If the world were perfect, evidence would be evident, precise, clear and
decisive. Also, the world would seem pretty boring, particularly to seating
and mobility clinicians and ATPs.
Your schedule would be neater, more linear and much shorter if your
clients never changed. It sure would be better for your clients if ALS didn’t
progress, and if pressure injuries never developed.
But change can also be triumphant, such as when early-intervention
clients start going to big-kids school, and when a client with a spinal cord
injury is able to go back to work.
If your DNA were all about being
neat and clean and doing everything
just once, you wouldn’t be in complex
rehab. This is an industry of inventors and
innovators and people who dream in all
This issue, we tackle evidence-based
practice and outcomes measures. It’s
an interesting topic for an industry that’s still wired to grab some tools and
tweak, tweak, tweak to find the right fit. Compiling evidence and objectively
measuring client outcomes can feel like, you know — using a flathead
screwdriver on a Phillips screw. When all clients are different from each other,
and even the same client is a little different every time you see him or her,
it’s easy to scoff at calls for evidence.
We’re not big pharma! We can’t just collect 5,000 kids with athetoid CP
and do a blind study by giving some of them custom-fit complex seating
and giving the rest of them a 2″ foam cushion on a slingback chair!
I was very interested, therefore, to hear what ATPs and clinicians thought
about evidence-based practice. I sent e-mails asking for comments, and
wow, did I get them.
The answers were thoughtful, complex and touched many different levels.
They were also open minded and, of course, client centered.
Here’s what Susan Cwiertnia, PT, MS, Director of Medical, VARILITE, said:
“Clinically, I believe outcomes measures will help to provide a roadmap to
guide recommendations for assistive technology and seating solutions. This
can be valuable, especially to newer therapists to identify individuals that
could benefit from improved seating. While therapists can often document
improved function, the outcomes tools might help show if the client is
satisfied and identify issues that may lead to equipment abandonment.”
This is a complex issue in an industry defined by its uniqueness, and the
ATPs and clinicians participating in the story (page 22) also noted that
subjective skills — observation, communication, experience, creativity,
persistence, patience — will always play important roles alongside black-and-white spreadsheets. Maybe evidence becomes another tool to call on.
Your days would be neater if your work could be more easily measured. But would you really trade in the smiles from your clients and their families
just to have perfect spreadsheets?