Acute care…is one of those things in Physical Therapy and Athletic Training that we often overlook, and in my humble opinion, is the lowest hanging fruit in accelerating post op results. Seeing as though that acute stage only lasts a few days, and its easier in many cases to let it “run its course”, then get on to the “important stuff,” like restoring ROM and strength…after all, acute care is just pain and swelling management…a few NSAIDS should take care of that, no?
Truthfully, this devil may care attitude drives me crazy. At best, its lazy, and at worst, well let’s just say it’s certainly not the patient that benefits from this “approach, “ or lack thereof.
First off, the term “acute care” is one of the main reasons its overlooked. By definition, the acute care stage is generally equated to the inflammatory stage of the healing process, therefore only a few days in duration, and considered to be the down time before a patient can begin rehab anyway… To this, I say BLASPHEMY!
First off, acute care takes place wayyyyyyyyyy longer than just 3 days… If a patient is still dealing with swelling and pain on any level, then they are still in the acute care phase, and depending on the person, this may last days, weeks, and in some cases even months!
Stay with me here… how many patients have you seen, months into their rehab…still dealing with post therapy pain and/or daily swelling…
Thats what I thought…TONS! And that, right there, is one of the many reasons quality acute care is more important that you may think…
The problem is, as clinicians, we have been programmed by insurance companies to time stamp every step of the rehab process…this is a business model of rehab, not a clinical model… So we move people through the process, and when things don’t go well, we blame them for not doing their home exercise program! (Don’t even lie, thats the first place your mind goes, isn’t it?😜) The reality… We need to do a better job recognizing the factors that delay our patients progress, and have a systematic way of intervention that is CRITERIA BASED, not time based. In addition, how well are we providing resources to our patients as far as best practices are concerned?
For example, let’s take 2 identical surgical procedures…let’s say an uncomplicated, isolated ACL Reconstructions. Patient A, a 25 year old fitness enthusiast, who eats clean, exercises regularly, gets consistent sleep, and generally speaking, does all the basic things right. Patient B, a 25 year old who eats fast food regularly, sits at a computer for work and recreation all day, stays up allll night on Fortnite, and sporadically takes part in questionable health decisions like smoking/drinking.
Is it reasonable to assume these 2 individuals would go through a rehab process, especially the acute stage, at the same pace? OBVIOUSLY NOT! The common sense in all of us shouts that these 2 individuals will likely have a far different experience in their prospective recoveries…
However, if we have been trained to identify lifestyle, and other factors that may impede progress, we could educate and inspire both patients, in ways specific to them, to optimize their recovery by giving them the tools and guidance to make better decisions before, during, and after the surgery takes place… versus just give them NSAIDs, which, by the way, carry with them even more health risks than someone might already have based on their lifestyle. Don’t believe me? Google it…In fact, we use NSAID drugs here in the US that have been BANNED by European countries for being unsafe.
Another important reason acute care matters is that it will impact a patients long term outcome. How could the first month, impact the next year, you ask? Well, just like any race, where you start, will impact where you finish. In fact, A 2015 cohort study in the Journal of Athletic Training showed that the first 2 months of rehab directly correlated to long term function outcomes and patient satisfaction. What does this mean? Well the patients who scored higher on functionality tests in the 1-2 month post-op range, also scored higher at 1+ year(s) follow ups. Again, where you start —> where you finish…
So for all those patients who got an ice pack for acute care, if we had a more integrated, holistic system of approach, could feel better sooner, move better sooner, and have those long term results that send referrals through your door for years to come.
Is there such a system? There is now! This is exactly why I came up with The MINDFUL Method of acute care. The MINDFUL Method replaces those old, outdated, evidence bereft acronyms like RICE, PRICES, POLICE, and so on and so forth. Yes…another acronym, but one that finally gives us cues for treating the short term, with the long term in mind, and that can used as a guide well beyond the “acute stage” Want to learn more about what the MINDFUL Method is??? Thought so!
