Visiting Basis ?

**emad** · 31-10-2005, 02:58 PM

Hi all ;

Just back i back from an English exam , nice to be back !

what are your basis for asking the pain patient to visit you ??

Frequency ?

Regards

Emad

**Diane** · 31-10-2005, 04:13 PM

As needed, no oftener usually than once/week. Average # of visits, 3-6.

**nari** · 31-10-2005, 08:34 PM

It varies somewhat depending on the degree of distress. Never more than once a week, mostly once every ten days or so. Intensive intervention by a physio is not required for the majority of patients, and is not very good for their understanding of their role in getting better. But I would make exceptions for a frail elderly person, in pain, and probably a carer for a spouse.

Good luck with your exam results, emad!

Nari

**emad** · 31-10-2005, 08:48 PM

Hi Diane & Nari :

Good Nari , thnx .

I think you got the point well , i am searching for the scientific base .

It is clear , that we need to stop that physio practice of 3 times weekly , this is not scientific at all , it is a market procedure , .

Currently, i am asking my clients to come once a week , and even longer as you mentioned above ,prticularly those with sever irritable pain .

From another point of view ,it is more respectable to ask the patient to vist once /week ,moreover ,visiting 3 times seems to be a more technical (technician ) aspect,more than a professional aspect .

Friends ,we are making history ,as those who make history have one character changing cultural practice role ,cultural practice means that signifiant number of patients believe that physio is more than once weekly ,thanks to dishonest physios who are fond of money collection ,modulated people ,s cortex to the input of more body input and work ,the mission is so difficult

.

let us discuss more how to support our views scientifially!

Regards

Emad

**nari** · 01-11-2005, 11:19 PM

emad, studies supporting our views on patient attendance is difficult - I didn't come up with anything much on the topic when I did a search last year. That doesn't mean there isn't something out there.

Attendance 3 times a week is a habit I think is largely devoted to money, and also some orthopaedic surgeons demand that frequency. That makes life tricky for some, because if a PT loses that surgeon's goodwill, again, it is not to their advantage. We are so tied to the medical model it is depressing.

I have no answers at present. I keep thinking about the study I read (haven't got access to it now) where one group of patients who had received rotator cuff repair were simply told what to do, and sent home; the other group recieved intensive PT. After some months (cannot remember, I think it was about 6 months) the two groups had progressed satisfactorily and comparably.
"Going to the Physio" did not make any difference in outcome..

Makes you think....

Nari

**bernard** · 02-11-2005, 07:34 AM

Well Emad,

Do not forget that Diane and Nari have a direct access in their countries. I think that it is not the case in your (as in mine).

I will be cautious and will treat the problem case by case.

If the doctor asks for 5 sessions/week, just do it and change patient attitude with time...
1/week may be also seen as difficult for many patients since they are waiting for more. You need time to educate them.

Patience and time are needed to move the World.

**emad** · 02-11-2005, 10:59 AM

Nari ;

I have /feel that research /evidences are not so highly reliable ,i doubt for one reason the research ,look at physios approachs in 80s -70s using electrotherapy (even currently in USA ) was and is supported by research reports ,and on the other hand there is much research opposses the elctro-efficacy .no definate research ,which we can rely on so much to support or ideas .Honestly , i do not know where is the main background dilemma in that issue! i mentioned that because you spoke about a research doubts the efficacy of that intensive physio .

However , i am sure of one thing , what i experience through my practical work ,patient s with severe pain better applied through long interefernce /distant time intervals.

Bernard :
What do you mean by direct access ??

If you mean the patient comes to physio without referring ,you are right i have nearly 50% referred to me personally from doctors ,48% referred to physio so that they come to me because they know me ,2% only who come to me without doctors but they have been referred to me and experinced good outcomes.

Regards

Emad

**bernard** · 02-11-2005, 03:25 PM

Emad,

I'm not sure that we understand ourselves. Direct access is the ability for a patient to come at our office and get an insurance reimbursement.

In France, I could receive a patient directly but no insurance is covering the session.

**Diane** · 02-11-2005, 03:50 PM

I think direct access can mean both:
1. As Bernard has indicated, the patient can be re-imbursed by insurance, doesn't have to have a doctors referral.
2. Therapist is legally entitled to see patients without their having to go through a doctor first to get a referral.

