On the heels of my articles featuring top 12 desired practice management software features, and an interview with 6 RMT-software developers , I want to ask you directly, “Can we tighten our assessment and outcome variables in our charting practices?” I’m wondering if our profession can collectively get tight around what we assess, how we measure it and how we qualify change brought about by our hands.
- Posture – (spine) kyphotic, lordotic, scoliotic
Posture – (shoulder & pelvic girdle) tilt, twist (torsion), protract (draw out) or retract (drawn back) - Range-of-Motion – full, limited, impaired (alternative degrees of motion)
- Muscle (motor) test 0 – 5
- Palpation: tension, tenderness, texture, temperature
(3 grades each, see table below) - Numeric Pain Scale 0 – 5 (0 no pain to 5 excruciating pain
- Neurologic/orthopedic tests + or – (positive or negative)
- Pain questionnaire – score (Vernon-Mior, Oswestry, DASH, Lower Extremity Functional Scale, etc)
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Tension
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Texture
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Tenderness
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Temperature
|
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Minimal
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Pliable
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Minimal
|
Minimal
|
|
Moderate
|
Adhesive
|
Tolerable
|
Warm
|
|
Spasm/strain
|
Fibrotic
|
Withdrawal
|
Inflamed
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Why would I suggest doing this?
1) Communication – if we’re all measuring the same variables we can engage in professional inquiry and qualify our experiences within and outside the profession
2) Credibility – using a common lexicon and producing the same outcome measures despite different practitioners contributes to the sophistication of research conducted and results measured. Credibility is essential to health care funding and gatekeeper HCP confidence in referrals.
Write me at don@massagetherapistpractice.com or join the discussion on Facebook and let me know if you can work within these variables.
For those who attended Work that Charting! at the Canadian Massage Conference this past weekend, here’s a sample of the completed Assessment/Treatment template for you to study.
If you’re interested in the methodology and accessing the templates, the revised self-study workbook will be available in the coming months. Keep posted on our Facebook page or sign up for announcements.
I have been practicing now for close to 10 years. For most of that time it has been in clinical settings, alongside many other RMTs with whom I was sharing clients – and therefore treatment notes.
Take any ten therapists and you’ll probably find ten different charting styles. That’s fine, so long as any practitioner’s notes are legible and consistent. My concern is what is omitted.
In my experience, massage therapists are loath to record any observation or client symptom that is in variance to a terrific treatment outcome. This is a shame because it can undermine our credibility in the eyes of our clientele. More importantly though, it robs therapists a chance to critically assess their own work and to take a scientific approach when an accepted practice fails to create an expected result.
At any rate, I’d like to suggest a few other symbols which I have borrowed from outside massage therapy. I use these to indicate the trend of a specific observation over multiple treatments:
> – improved
>> – greatly improved
< – worse
<< – much worse
(?) – paradoxical, unexpected or inexplicable result
My notes are littered with these easy-to-use little symbols. I'm not particularly proud that they highlight a pattern of uncertainty and repeated failures, but I can accept that I'm improving my profession and my own career in it.
Cheers.