After doing a quick search for the specific ACL treatment protocol for the Mayo Clinic (one of the surgery locations patients come from for therapy), I found that physical therapy is required for ACL injuries and patients can choose to use a brace and/or crutches for stability. Many of the ACL reconstruction patients who come in do wear a brace, which can be unlocked for certain therapeutic exercises.
Fortunately, those with the knee braces also use crutches to walk around and don't end up looking like this clumsy pup. Based on a frequently asked questions page from Columbia University Shoulder, Elbow and Sports Medicine Service, patients must wear the brace for 4 weeks following their surgery.
Many hospitals and surgeons have similar timelines for when patients can stop using their brace, participate in sports again, and even begin driving after their operation. Normally, the first post-op follow-up appointment occurs within the first two weeks, with following appointments being decided by the doctor (often every month). However, my on-site mentor informed me that many of the surgeons CAP works with do not provide set protocols when they refer their patients for physical therapy. Those who do (about 1/4 of the post-operative cases) might meet with the therapist regarding what is expected. Dr. Jeschien also told me he prefers when surgeons don't include the protocols as much of the rehab process is dependent on individual progress and ability rather than set weekly or monthly deadlines to be reached.
I found this especially interesting. There isn't a definitive 6 month or year time in which a patient's therapy will be done, but the recovery is based on the therapist (and surgeon) opinion of how well the recovery is progressing and what they are able to complete.
As I've started to understand more about the surgeon-therapist-patient interaction, I'm anxious to begin research on other factors that impact the specialization of rehab!
Another interesting resarch! I am sure that not all patients recover from their injuries, such as the ACL. What is the percent of recovery rate? And if they fail to regain their previous mobility, what kind of tools would help them with daily life, or would help be unnecessary? Looking forward for the next post and the dog gifs!
ReplyDeleteHi Tsugumi! I'm not totally sure, but I believe most patients do make at least a partial mobility recovery, however some do injure themselves again or further after they complete the first treatment.
DeleteHello Carla! Is there something special about the 1/4th of cases where protocols are set? Like do these cases generally involve older patient? Or patients with more serious injuries? Or is it all just somewhat random?
ReplyDeleteBased on what my on-site mentor said, it's mostly just if the surgeons are familiar or comfortable with the physical therapy site or not.
DeleteI'm sure you've mentioned this at some point, but is there a standard way of assessing patient progress (like a series of boxes to be checked) or is it a bit more fluid? I guess I want to know how, specifically, patient progress is assessed and how much the patient is kept in the loop about their progress throughout their treatment.
ReplyDeleteThe patients usually discuss their progress every appointment at the end with their therapist after they have gone through the exercises.
DeleteThis week sounded like an exciting week. Based on what you have observed so far, which interaction do you think is the most important on site for the patients? Is recovery progress significantly different based on age or is it just based on the amount of sessions and effort the patient puts in? Can't wait to see next weeks post.
ReplyDeleteI think the initial evaluation the patient has with a PT helps to determine the rest of the interactions following. For most of the older patients, they struggle with their regimens, but still complete them. Personally, I think it's based on patient's comfort with their exercise program and regularity of appointments.
DeleteThis week seems quite interesting! I noticed that you mentioned that the the effectiveness of recovery is based on the opinions of the surgeons and therapists, but I was wondering whether there are guidelines, either loose or closely followed, to determine the wellness of the patient. Since it's subjective, have there ever been cases where surgeons or therapists miscalculated and let a patient go out early on accident? Good luck going forward for your research!
ReplyDeleteHmm, I don't think they've ever released a patient when they're not ready. However, it is possible that the initial regimen designed could be less efficient than necessary.
DeleteHey Carla! You mentioned that Mayo Clinic is one of the surgery locations that patients come from, is the Center for Athletic Performance and Physical Therapy a place that hospitals like Mayo Clinic recommend often? Also, how do the patients react to the lack of set protocols when they are referred for physical therapy?
ReplyDeleteHi Carla! Do patients tend to have a faster recovery time predicted by the surgeon based on their age? Also, are there "relapses" in physical therapy, where someone is deemed ok to go without crutches or drive and then comes back to physical therapy with a worse problem than before?
ReplyDeleteHi Carla! It is very interesting to read about your experience. Are there any ways to speed up a recovery? Is recovery quicker for younger patients? Good luck on your research. I look forward to reading more.
ReplyDeleteHi Carla! This was a great post. Why specifically did you look at ACL protocol at Mayo Clinic, and what are some factors that can expedite the patient's recovery in the physical therapy?
ReplyDeleteWow, Carla! Your project seems to keep getting more interesting, and I really like that you have a new question to pursue each week. Do you have any idea of what your final question might be, or at least a sense of the direction that your project is tending toward?
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