Orthopedic Protocols: Time for a Change?

According to a recent Cochrane Review, we at least need to consider examining them more closely. This article had me thinking more closely about some of the rehab protocols we use throughout our daily practice.

Two statements from the review caught my eye:

• "This review found no evidence to support one form of exercise programme over another in managing recovery from the injury looking at return to daily activities, work and sporting activities."

• "Limited conclusions in this review are a consequence of the small number of trials, non-standardised exercise programmes and methods of measuring their effectiveness, and poor quality reporting of the results."

I currently utilize several different protocls for rotator cuff repairs of various sizes, ACL reconstruction, Bankart repairs, shoulder arthroplasty, and several others.

I doubt the outcomes of my patients far exceeds or lags behind those of most orthopedic therapists. However, it may benefit our patients and professional standing if we took a more proactive stance in establishing treatment progressions that represent best practice versus simply following the orders of our physicians.

The last half of that sentence might be a tough one. For some of us, convincing an orthopedist to modify or change a rehab protocol could prove to be a daunting task. I know it would be for more than a few of my consistent referral sources. However, despite what we may think, many surgeons are actually receptive to our suggestions regarding the postoperative management of their paitents.

If we can present our referrals with some good evidence supported by clinical reasoning, I think we may find a great opportunity to greater autonomy with our patients and actually enhance the relationships we have with our valued referral sources! It's 2008 and I'm going to give this a shot with at least a few of my regular referring doctors. Hopefully we'll see good things to come down the road.