Assessment - how often should I see this patient?

Question 1

What is the natural history of adhesive capsulitis?

Answer 1

Takes 12-48 months, self limiting

3 phases

Question 2

What’s the natural history of LBP? Neck pain?

Answer 2

LBP - rapidly better in first 3 months; small % develop chronic pain; high rate of recurrence

Neck pain - 1/3 resolve completely, 1/3 improve without resolution of sx’s; 1/3 have no change in sx’s

Question 3

Whats the natural history of RTC pathology?

Answer 3

1. Asymptomatic tears - 50% remained asymptomatic 3 years later

For full thickness RTC tears (<60 yoa pts):

• 49% increased in size 2-3 years later
• 43% didnt change
• 8% decreased in size

Question 4

Describe the findings in the article on IT workers in the Scad J Work Env Health with regards to:

• progression if you have clinical findings of shoulder pain
• if you are healthy without shoulder pain

Answer 4

Looked at IT workers with shoulder pain (n=436) and asked them about shoulder pain/burning in the past 12 months; pain present in the last 7 days; shoulder test on PE - then separated them based on symptoms, findings

• found that if you HAVE symptoms and findings of shoulder pain - then 40% of people recover fully a year later; 33% see no change a year later
• in healthy people - the incidence of shoulder pain is 2%

Question 5

What’s the natural history of ACL injury?

Answer 5

• almost always leads to OA
• in females - 12 years post injury:
• 82% had radiographic changes
• 51% had radiographic OA
• 75% reported that injury affected their knee QoL

Question 6

Describe the different types of patients and the graph that you can draw to represent this relating time and pain/function

Answer 6

1. The predictable patient
2. The unfortunate patient
3. The lucky physio
4. The unlucky physio
5. The patient who believes he’s getting worse

Question 7

What are the factors that influence physio treatment frequency/discharge?

Answer 7

Time, $, location

Natural history, potential to improve, age, occupation, goals, physical activity level, support system

Question 8

What is the average number of visits a physio sees someone?

Answer 8

7 visits over 27 days or 2-3x for 6-8 weeks

64% of pt’s experienced improved in disability >MCID (2)