4-Stage System

1. Assess
2. Sub-classify
3. Rehabilitate
4. Re-evaluate

Stage 1 - Assess

There are many diverse areas we need to make decisions on when managing musculoskeletal disorders.

In the first stage of the system we help you:

• Extract relevant subjective information from the client to formulate an opinion on your assessment, and identify red, yellow, orange or green flags (serious medical conditions, psychosocial factors, psychiatric conditions and positive outcome indicators, respectively)
• Understand the client expectations
• Set realistic goals with the client
• Use suitable outcome measures
• Decide if any other health care professionals need to be involved
• Perform an effective physical assessment

We have developed simple and easy to use screening questionnaires for you to use yourself or for you to give clients to help you.  We will also show you how to use the Functional Performance Evaluation © to help you identify the client’s functional requirements, which can then later be used for designing a functional and specific rehab program.

Stage 2 – Sub-classify

In the second stage of the system we use the information gained in the subjective and physical assessments, along with any questionnaires, individual factors and other relevant information to:

• Make five categories of diagnoses.  Our all inclusive sub-classification system addresses the diverse range of identified changes that occur following pain.
• Prioritize each diagnosis

Each sub-classification has clearly defined clinical prediction rules that can easily be interpreted from the questionnaires and clinical findings. We will give you a decision tree to show you how to prioritize each diagnosis.

Stage 3 - Rehabilitate

In the third stage of the system we:

• Decide on appropriate rehabilitation strategies from a vast array of Therapeutic Options
  • Each sub-classification has clinical prediction rules (evidence based rehabilitation guidelines).  These guide you to the Therapeutic Options that are more specific for each sub-classification.
• Use this along with the previous information to make decisions on prognosis and timeframes for rehabilitation
  
  • We have identified short term goals based upon milestones of rehabilitation and will give you the current literature on how to predict outcome.
• The rehab program you chose can be used alongside manual therapy, neurodynamic, myofascial, connective tissues, viscero-fascial and reflex techniques you may feel are indicated.
  
  • Our system will help you identify priorities to better direct your treatment
  • As described above, the Functional Performance Evaluation © (FPE) can help you identify the client’s exact functional requirements, which can then be used for designing a functional and specific rehab program.  Another use for the FPE is to identify rehab risks in order to avoid contributing to harm or prolonging the problem by giving inappropriate rehab exercises.  Obstacles can be identified and strategies implemented to overcome these risks.  This can increase the likelihood of the success of the intervention.

Below are several Therapeutic Concepts, which each contain Therapeutic Options.  For example, Disability Prevention is a Therapeutic Concept and there are numerous Therapeutic Options we have to help prevent disability.  Similarly, if we want to improve Physical Working Capacity there are several Therapeutic Options we have to achieve this concept (i.e. strength, endurance).  Some Therapeutic Options are best used for some clients and not for others.  For example, if someone has a low risk for disability, we don’t have to spend a long time addressing Disability Prevention.  As well, if someone does not functionally require high load, we do not need to do high load strengthening.

Stage 4 – Re-evaluate

The fourth stage if the of the system is a self assessment component to ensure that the treatment is effective and encourages the clinician to reflect back upon their decisions.

• Re-administer outcome measures at appropriate timeframes in which CNS learning and plasticity have occurred in a sufficient amount to allow a clinical change
• Reassess and modify the interventions
• Identify any barriers to rehabilitation and develop strategies to address them if appropriate 
• Refer to another health care practitioner and see the client concurrently, at a later time or discharge
• Reassess the client`s needs and reassess goals
• Follow up is still appropriate even if the client has been discharged.