less awkward…Good Luck.

What is “patient goal setting in rehab”?

Looking at objective measures

  • ROM
  • Strength parameters 
  • Rep or weight count
  • Pain is an important measure – you can include subjective measures
  • Do not say “the patient will be better”
  • Use the SMART concept
    • Specific; Measurable; Attainable; Realistic; Time-Bound 

Working on them together

Recognizing them as a total person

Continually listening

How is it affecting the quality of life?

What is not “patient goal setting in rehab”?

If you take the patient out of the equation you are showing your ego… “I want the patient back playing in two weeks..”

A big failure is removing the patient from the equation

Having coaches dictate when an athlete or parent can return to play.

Daria: LongCOVID – I want to get back to running, walking, dancing.  I am stubborn and would do them but then was just crashed out.

How I have asked:

“What is your goal for today?”

“What are you hoping to get out of coming in today”

“What are you wanting to hear after the evaluation?”

Thoughts on asking these goal-setting questions?

With kids, it may just be awkward because they are answering them for themselves the first time

  • There are therapy goals and then daily goals
  • They should still tie into what the overall goals are

John: Relationship building

  • A majority of people will not know what their goals for the day are.
  • What is the real question?
    • Realistically you are talking about the history
    • “How are you doing today?”
    • “What have you learned today?”
  • You use those things as clinicians to help them define their goals.

Remember the history and relationship with the kid and consider that as you are asking the “goal” question.

  • We do not use a lot of objective goals because we do not have to report it, but they can be useful in motivating.

“How can I help you today?”

Ray Olivo – on helping patients set goals for their healthcare

Continue to ask questions to figure out who they are as a person rather than an injury

“How can we work together to get you to your goal?

Daria – the psychosocial is such a huge piece as well.

Some goal-setting is defined by statements such as: “I want to get on the floor with my kids/ grandkids and play but the pain is preventing it.”

Trying to document for insurance forces Daria to put all of the pieces together.

  • Are there stairs in your apartment
  • It sounds like you are saying this, this, and this.  How can we work together to get better?

Example of “Goals” for athletes

Ankle sprain

  1. Walk pain-free
  2. Jog pain-free
  3. Run pain-free
  4. Practice pain-free
  5. Return to play

Instead of “Here is what you are going to do today.” 

Maybe try:

“Here is what I feel like we need to work on how do think we can accomplish that?

John – I like to look at it as a department view

“What are our professional goals”

  • We write them out and put them on the wall and it leads everything we did

You still need to have a goal as an AT to guide the patient’s recovery.

Celebrate small goals

In the secondary setting where we potentially see them every day, what should this look like?

John – The target – “what is your bullseye?”
Work backward from the outer rings to see how they get to the bullseye.
We keep soap notes and rehab sheets out for all of our athletes. Rehab charts are on the back of the soap notes.

WRITE THINGS DOWN

Daria – know the target and work out from there
8 weeks walking pain-free
So what steps can we use to get you there at 2 weeks, 4 weeks, and 6 weeks?

Ray– having them see their goal is important
Let’s take a picture of your ankle daily and compare it
Or lets video you walking and running
Each athlete is by appointment currently and they have an agenda for the day.
Ask them what their plan is

Other tips for implementing the patient goal setting in rehab?

Daria: Long-standing pain – the goal is not being pain-free, but finding distractions to keep his mind off his pain.

Certain hobbies and activities and helping him build those into their life and improving the ability to perform those tasks.

Ray: There are many ways to do goal setting.

IT’S ALL ABOUT THE PATIENT

John: Practice what we preach.

How are your goals going to help your patient population?

If you are good at setting your own goals it will show in your practice

https://www.facebook.com/980579115403772/videos/411065410067494

Got tips for us?

Daria Oller – @OnTapPhysio

Ray Olivo

John Ciecko

Jeremy Jackson

Goal Setting Resources

Setting Quality Goals – use the promo code “1FreeCourse” to earn some 2 CEUs related to the discussion.

Financial Supporters

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

Donate and get some swag (like patreon but for the school)

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Marc Pro – Use “THESMB” to recover better.

PhysicalTherapy.com; 1freecourse; continued; Physical therapy

Energy Drink Education – 650

Energy Drink Education; Brett Singer; Shawn Ready; Ray Olivo
https://www.facebook.com/sportsmedicinebroadcast/videos/2460115144109830/

Contact us:

Jeremy Jackson

Shawn Readyshawnreadyatc@gmail.com

Ray Olivorayolivo1@gmail.com

Dr. Mark Knoblauchmaknobla@Central.UH.EDU

Dr. Layci Harrisonlharris5@Central.UH.EDU

Bob MarleyBob.Marley@uth.tmc.edu

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

Donate and get some swag (like patreon but for the school)

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Marc Pro – Use “THESMB” to recover better.

Athletic Shoulder – Stephen Simonich – 619

What does the Athletic Sholder look like in 2019?

Dr. Stephen Simonich, MD joins us today to talk about the athletic shoulder from the Memorial Hermann Sports Medicine Update.

Dealing with Challenging Parents

Ever wondered how to explain the rotator cuff as a secondary stabilizer in the GH joint to either your athlete or their family?  Dr. Simonich has the perfect analogy.

