Certainly patient attendance is critical in managing LBP.   They can't get better if they don't show up.

 

The characteristics of a "good" patient are what I call "The 3 C's":

LBP is hard enough to treat in and of itself.  As my good friend Angelo DiMaggio, PT, DipMDT says frequently, it requires "focus & detail".   That, it certainly does.   However, my most successful patients are the ones who are fully engaged in their treatment.  They don't come to therapy because their doctor simply recommended it; they are looking for a solution. 

 

Coincidentally, these are also the most enjoyable people to treat because they value your (my) being there engaged with them to help solve their problem.  It makes treatment...easier.

 

But, we've all had patients bag out on us.  Sometimes, it's for the best; other times though, it's not the best for your practice and professional PR (public relations).  It also doesn't solve the problem of LBP.

 

So how can we curb this?

 

Can we predict who will bag out?

 

Yes, to a degree.

 

Studies done by Peterson, Long and others point to different variables that increase the likelihood of someone withdrawing from treatment.  

 

1. Smokers.    Odd, huh?  Statistically this group in some studies showed up as a variable that was a prognostic indicator of volitional withdrawl from treatment.  Why?  Well, smokers tend to not be able to follow through on matters of self-discipline, especially if they've attempted to quit one or more times and failed.  This is a deep issue with different viewpoints, but one that has been reported as statistically significant.

 

2. Duration of Symptoms.   Studies have shown that the longer a person has pain (and a lower perceived benefit from treatment) will increase the likelihood of withdrawl from treatment.   We've all seen the chronic pain patient who's been to seven different doctors and therapists, etc. and still has the same symptoms.   Obviously if you repeat what everyone else has done...you lose.  But if they perceive that you're the same as everyone else...same thing: a zero-sum gain.  You lose, and so does the patient.

 

3.  Low Expectation of Future Work Ability.   The area of fear-avoidance behaviors with regard to personal life, recreation and workplace activities has been receiving more attention as there is high correlation with higher fear avoidance behavior scale ratings and poorer outcomes.  But again, if we glance into the patient's psyche, we can see that if one's expectations of improvement and being able to do their job (not whether or not one wants to do their job) in the future is low, their impetus to commit to a form of treatment is also reduced. 

 

4.  Incorrect Treatment.  Although some studies differ in this conclusion, it has been shown and is generally accepted that patients who are not responding to treatment as a result of being placed in an incorrect treatment category, will withdraw from treatment as no benefit is perceived.  However, a study by Long showed that patients who are mis-categorized and given the wrong treatment can actually worsen. 

 

This, of course, must be avoided.

 

And we'll talk about it at length on day one of the course.  Plus much, much more.

 

For more details, follow the link to the page with course info.