To assure effective rehabilitation, you need to
know, communicate and prove each of the following points - isokinetics
gives you the answers.
- What is the clinical status of the patient and how
does it influence function?
- What is the most appropriate treatment for the
patient?
- How much treatment will be required?
- Has the patient been rehabilitated?
- That there is NO less intensive or more appropriate
evaluation or treatment alternative.
Issue 1:
What is the clinical status of the patient and how does it influence
function?
Disease leads to impairment, impairment leads to
functional limitations and functional limitations lead to disability.
Physicians, therapists and athletic trainers have relied on isokinetic
testing for quantification of musculoskeletal performance impairments.
The impairment is expressed as a deficit in a muscle’s ability to
produce force, perform work,or generate power. All the referenced
studies use isokinetic assessments to establish baselines and goals for
criterion based rehab programs.
Issue 2:
What is the most appropriate treatment for the patient?
The referenced studies document treatment programs
for many common pathologies. When used in conjunction with
evidence-based protocols, the isokinetic data allows the clinician to
make the appropriate changes to the clinic activity portion and/or the
home based portion of the program. The isokinetic data may also show
that a patient is no longer responding to therapy or that therapy should
be discontinued.
Issue 3:
How much treatment will be required?
These studies document that even with complex
problems, ACLs, shoulder impingement, arthroscopic subacromial
decompression, rotator cuff and ankle instability, that there are fairly
consistent and predictive time frames for returning to different levels
of function.
Wilk (1992) documents the status of 250 ACL
reconstructed knees at 12 weeks post-op. Timm (1988) shows the results
after an average of 8.9 weeks of rehab for post-surgical knees.
Issue 4:
Has the patient been rehabilitated?
All the studies show a correlation between the rehab
program, isokinetic data and return to functional activities. The study
by Timm (1988) documents that isokinetic exercised based programs are
more efficient and effective than non-isokinetic programs. Wilk (1991,
1992) follow-up studies with ACL patients 12 weeks and 6 months post-op
document successful rehab programs. The study by Ambrosios (1994),
showed the average therapy sessions for a non-surgical group was 4.39
weeks versus 7.59 weeks for the surgical intervention group. The cost of
therapy was twice as much for the surgical group. Both groups achieved a
high return to work rate: surgical 84%, non-surgical 98%.
Issue 5:
Is there a less intensive or more appropriate diagnostic or treatment
alternative?
No. Some consider a manual muscle test as an
alternative for measuring strength. Many references to the problems
associated with a manual muscle test are cited in Wilk (1991) and Kulman
(1992). These problems include consistency in grading and method,
subjectivity in reporting, and poor inter-tester reliability. Also,
manual muscle tests are performed statically, whereas isokinetic testing
renders objective reliable data regarding muscular performance during a
dynamic contraction.
[“...isokinetic testing renders objective reliable data
regarding muscular performance during a dynamic contraction.”]
(Wilk 1991)
The medical providers that utilize isokinetics are
telling the insurance companies that they want to control costs and
manage cases objectively towards a positive outcome. Insurance companies
that reimburse for isokinetic tests are telling providers they expect
objective case management.
