Reflecting on 2009 and Moving to 2010

As 2009 comes to an end, it's probably the perfect time to kick back and reflect on the year, what you've learned throughout the year and even more importantly how you grew and implemented what you learned into practice.  I would tag Dr. Gail Jensen as the queen of knowing how experts practice.  If you want to be an expert physical therapist, you need to self-reflect.

So... back pain... the majority of patients treated in outpatient settings are going to have back pain.  For the patients you treated with persistent, non-specific low back pain, did you incorporate motor control exercises?  Did you stay away from the feel good short term modalities.  You know what I'm talking about... did you avoid ultrasound, hot packs, massage and electrical stimulation?

How about this... did you attend a continuing education course?  Did you become more effective in treating those specific patients?  Literature seems to indicate continuing education alone doesn't improve physical therapist effectiveness in treating neck pain.  What does seem to improve effectiveness are episodic reminders or pushed information on what was learned.  If you attended a continuing education course, did you incorporate some mechanism to keep you mentally alert throughout the year about the topic you learned?

Clinical prediction rules... where are you on that topic?  Have you mentally battled your thoughts on those?  Have you looked at both sides of the debate?  Would you be able to debate about the value or lack of value at a higher level than "cookbook" philosophy?

What about incorporating standardized outcome measures into practice?  Have you done this yet?  How are you capturing change that does or does not occur with physical therapy intervention?  How are you learning of your clinical experience to know how you practice and know your level of effectiveness?

Have you thought about the logistics within the setting in which you practice?  Are you shying away from using physical therapist assistants or are you taking a bit more control in the delegating process?  Have you measured to learn if outcomes changed?

Did you know that there were 3.7 million single falls and 3.1 million recurrent falls in 2002 in adults 65 years of age and older?  Of those falls, 2.2 million resulted in a medically injurious fall.  Only 48% of fallers reported falling to a health care provider.  Of those that did report a fall, only 60% received any fall prevention information.  How did you practice in 2009?  Did you address falls?

Oh, and what about adhesive capsulitis?  Uh, huh... after learning that the likelihood of improvement is reduced by 19-32% if iontophoresis, phonophoresis, ultrasound or massage were included in treatment plans, did you step away from the passive interventions?  Did you change your plan of care to focus on interventions that would move the patient forward and get them back to life?

Have you begun taking steps to screen for psychosocial factors that affect physical therapy treatment sessions (i.e. fear or depression)?  Do you just go through the motions of screening or do you step up to the plate and use the information gained from the screening process to alter your treatment sessions?

The new news... single level microdiskectomies... do you treat those patients as being frail or are you progressively strengthening their back extensors working up to 80% of 1 repetition maximum?

Are there any topics I missed that would be great for self-reflection?  Do you have any method for self-reflection?  What method do you use to ensure you are an expert?

photo by irargerich via flickr

~Selena