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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I'm very unhappy by the way I'm being treated (or not treated) at the sports medicine clinic I'm going to. I have a knee injury that I'm getting rehab for. Every time I complete the level of program I'm on, they remeasure me. But it's always range-of-motion and strength. No one pays any attention to the fact that I still can cut corners or pivot while playing basketball. How do I get some help here?

The changes that are occurring in measuring the results of treatment for knee injuries are placing more of an emphasis on global (overall) assessment. Scales used can assess both recovery from the knee injury and effect of specific treatments applied. Including patient quality of life and satisfaction rounds out the results. All of these measures should be used to justify treatment selected or to modify treatment when expected results are not forthcoming. You are quite right in your concern. In general, among health care professionals, greater recognition is being given these days to the importance of patient satisfaction. Along these lines, a shift has come with a change from clinician-based measures of results to a more patient-reported outcomes base. This has meant a modification in the tools doctors and other clinicians treating knee injuries use to measure change. Patient-reported outcomes are certainly subjective (based on the patient's assessment). This is a shift from the measurements clinicians have always relied upon (e.g., range of motion, strength, motor control). And it is a reflection of the fact that sometimes objective measures of strength show improvement, but the patient's function doesn't improve or the patient isn't happy with the results. If a patient improves enough to return to school or work but not enough to return to sports or recreational activities, is that good enough? And by whose standards? In other words, who sets the bar for acceptable results -- the surgeon, the patient, or the health insurers? Experts suggest that separate measures are needed for separate areas. There are multiple tools to assess outcomes -- more than 50 for the knee alone, a dozen just on anterior cruciate ligament (ACL) injuries. At the very least, the clinician should use a general health survey and a second scale to measure specific results of the disease, injury, or condition. When choosing the right assessment tool, the surgeon or other health care clinician must keep in mind several factors. Is it relevant to the patient? Is it reliable and valid? Is it easy to administer, score, and interpret? Is it responsive? In other words, can it detect a change (improvement, decline) when it occurs? It may be helpful to match the patient's goals with scales that provide a way to tell whether or not the goal(s) have been met. A different tool may be used with athletes who have higher expectations than an older adult who just wants to be able to walk again. Here's where you come in. Let your team know of your dissatisfaction. Explain your concerns and what goals you would like to meet. Ask for a better (or maybe just different) standard for measuring or assessing your progress. That should be enough to redirect your evaluation process and possibly even change the type of treatment you are receiving.


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