Great Outcomes Require Proper Dosing

While this concept of dosing is commonly understood regarding medication, it is often lost on physical therapists and their patients. Without an explicit explanation, patients often don’t realize that their success will depend upon the right amount of treatment intervention to fully experience the benefits of therapy. In my experience, many PTs often fail to realize the power of discussing the importance of the proper dose of treatment to achieve an outcome. When striving to improve patient engagement, talking about dose can be a useful tool in the toolbox. 

Defining Dosage

It’s essential that patients understand that therapy (physical therapy and psychotherapy) is a process. Our ability to progress patients depends upon the patient’s ability to understand and respond to the treatment. And the amount of treatment depends upon an accurate assessment of all the patient’s involved systems. In short, we are trained to identify the systems that need to adapt for a successful functional outcome.  

Early in the plan of care, the treatment dose may be directed at one system, such as psychomotor control, or pain modulation. As the plan of care progresses, the treatment will include additional systems, such as cardiopulmonary to improve endurance. All phases of the treatment plan may include some form of behavioral modification. Each of these systems are “dosed” with an intervention, an exercise, manual technique, or conversation that enhances the patient’s resourcefulness.  

If you overdose the treatment, there are side effects. If you underdose the treatment you may not see the necessary changes. Proper dosing of an intervention can determine the patient's level of engagement, satisfaction, and eventual clinical outcome.

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Communicating Dosage to Patients

I recently wrote about the importance of developing your power skills to help patients better understand their affliction, realize there is a way forward, and instill confidence in them by helping them build self-efficacy. Any time you use power skills to help the patient frame their experience of injury, pain, and healing, you are helping the patient become more resourceful. 

While your active listening and empathic connection will create a foundation of safety and trust, your explanation of their diagnosis and treatment plan will create a cognitive map that contributes to the patient’s total experience. When done skillfully, you are not just doing stuff to the patient, but rather helping them to contextualize their experience. Helping them understand why a proper dose of your treatment is important to success is critical to this, and therefore patient success.  

Co-Creating a Treatment Plan

When possible, create a therapy roadmap at the first visit. We learned from The PT Patient Experience Report that outlining this process at the start of their journey is essential to helping patients better understand their role in their plan of care and what to expect. In doing so, patients are more likely to follow you when you describe to them the road ahead. Co-creating a vision of their future and describing the phases and interventions will help to calm their anxieties about the journey, build trust, and prime their brains for actively engaging in the treatment plan. I often draw a timeline on the board to illustrate the phases of the treatment plan and how it ends with a successful outcome.

When co-creating the treatment plan, consider framing each visit and your interventions as “doses” of treatment. Your hands-on treatment and motor control training are valuable interventions, yet patients may not understand their value. You can increase the perceived value by explaining the importance of getting the necessary dose to achieve the desired outcome. 

It might sound something like this: “OK, you want to get back to playing golf, and you are concerned about this back pain. From our examination today, you have tight hips, poor core muscle control, and some balance issues. Getting you back on the course and feeling better is going to require addressing each of these things in small doses so that your body adapts to the changes you want. Each time you come to the clinic, we will address each of these areas. If we get the proper dose of treatment on each, you are likely to get back to playing and less likely for it to recur.”  

Of  course, the content of this discussion will vary depending on the affliction, the structure of the conversation will be similar.  

Bottom line: the patient needs the proper dose of treatment to achieve an optimal outcome. Therefore, they need to understand that skipping a treatment session with you is like skipping a dose of important medication. When patients understand that their body needs a dose of your interventions to improve, they will place a higher value on the experience, make the conscious choice to attend, and be more likely to reach their goals.