Why "it depends" is actually the best answer
For someone who has a very rigid type A personality, coming into DPT school and hearing the answer “it depends” for at least half of my questions was extremely frustrating. I kept thinking to myself What do you mean it depends? You’re the Professor you should be able to give me a concrete answer.
It became a running joke in my class and a funny catch phrase that we would use on each other. But still, it bothered me. I couldn’t believe that we were being taught all this information on different body systems, disease processes and injuries and yet when it came to information on the treatment more often than not the answer would be “it depends.” It wasn’t until my second year of DPT school (yes it really took me that long) to realize how the answer “it depends” is actually the most important and informative answer I could have ever received.
What is so great about physical therapy is that we get to work one on one with a human being. People are complex. Rarely will you find in the clinic a patient where the only thing going on in their life is their rehabilitation for their total knee arthroplasty (TKA). They most likely have responsibilities that they need to fulfill and your home exercise program (HEP) is the last thing on their laundry list of things to do. They might have stressors at work, at home, or internal battles within themselves.
Some live in a one story home and sit at a desk for work while others live in an apartment with two flights of stairs to enter and a job that requires them to do heavy lifting all day long. With all of the different demands life asks of an individual, there is no possible way that we could treat each TKA the exact same. Nor would I want to. How boring of a job would that be if you did the exact same interventions for every patient, every day?
Because, as students, we don’t have the vast clinical experience that our professors do, seeing all the different options and interventions can be overwhelming. And trust me, I can relate. What has worked well for me is to take in all the knowledge about the disease process and keep it in mind when talking to a patient. It is still important for you to know everything about the condition and all of the possible interventions (as well as keeping up to date on the latest research). However, the important caveat that our professors have been trying to teach us, is that when it comes to treating a patient you must hand pick individual components of those interventions that best suit the needs and wants of your patient.
So what does it depend on?
- How the condition presents itself for that patient
- Objective measures such as strength, ROM, sensation
- Patient’s beliefs about their condition
- What do they know about their condition? How do they think this affects them and their ability to participate in life?
- Patient’s coexisting health conditions
- Obesity, Diabetes, HTN, OA
- Patient’s expectations for physical therapy
- Patient’s past experiences with physical therapy
- What do they expect from you?
- Patient’s time
- How much free time do they have during their day?
- This will have an impact on their ability to complete their HEP
- Patient’s insurance/ socioeconomic status
- Patient’s home environment, work environment, social activities, support system
- And so on and so on..
If you’re going to take one thing out of DPT school it should be that your intervention must depend on the specific patient in front of you. You should listen to their story, figure out what their main concern is, find out what they believe about their condition and how it is affecting their life, and only then can you start to build an intervention that is tailored to address their main concerns and fit into their lifestyle.
Megan Mitchell, SPT