I cover the MINDFUL method in great detail in my new course, THE END OF THE ICE AGE: A MODERN APPROACH TO ACUTE CARE. You can pre-register on my website, and get early access AND A SPECIAL DISCOUNT, only available to those on the list!, Just drop the old email in the form at Acute care…is one of those things in Physical Therapy and Athletic Training that we often overlook, and in my humble opinion, is the lowest hanging fruit in accelerating post op results. Seeing as though that acute stage only lasts a few days, and its easier in many cases to let it “run its course”, then get on to the “important stuff,” like restoring ROM and strength…after all, acute care is just pain and swelling management…a few NSAIDS should take care of that, no?
Truthfully, this devil may care attitude drives me crazy. At best, its lazy, and at worst, well let’s just say it’s certainly not the patient that benefits from this “approach, “ or lack thereof.
First off, the term “acute care” is one of the main reasons its overlooked. By definition, the acute care stage is generally equated to the inflammatory stage of the healing process, therefore only a few days in duration, and considered to be the down time before a patient can begin rehab anyway… To this, I say BLASPHEMY! First off, acute care takes place wayyyyyyyyyy longer than just 3 days… If your patient is still dealing with swelling and pain on any level, then you are still in the acute care phase, and depending on the person, this may last days, weeks, and in some cases even months!
Stay with me here… how many patients have you seen, months into their rehab…still dealing with post therapy pain and/or daily swelling…
Thats what I thought…TONS! And that, right there, is one of the many reasons quality acute care is more important that you may think…
The problem is, as clinicians, we have been programmed by insurance companies to time stamp every step of the rehab process…this is a business model of rehab, not a clinical model… So we move people through the process, and when things don’t go well, we blame them for not doing their home exercise program! (Don’t even lie, thats the first place your mind goes, isn’t it?😜) The reality… We need to do a better job recognizing the factors that delay our patients progress, and have a systematic way of intervention that is CRITERIA BASED, not time based. In addition, how well are we providing resources to our patients as far as best practices are concerned?
For example, let’s take 2 identical surgical procedures…let’s say an uncomplicated, isolated ACL Reconstructions. Patient A, a 25 year old fitness enthusiast, who eats clean, exercises regularly, gets consistent sleep, and generally speaking, does all the basic things right. Patient B, a 25 year old who eats fast food regularly, sits at a computer for work and recreation all day, stays up allll night on Fortnite, and sporadically takes part in questionable health decisions like smoking/drinking.
Is it reasonable to assume these 2 individuals would go through a rehab process, especially the acute stage, at the same pace? OBVIOUSLY NOT! The common sense in all of us shouts that these 2 individuals will likely have a far different experience in their prospective recoveries…
However, if we have been trained to identify lifestyle, and other factors that may impede progress, we could educate and inspire both patients, in ways specific to them, to optimize their recovery by giving them the tools and guidance to make better decisions before, during, and after the surgery takes place… versus just give them NSAIDs, which, by the way, carry with them even more health risks than someone might already have based on their lifestyle. Don’t believe me? Google it…In fact, we use NSAID drugs here in the US that have been BANNED by European countries for being unsafe.
Another important reason acute care matters is that it will impact a patients long term outcome. How could the first month, impact the next year, you ask? Well, just like any race, where you start, will impact where you finish. In fact, A 2015 cohort study in the Journal of Athletic Training showed that the first 2 months of rehab directly correlated to long term function outcomes and patient satisfaction. What does this mean? Well the patients who scored higher on functionality tests in the 1-2 month post-op range, also scored higher at 1+ year(s) follow ups. Again, where you start —> where you finish…
So for all those patients who got an ice pack for acute care, if we had a more integrated, holistic system of approach, could feel better sooner, move better sooner, and have those long term results that send referrals through your door for years to come.
Is there such a system? There is now! This is exactly why I came up with The MINDFUL Method of acute care. The MINDFUL Method replaces those old, outdated, evidence bereft acronyms like RICE, PRICES, POLICE, and so on and so forth. Yes…another acronym, but one that finally gives us cues for treating the short term, with the long term in mind, and that can used as a guide well beyond the “acute stage” Want to learn more about what the MINDFUL Method is??? Thought so!
I cover the MINDFUL method in great detail in my new course, THE END OF THE ICE AGE: A MODERN APPROACH TO ACUTE CARE. You can check out the first 2 chapters for FREE! Just use the link below and set up an account!
https://themovementunderground.thinkific.com/courses/end-of-the-ice-age-a-modern-approach-to-acute-care-of-injuries
