Monday Memo 11/25/2019

February 17th, 2020                                                              PITT DPT STUDENTS

Individualizing Treatment and Instilling Confidence 

A recent patient encounter at my clinical site has influenced my views on the roles we, licensed and aspiring physical therapists alike, play in the day-to-day lives of our patients. One afternoon, my rather apprehensive, timid and cautious patient came into the clinic for a follow-up visit. After working with her for a few visits, I was reminded that patients have various factors – social, environmental, psychological, and cultural – that PT’s must consider when initiating treatment. As we have learned countless times, all patients have their own personal dynamics that influence the physical therapist’s choice in therapeutic exercise, modalities and manual therapy.

After asking the patient how she was feeling that day, she quietly admitted that everything seemed to be going okay. As we spoke more throughout the session, she opened up to me about her apprehension regarding the safety of her bath transfers. As an extremely modest individual, I took her disclosing this information as a moment of vulnerability. Rather than keeping her struggle to herself, she decided to share her concern with me. Quickly, I compiled a few materials from the clinic to simulate the height of the bathtub that the patient needed to navigate at home. After a few trials to find the right height, the bath setup (a blue Airex foam and a hurdle) was complete. I started by asking the patient to transfer as she currently does, forewarning her that I was guarding closely behind, should she lose her balance. Once I was able to identify areas for improvement, I demonstrated the proper technique – visually and verbally – and the patient then replicated.

Not only was this patient better at performing the transfer, she was practically oozing with a sense of confidence and relief. Progress was made both physically and emotionally – the patient exhibited greater confidence than I have seen to date. I attribute the results we attained to her trust in me; my actions to quickly provide a solution proved, through practice, that we would address her concern. I was positive that together, we would perfect the transfer, and I could tell the patient was comforted by my confidence in her. Knowing that she was with someone that believed in her ability, allowed her to also believe in herself. Sometimes, our own confidence in a clinical situation translates to a patient feeling more competent and at ease.

While the set-up may have been make-shift and sub-par, and the situation “simple” for many, this experience left a lasting impression on how I plan to continue to individualize treatment. The current vision of the APTA is to, “transform society by optimizing movement to improve the human experience.” To do so, the APTA explains, “movement is a key to optimal living and quality of life for all people that extends beyond health to every person’s ability to participate in and contribute to society.” For right now, assisting someone to position themselves appropriately to enter and exit the bathtub may be what they need to participate in their normal life with more confidence and independence. Naturally, the patient was also receiving therapeutic strengthening exercises, flexibility and modalities. I recognized this situation as a classic demonstration of the importance of the specificity of treatment; hip strengthening makes your hips stronger, but hip strengthening doesn’t teach you to safely maneuver a bathtub. Sometimes, the practice of initiating a transfer or specific ADL is more important and beneficial for the patient at that moment.

From this, we should be reminded of individualized treatment: an idea that should be central to our care; an idea that can easily be overlooked and forgotten. Never underestimate the importance of something seemingly simple and its influence in promoting safety, wellbeing and confidence in a patient.

-Erica Vuocolo, SPT