Developing an Engaging Management Plan
Talysha Reeve
Musculoskeletal Podiatrist & Clinical Educator - I want to work with you to help you stay at the forefront of evidence-based practice and achieve great clinical outcomes.
Creating engaging and effective management plan is an essential, yet sometimes overlooked element of musculoskeletal pathology management.
Providing your client with a clear management pathway is often the cornerstone for achieving great clinical outcomes.
When we are able to provide our clients with what their recovery journey may look like, it provides reassurance, enhances patient satisfaction and facilitates improved engagement.
Today I want to share some tips to help you craft comprehensive treatment plans that resonate with your patients, all with the goal of improving your patient outcomes.
The Importance of Having a Plan
One of the most crucial steps in developing a management plan is educating your patients about what you're planning, why you're planning it and how it relates to their goals.
It's important to:
Explain the condition
Use simple, clear language to describe the patient's condition.
Remember, word salads don't belong in healthcare
Visual aids or diagrams can be particularly helpful.
Analogies are also a great way to bridge the gap of understanding (read more here).
Discuss effective treatments
Share with your client the evidence-based treatments that are most likely going to have a role in achieving a successful outcome for them. Always ensure that your treatment recommendations align with the individual's clinical presentation.
Knowing the therapeutic goal of your treatment intervention is essential
This helps patients understand the rationale behind your recommendations.
Discussing the treatment options also lets you know what definitely is or isn't on the cards for your clients.
If they can tell you outright that there is something that they definitely won't do, even if this is an essential element, you can adjust your plan around this, or even refer on to someone better positioned to help them.
The more you explore barriers with your clients, the more ways you learn to become adaptable. This is also why it is so important to understand the therapeutic goal of your treatment intervention.
For example; if you only have one "gold standard" exercise in your repertoire and your client 100% won't do at home or gym-based rehab, having an understanding of other methods that may load the tissue to achieve a similar result is hugely beneficial.
Read: Dosed Movement Alternatives to "Standard" Rehabilitation Exercises here
Identify Macro and Micro Goals
Setting goals is a critical component of any management plan.
Goals should be structured at both macro and micro levels:
Macro Goals
These are your overarching treatment goal(s).
These are the big-picture objectives, such as full recovery, return to sports, or achieving pain-free mobility.
Micro Goals
These are often your between appointment goals, or identifiable steps along the recovery journey.
For example;
"Once you are able to do 3 sets x 20 repetitions of this exercise over 3 consecutive sessions without a flare, we will progress the exercise."
"Once you're able to run 3 x per week for 30min @ 6:00min/km pace with no flares, we will introduce; another session / an increase in running time / an increase in pace (dependent of overall goals)
Break these down into smaller, manageable steps that can be achieved between appointments. This approach keeps patients motivated and provides a clear pathway to their macro goals.
Plan A, B, and C
Having multiple treatment plans (A, B, and C) is essential for flexibility and patient confidence.
Why do I tell my clients what Plan A, B (and possibly C) are?
1) We're rarely know 100% exactly how someone is going to respond to a therapeutic intervention. We may have a high-degree of certainty, but there's always that one patient who becomes the exception to the rule.
2) If you marry yourself to an exact process with little room for adjustment and adaptation, if it doesn't go to plan (i.e., this person is the exception to the rule) it can increase their feelings of uncertainty, anxiety, and (importantly) damage their confidence in you as being someone who may be able to help them.
There certainly are instances in which we are limited in what we can offer a client. In these situations your Plan B may be referring on to another practitioner or service that may be able to assist.
Remember, an appropriate referral is one of the best things you can do for your patient, your reputation and your business!
Plan A
This is your primary approach based on the patient's clinical presentation.
For example, "Based on your symptoms/clinical presentation, I would recommend starting with ____________________ treatment(s), as this appears the most likely to be effective in addressing ____________________ (symptoms/pathology drivers etc)."
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Plan B
Have a secondary plan ready in case Plan A is not effective / is limited in its efficacy.
Explaining to your patient, "If we don't see the desired results with Plan A, we will move to Plan B to address __________________.",
You can have a "Plan B" for an entire treatment approach (e.g., conservative vs surgical, load management vs LM + orthoses etc...), or you can have a "Plan B" for elements of a treatment (e.g., an exercise regression, trialing strapping vs orthoses, footwear changes vs orthoses etc...)
Benefits
✓ Allows for flexibility in treatment approach & delivery.
✓ Builds and maintains confidence if things don't go to plan.
✓ Allows you to utilise & practice your clinical & critical thinking skills.
Plan C (not always required)
This is a tertiary option to address further contingencies.
Transition from Plan A to B (or C) should be based on:
Importance of Having a Plan
A structured management plan is crucial for several reasons:
Engagement
Involving patients in the planning process improves their engagement and adherence.
"I understand why we are doing things this way."
Positive Outlook
A clear (yet, adaptable) plan provides reassurance and fosters a positive outlook on treatment and recovery.
"I know what to expect and where my treatment is going."
Avoiding Negatives
Without a plan, patients may feel uncertain about their treatment, leading to disengagement, increased attrition rates, and a negative outlook.
"This has made my pain worse, clearly _____________ doesn't know what they're doing!"
"This hasn't worked, I need to find someone else who can help me."
Components of a Management Plan
An effective management plan should include:
If you'd like a free guide that helps step you through the exercise prescription thought process, the Movement Prescription Blueprint can be downloaded here.
Linking Patient Goals to Therapeutic Goals
Finally, it's important to link what the patient wants to achieve (their goals) with what you plan to do (therapeutic goals). For instance, if a patient wants to return to running, your therapeutic goal might involve a structured rehabilitation program focused on strengthening and flexibility exercises tailored to running mechanics.
Clients tell us what, we show them how
Looking through a musculoskeletal rehabilitation lens, for a clinician to formulate therapeutic goals there are a number of elements we must explore the what, why and how.
The Art of Therapeutic Goal Setting - Read Here
By following these guidelines and continuously engaging with your patients, you can develop robust and effective management plans that enhance treatment outcomes and patient satisfaction.
Remember, failing to plan is planning to fail...
As always, I'd love to hear your thoughts on this article.
Leave a comment or drop a DM.
Lastly, if you're wanting 1-on-1 support to improve your lower limb MSK rehabilitation practices, I can help.
Check out www.progressivepodiatryproject.com/p3me or email me at info@progressivepodiatryproject.com, I'd love to hear from you.