He tells his patients that it is like if I were to take a big exercise ball in my right arm and pull it into my chest.  My chest would be the socket, the exercise ball my humeral head, my arm would be the rotator cuff and my hand the tendons of the cuff.  That demonstration can help show how difficult it is for the rotator cuff to stabilize the joint.

What are the two types of shoulder dislocations, where do you see them and how should we treat them?

TUBS (Traumatic Unilateral Bankart Surgical) and AMBRI (atraumatic multidirectional bilateral rehab rarely inferior capsular shift) are the two types of dislocations.

You will see TUBS is most often in contact or collision sports like football or rugby.  AMBRI is seen often in swimmers especially at the end of a long season.  

Post a TUBS dislocation and relocation Dr. Simonich likes to use the apprehension test as an indicator of further treatment.  He also uses athlete age (young athletes have a high rate of recurrence) individual goals, sport played and level of participation as indicators for surgery.  Surgery reduces the high rate of recurrence in young athletes.

What are the types of AC joint separation and how do you treat them?

AC joint separations are relatively easy to see and cause biplanar instability.  There are 5 types with Type I and II requiring conservative treatment, Type III going either way but trending non-operatively and Type IV V VI requiring reconstruction with a joint tie-down.

Clavicle fracture treatments have changed throughout the years due to research.  What does the current research say?

Prior to 06’-07’ most clavicle fractures were treated non operatively.  Research was introduced in two studies in those years that saw a better union rate with fixation in the clavicle post-fracture and surgeons began to surgically treat and fixate. 

In 2017 a new study showed that while the rate of union is still higher in clavicle fractures with fixation, fixation doesn’t improve shoulder function nor does it decrease limitations in the shoulder.  Dr. Simonich will put a plate to fixate the clavicle on an athlete with shortening, displacement, or comminution because they get faster healing rates, are more predictable and can get them back to their sports.

Watch the Athletic Shoulder 2019 presentation on Facebook

https://www.facebook.com/sportsmedicinebroadcast/videos/2274909885935150/

Contact Us

Stephen Simonich(713) 486-9800

Jeremy Jackson

Shawn Readyshawnreadyatc@gmail.com

Ray Olivorayolivo1@gmail.com

Dr. Mark Knoblauchmaknobla@Central.UH.EDU

Dr. Layci Harrisonlharris5@Central.UH.EDU

Bob MarleyBob.Marley@uth.tmc.edu

Sponsors

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

Donate and get some swag (like patreon but for the school)

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Marc Pro – Use “THESMB” to recover better.

PhysicalTherapy.com; 1freecourse; continued; Physical therapy; Athletic SHoulder

Previous episodes discussing the Athletic Shoulder:

The Athletic Shoulder: What You Need To Know – 394

Shoulder Rehab Tips – 494

Shoulder Anatomy – 489

Stop Using Ice – Gary Reinl – 576

Stop Using Ice!!!

Stop Using Ice; Gary Reinl; Ray Olivo; John Ciecko

Buy a FrioHydration Unit that will hold ice for days and then STOP USING ICE and be done…

Actually, this is about using Ice as a treatment option for injuries.

In his book, Iced, The Illusionary Treatment Option, Gary Reinl covers almost everything we talk about here.

Stop Using Ice, Gary Reinl, Delayed healing, congestion of waste

Why should you Stop Using Ice?

There is very little research to support its efficacy

It actually slows the healing down by creating congestion at the damage site. Similar to a lane closure on a freeway due to an accident. when the cars back up the Emergency crew can not get there quickly and the 30-minute commute now takes 90 minutes.

There is no Google or Waze app for the human body. It really tries to repair rather than destroy itself. Let it run its course.

We confuse swelling and inflammation

Swelling can occur when a part of the body becomes inflamed. However, it is caused by the accumulation of fluid in tissues throughout the body, or in a specific region of the body

Inflammation is classified as a protective response from the immune system to injury, infection, or irritation.

Discussion on the SMB not in the book…

Practical application of the principal

  • How to talk to your coaches about it
  • How to talk with your athletes about it
  • How to discuss changing your physician's protocol

Slight exception to the rules:

  • If you have a dislocation and need to transport, ice will reduce swelling which will allow for a better relocation.
  • If you are using it once as an emotional trigger to help calm down the athlete

What About MarcPro

Using my code (TheSMB) helps to ensure your best discount as well as support the SMB

A medical-grade device that can run for hours to relieve the congestion of waste in and around the damaged tissue.

Try out the loaner program and see if it is worth your while – Email Gary@MarcPro.com and mention the Sports Medicine Broadcast and the Loaner Program

Contact us:

Gary Reinl – Email Gary Reinl

Jeremy Jackson

Shawn Readyshawnreadyatc@gmail.com

Ray Olivorayolivo1@gmail.com

Dr. Mark Knoblauchmaknobla@Central.UH.EDU

Dr. Layci Harrisonlharris5@Central.UH.EDU

Bob MarleyBob.Marley@uth.tmc.edu

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

Donate and get some swag (like patreon but for the school)

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Marc Pro – Use “THESMB” to recover better.