The development of a decision making pathway for the Physiotherapy treatment of Adult scoliosis Betts, Tony (Royal National Orthopaedic Hospital,

Transcription

1 The development of a decision making pathway for the Physiotherapy treatment of Adult scoliosis Betts, Tony (Royal National Orthopaedic Hospital, London, United Kingdom)

2 The development of a decision making pathway for the Physiotherapy treatment of Adult scoliosis Aim To develop and pilot a decision making pathway which would be robust, measurable, easy to follow and effective. Method Initially a Brain storming session was used to develop the key pathways to assessment and treatment. Adult patients were given open questions on the goals and expectations of treatment. patients were shown the pathway and asked for comments. The pathways was taught to the Hospital department and integrated to the Care pathway file for the treatment of scoliosis.

3 The development of a decision making pathway for the Physiotherapy treatment of Adult scoliosis Results Feedback from an analysis of the Open questionnaire was carried out by categorisation of the key topics from comments and feedback forms. This was triangulated with two separate Therapist reviewing the feedback comments and then reaching agreement on the Key topics revealed by the questionnaire process. The main categories were; The pathway guides treatment The pathway ensures safe application of treatment The pathway needs more medical pain management options The pathway should include long term management options The decision making process should involve more multi-disciplinary communication The Key words from the review were Guides/protects/safety/long term options Pain management options/team approach/analgesia/functional movements

4 An Alogorithm for the treatment of Adult spinal deformity (inc scoliosis kyphosis and lordosis) Diagnosis of adult spinal deformity by medical practitioner. Review of analgesics and or referral to pain rreview management Correctable (No s 1,2) With pain Without pain Assessment by therapist of the flexibility of the deformity and classification into groups (1) (2) (3). Non Correctable Rigid deformity (No 3). Referral to Orthopaedic specialist for monitoring of deformity. Relieves Pain Provokes Pain With/without Pain Continue postural correction Stop postural correction exercises Hold stabilisation exercises in new posture for 10 seconds or more Mobilisation (gentle) myofascial/joint +general pain relieve modalities maintain postural control with ADL activities Stabilisation exercises in deformity posture Key: (1) A flexible deformity that is able to be corrected beyond the midline / spinal neutral. (2) A flexible deformity that is able to be corrected but only to the midline. (3) A Non flexible deformity that cannot be corrected. Pain relieving- YES Continue exercises through to corrective deformity posture, if able without pain Pain relieving - NO Stop and refer to medical/surgical/ orthotic

5 Postural Shift exercises in Coronal and Sagittal Planes» PATHWAY 2/3» PATHWAY 1 CORRECTABLE PATHWAY 1

6 The development of a decision making pathway for the Physiotherapy treatment of Adult scoliosis The pathway provides three main pain-treatment options; 1.Maintain treatment if curve correctable pain reducible 2. Continue treatment if pain relieving after manual and-or pain management options 3. Stop and refer back if treatment( postural correction exercises and Analgesia) is not pain relieving Following feedback the pathway has been modified, to include; more pain management options, to distinguish clearly between the three pathways, to provide options for long term management, to ensure communication occurs across all the involved medical team, to ensure exercises corrective movements include sagittal and transverse planes Conclusions A pathway provides a structural decision making process which can aid the correct application of treatment techniques to a condition. This needs to be developed by discussion and consensus