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Functional Outcomes

Functional outcomes is a method of working with a client that the insurance companies are requiring to prove medical necessity and allow massage therapists to get paid.  They are more interested in what is going on in the clients functional life, rather than what we are doing in a session.  It is the only thing they can measure.    They only want to know if the client can resume normal activity, not whether or not the client is completely recovered from their injury -which by my definition is the tissue healed to a pre-injury status.

It involves setting goals with the client to get the client back to normal functioning assuming that they have limited function. A functional goal starts with a long term goal such as " resume running 200m sprints within 6 weeks".  It is further broken down to a short term goal such as " lightly striding 60m sprints within 2 weeks".

Functional Goals, according to Diana Thompson, author of "Hands Heal", should be charted in the assessment section of SOAP. 

My issues with functional outcomes:

What happens to the people who come in with a stiff neck, but are still climbing Mt. Rainier on the weekend or riding their bike 120 miles? They are totally functioning in everyway, but are tired of waking up every morning feeling stiff.
What about the people who are injured and have loss of ROM, have pain but no loss of function?

The definition of healing has become one of can the client go back to work or resume normal activity, not is the tissue actually healed to a pre-injury/condition state.  Insurance companies don't want to be responsible for total recovery as they think that it may not be possible and will also increase what they have to pay out in settlements and services. 

To be able to make a long or short term functional goal assumes that the massage therapist has training in determining (diagnosing or assessing?) injuries and knowing when they are healed enough to resume physical activity.  Physical therapists are highly trained in this and there are specific textbooks that I assume go with college level Physical therapy class in physical therapy. Just do a search at www.amazon.com for functional outcomes.

Functional Outcomes Document for Physical Therapists
by Lori Quinn, James Gordon, Richard B. Goldbloom  ISBN: 0721689477

Lower Extremity Amputation: A Guide to Functional Outcomes in Physical Therapy Management
by Linda Karacoloff, Frederick Schneider (Editor), Carol Stube Hammersley
ISBN: 0834202913

Functional Assessment and Outcome Measures for the Rehabilitation Health Professional
by Sharon S. Dittmar (Editor), Glen E. Gresham (Editor) ISBN: 0834209292

Can a Massage therapist learn how to set up functional outcomes in a 5 hour workshop?

Are we qualified as massage therapists to determine the severity of the injury and determine when the client should get back to their normal activity?  What is involved in setting up functional goals?  We need to be able to determine if the muscle/joint is capable of sustaining the movement without further injury or setback.  To me this involves having a diagnosis - how much has the tear healed? To me setting a functional goal is outside my scope of practice.  I would not want to tell someone to go out and lift their toddler with their rotator cuff tear, just because the pain is somewhat reduced.  What if it isn't totally recovered and able to handle normal functioning?  From what I know, this is in the realm of physical therapy.

The definition of massage in WA state is:

"Massage" and "massage therapy" mean a health care service involving the external manipulation or pressure of soft tissue for therapeutic purposes. Massage therapy includes techniques such as tapping, compressions, friction, Swedish gymnastics or movements, gliding, kneading, shaking, and fascial or connective tissue stretching, with or without the aids of superficial heat, cold, water, lubricants, or salts. Massage therapy does not include diagnosis or attempts to adjust or manipulate any articulations of the body or spine or mobilization of these articulations by the use of a thrusting force, nor does it include genital manipulation.

The scope of practice for Physical therapy in WA state seems more applicable.

"Physical therapy" means the treatment of any bodily or mental condition of any person by the use of the physical, chemical, and other properties of heat, cold, air, light, water, electricity, sound, massage, and therapeutic exercise, which includes posture and rehabilitation procedures; the performance of tests and measurements of neuromuscular function as an aid to the diagnosis or treatment of any human condition; performance of treatments on the basis of test findings after consultation with and periodic review by an authorized health care practitioner except as provided in RCW18.74.012; supervision of selective forms of treatment by trained supportive personnel; and provision of consultative services for health, education, and community agencies. The use of Roentgen rays and radium for diagnostic and therapeutic purposes, the use of electricity for surgical purposes, including cauterization, and the use of spinal manipulation or manipulative mobilization of the spine and its immediate articulations, are not included under the term "physical therapy" as used in this chapter.

So again, my question are:

What do we want to be telling insurance companies and medical professionals about what we do?

What are we allowed to assess an injury?

What is the difference between a diagnosis and an assessment?

Discuss these and other issues at theCommunity Bulletin Board or with your peer supervision group at www.massagepracticebuilder.com

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