**emad** · 02-11-2005, 07:26 PM

Diane :

Thanks for clarifing the issue for second-English speakers.

Emad

**emad** · 03-11-2005, 02:56 PM

Hi all ;

I believe increasing the fees for visiting physiotherapist is better than ,low fees for 3 times a week .

Regards

Emad

31-10-2005, 02:58 PM	#1
emad Arbiter Join Date: Mar 2004 Location: The Earth Planet Age: 38 Posts: 2,067 Thanks: 1 Thanked 2 Times in 2 Posts	Visiting Basis ? Hi all ; Just back i back from an English exam , nice to be back ! what are your basis for asking the pain patient to visit you ?? Frequency ? Regards Emad

31-10-2005, 04:13 PM	#2
Diane Human Primate Social Groomer and Neuroelastician Join Date: Mar 2004 Location: Weyburn Sask. Posts: 19,667 Thanks: 1,485 Thanked 3,185 Times in 1,566 Posts	As needed, no oftener usually than once/week. Average # of visits, 3-6. __________________ Diane www.dermoneuromodulation.com SensibleSolutionsPhysiotherapy HumanAntiGravitySuit blog Neurotonics PT Teamblog Diane Jacobs.com (personal website) Canadian Physiotherapy Pain Science Division (Archived newsletters) Canadian Physiotherapy Association Pain Science Division Facebook page @PainPhysiosCan WCPT PhysiotherapyPainNetwork on Facebook @WCPTPTPN Neuroscience and Pain Science for Manual PTs Facebook page @dfjpt SomaSimple on Facebook @somasimple "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

02-11-2005, 07:34 AM	#6
bernard Admin, Moderator... Join Date: Mar 2004 Location: France Age: 56 Posts: 12,013 Thanks: 241 Thanked 136 Times in 90 Posts	Well Emad, Do not forget that Diane and Nari have a direct access in their countries. I think that it is not the case in your (as in mine). I will be cautious and will treat the problem case by case. If the doctor asks for 5 sessions/week, just do it and change patient attitude with time... 1/week may be also seen as difficult for many patients since they are waiting for more. You need time to educate them. Patience and time are needed to move the World. __________________ Simplicity is the ultimate sophistication. L VINCI We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON Everything should be made as simple as possible, but not a bit simpler. If you can't explain it simply, you don't understand it well enough. Albert Einstein bernard

02-11-2005, 03:25 PM	#8
bernard Admin, Moderator... Join Date: Mar 2004 Location: France Age: 56 Posts: 12,013 Thanks: 241 Thanked 136 Times in 90 Posts	Emad, I'm not sure that we understand ourselves. Direct access is the ability for a patient to come at our office and get an insurance reimbursement. In France, I could receive a patient directly but no insurance is covering the session. __________________ Simplicity is the ultimate sophistication. L VINCI We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON Everything should be made as simple as possible, but not a bit simpler. If you can't explain it simply, you don't understand it well enough. Albert Einstein bernard

02-11-2005, 03:50 PM	#9
Diane Human Primate Social Groomer and Neuroelastician Join Date: Mar 2004 Location: Weyburn Sask. Posts: 19,667 Thanks: 1,485 Thanked 3,185 Times in 1,566 Posts	I think direct access can mean both: 1. As Bernard has indicated, the patient can be re-imbursed by insurance, doesn't have to have a doctors referral. 2. Therapist is legally entitled to see patients without their having to go through a doctor first to get a referral. __________________ Diane www.dermoneuromodulation.com SensibleSolutionsPhysiotherapy HumanAntiGravitySuit blog Neurotonics PT Teamblog Diane Jacobs.com (personal website) Canadian Physiotherapy Pain Science Division (Archived newsletters) Canadian Physiotherapy Association Pain Science Division Facebook page @PainPhysiosCan WCPT PhysiotherapyPainNetwork on Facebook @WCPTPTPN Neuroscience and Pain Science for Manual PTs Facebook page @dfjpt SomaSimple on Facebook @somasimple "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

