April 2007

Increase patient retention with ADL questionnaires

by Dr. Charles Annunziata

Setting goals is an important part of a balanced and successful life. So why do so many chiropractors fail to set goals for their patients? The main reason is the difficulty in finding objective criteria which will show patient progress. Outcome Assessments give us those objective criteria.

Outcome Assessments are procedures or methods which effectively measure and document the patient's functional and symptomatic responses to the treatment provided. Simply stated, it is the documentation of accountability.

Common Outcome Assessments include: Pain scales, pain drawings, ADL questionnaires, range of motion, and physical capacity tests. Each one of these will give an objective value which can be used to re‑assess the patient's care plan. This will help to properly document the patient's condition, measure the progress or in some cases lack of progress of the patient's care plan, educate the patient, and help set short and long term patient goals.

Here is an easy but effective way to set goals for patients using one of the Outcome Assessments mentioned above, the ADL questionnaire!

As we all know, getting a patient to a pain‑free state is usually a fairly easy job for the competent chiropractor and may take only a few visits depending on the condition. We also know this is only the first victory in the long battle to full patient recovery as we now shift our treatment focus to removing the underlying cause of the patient's original symptoms by improving flexibility, ROM, posture, strength, coordination, etc.

However, patients don't share in our lengthy view of rehabilitation. They are finally free of most of their pain. Chiropractic worked! They now want to go out and do all the things they weren't able to do while living with their symptoms. While we share in their enthusiasm, we must also keep them focused on the big picture. The goal of care is more than pain relief. It is restoration of function, optimal health, and patient wellness. Setting short and long term goals using ADL questionnaires will help with this process.

There are many different ADL questionnaires available for the chiropractor to use (I recommend the Revised Oswestry for low back complaints and the Neck Disability Inventory for cervical problems). Each of these questionnaires is comprised of 10 questions with six possible answers per question. Each answer is given a numerical value with a higher value for a more debilitating response. Therefore, the higher the patient's total score, the more serious his or her condition.

For example, Section 4 of the Revised Oswestry Questionnaire has to do with walking. Here are the possible answers (followed by score):

A. Pain does not prevent me from walking any distance. (0)       

B. Pain prevents me from walking more than one mile. (1)

C. Pain prevents me from walking more than 1/2 mile. (2)

D. Pain prevents me from walking more than 1/4 mile. (3)

E. I can only walk while using a cane or crutches. (4)

F. I am in bed most of the time and have to crawl to the toilet. (5)

Let's say a patient answered letter "D" to the above section. That would have indicated that his or her pain prevents walking more than one‑quarter mile. That patient's score for this section would be "3." Now, if we want to set a short term goal, it would be for the patient to be able to answer one letter above his or her original answer within 30 days. So, the person's short term goal for this example would be an increased tolerance to walking more than one‑half mile without pain within the next 30 days (answer "C"). The long term goal would be for the patient to return to the normal ability to walk without pain in the next 90 days (answer "A").

These short and long term goals can be used with almost every section of the Revised Oswestry and Neck Pain Disability Index Questionnaires. Find out what aspect of a patient's life is most disrupted by his or hr condition (walking, lifting, sitting, headaches, etc.) and use that section for your goal setting.

Here are some tips on administering these questionnaires:

***  Give to the patient on the first visit and every re‑exam.

***  Be sure the patient fills these out himself or herself to avoid bias.

***  Be sure the patient signs and dates each questionnaire.

***  Must be kept in the patient file as part of prudent documentation.

ADL questionnaires are an easy inexpensive way to improve patient retention. Document the improvement in patients' scores from their initial visit to their re‑exam and show them this improvement as part of the Report of Findings. Once they reach their short term goal, congratulate them on a job well done and explain that their long term goal can be in reach if they continue with the next phase of their care plan.

Give this simple yet effective goal setting tool a try. You'll find an increased retention and patient compliance if used properly. Remember, an educated patient is your best customer!

(Dr. Charles Annunziata is a national lecturer with DC Seminars on such topics as Myofascial Trigger Point Therapy, Rehabilitation of the Spine, and Clinical Documentation. DC Seminars provides approved continuing education seminars throughout the country. For more information, go to dcseminarsinfo.com or contact Dr. Annunziata at 800‑897‑2476.)