Scholarship Finalist - AB - Emilie Dick

Evidence-based Guidelines in Physiotherapy: 2019 Scholarship Finalist (AB)

Emilie Dick

University of Alberta – Master of Science in Physical Therapy – 2020

As a physiotherapist, I am ideally positioned to incorporate preventative healthcare into my future clinical practice. The Physiotherapy Alberta College + Association outlines in their position statement the role physiotherapists in primary care health teams have in illness prevention and health promotion. Physiotherapists can work in a variety of settings, from intensive care units to elite sports medicine centres to community health programs. Such variety allows us to reach many different populations and provide preventative healthcare to a range of patient demographics. I will draw on my clinical experience from placements I’ve had throughout my schooling to provide examples of how I have seen preventative healthcare incorporated by more experienced therapists. There are two strategies I will discuss: the use of evidence-based discharge criteria and the use of corrective therapeutic exercise. I observed these strategies in a private practice settling, but they can be applied to other clinical scenarios. By applying appropriate discharge criteria and teaching corrective exercise to all my patients in my future practice, I hope to have an impact beyond their current health complaint and provide them with the tools they need to avoid future health issues.

While on placement at a private clinic in Lethbridge, Alberta in May of this year, I had the terrific opportunity to work with a physiotherapist who was adamant on the use of evidence-based guidelines to form her discharge criteria. She based her discharge guidelines on research analyzing normative values of muscular strength in individuals without musculoskeletal pain. For example, for a patient with an initial complaint of back pain to be officially discharged from her treatment program, that patient needed the muscular endurance to perform a 90 second side-plank on both their left and right sides. This benchmark was set from research by Stuart McGill; he demonstrated that individuals without back pain could achieve a 75 second side plank with ease (the 90 second benchmark is 1 standard deviation above that time – my supervisor encouraged her patients to achieve excellence). She had normative values for other injured body regions as well, such as for shoulders and ankles. By relying on evidence-based values to guide her discharge plan, she was ensuring that her patients were 100% ready to go back to their full activities. She did not rely on the subjective report of pain absence alone; she used objective measures to confirm that they were strong enough to prevent the injury from recurring. This example of using objective measures to set discharge criteria to prevent future injury is a strategy I will incorporate into my future practice.

Teaching corrective exercise is another prevention strategy I learned while working in Lethbridge. Correcting movement strategies is essential not only for injury resolution, but also prevention. For example, several people who came to the clinic presented with shoulder and neck pain. Many of these patients had jobs that required them to sit at a computer or desk for many hours a day, which contributed to their pain. My supervisor taught posture correction, strengthening exercises, and relaxation techniques, all of which reduced or absolved their complaint. Not only did the patient leave the clinic feeling better, they also had tools to help manage and prevent flare-ups once they resumed their occupation. My supervisor ensured that each patient had a plan of action to manage themselves at home if they noticed the pain returning. Enabling patients to “be their own best therapist” gives them the self-efficacy and knowledge to manage their bodies and control or prevent injury, which is an excellent method of incorporating preventative healthcare into practice.

To incorporate preventative healthcare into my future practice, I will utilize evidence-based discharge criteria and teach corrective therapeutic exercise to all the patients I treat. These approaches are by no means comprehensive; as I learn and progress in my career, I’m sure I will establish other strategies. My hope is that by using the above-mentioned strategies, my patients will be able to stay active in their communities doing the activities that they love. Helping people participate in their lives in a meaningful way can improve their quality of life and overall well-being, which is my goal for any patient I will work with.