31-10-2005, 08:34 PM	#3
nari NeuroNut Evangelist Join Date: Mar 2004 Location: ACT Aust Posts: 7,678 Thanks: 704 Thanked 233 Times in 167 Posts	It varies somewhat depending on the degree of distress. Never more than once a week, mostly once every ten days or so. Intensive intervention by a physio is not required for the majority of patients, and is not very good for their understanding of their role in getting better. But I would make exceptions for a frail elderly person, in pain, and probably a carer for a spouse. Good luck with your exam results, emad! Nari

31-10-2005, 08:48 PM	#4
emad Arbiter Join Date: Mar 2004 Location: The Earth Planet Age: 38 Posts: 2,067 Thanks: 1 Thanked 2 Times in 2 Posts	Hi Diane & Nari : Good Nari , thnx . I think you got the point well , i am searching for the scientific base . It is clear , that we need to stop that physio practice of 3 times weekly , this is not scientific at all , it is a market procedure , . Currently, i am asking my clients to come once a week , and even longer as you mentioned above ,prticularly those with sever irritable pain . From another point of view ,it is more respectable to ask the patient to vist once /week ,moreover ,visiting 3 times seems to be a more technical (technician ) aspect,more than a professional aspect . Friends ,we are making history ,as those who make history have one character changing cultural practice role ,cultural practice means that signifiant number of patients believe that physio is more than once weekly ,thanks to dishonest physios who are fond of money collection ,modulated people ,s cortex to the input of more body input and work ,the mission is so difficult . let us discuss more how to support our views scientifially! Regards Emad

01-11-2005, 11:19 PM	#5
nari NeuroNut Evangelist Join Date: Mar 2004 Location: ACT Aust Posts: 7,678 Thanks: 704 Thanked 233 Times in 167 Posts	emad, studies supporting our views on patient attendance is difficult - I didn't come up with anything much on the topic when I did a search last year. That doesn't mean there isn't something out there. Attendance 3 times a week is a habit I think is largely devoted to money, and also some orthopaedic surgeons demand that frequency. That makes life tricky for some, because if a PT loses that surgeon's goodwill, again, it is not to their advantage. We are so tied to the medical model it is depressing. I have no answers at present. I keep thinking about the study I read (haven't got access to it now) where one group of patients who had received rotator cuff repair were simply told what to do, and sent home; the other group recieved intensive PT. After some months (cannot remember, I think it was about 6 months) the two groups had progressed satisfactorily and comparably. "Going to the Physio" did not make any difference in outcome.. Makes you think.... Nari

02-11-2005, 10:59 AM	#7
emad Arbiter Join Date: Mar 2004 Location: The Earth Planet Age: 38 Posts: 2,067 Thanks: 1 Thanked 2 Times in 2 Posts	Nari ; I have /feel that research /evidences are not so highly reliable ,i doubt for one reason the research ,look at physios approachs in 80s -70s using electrotherapy (even currently in USA ) was and is supported by research reports ,and on the other hand there is much research opposses the elctro-efficacy .no definate research ,which we can rely on so much to support or ideas .Honestly , i do not know where is the main background dilemma in that issue! i mentioned that because you spoke about a research doubts the efficacy of that intensive physio . However , i am sure of one thing , what i experience through my practical work ,patient s with severe pain better applied through long interefernce /distant time intervals. Bernard : What do you mean by direct access ?? If you mean the patient comes to physio without referring ,you are right i have nearly 50% referred to me personally from doctors ,48% referred to physio so that they come to me because they know me ,2% only who come to me without doctors but they have been referred to me and experinced good outcomes. Regards Emad

02-11-2005, 07:26 PM	#10
emad Arbiter Join Date: Mar 2004 Location: The Earth Planet Age: 38 Posts: 2,067 Thanks: 1 Thanked 2 Times in 2 Posts	Diane : Thanks for clarifing the issue for second-English speakers. Emad

03-11-2005, 02:56 PM	#11
emad Arbiter Join Date: Mar 2004 Location: The Earth Planet Age: 38 Posts: 2,067 Thanks: 1 Thanked 2 Times in 2 Posts	Hi all ; I believe increasing the fees for visiting physiotherapist is better than ,low fees for 3 times a week . Regards Emad

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