Part I Overview
This text contains concerns for more than 100 interventions and 7 tests used in physical rehabilitation and related disciplines. This section provides an overview and an illustrative summary for many of these concerns.a
Table 1 gives a birds-eye view of interventions classified into 10 major categoriesb: therapeutic exercise, manual techniques, AAOPSP (equipment), airway clearance, wound care, injections, physical agents, mechanical modalities, electrotherapy (E stimulation), and complementary and alternative medicine (CAM). Concerns under an intervention are listed by disease categories (ICD-10). By identifying an intervention in the left column and then reading across the disease categories from left to right, the reader can identify categories that may be of concern for a particular intervention (noted by solid circles). For example, power mobility lists the eye disease category as a concern. By consulting the power mobility chapter, the reader will see blindness listed as a contraindication.
Table 1 a, (1) Table and figures illustrated here contain many but not all concerns that are listed in the text. Examples of items not included are communication, teaching, documentation issues, older driver concerns (>100 concerns), and concerns where averaging individual source contraindication (i.e., where sources do not offer a set of guidelines) would be inappropriate (e.g., aerobic exercise, resistive exercise). (2) Figure D (Review of systems) contains procedural and vulnerable tissue concerns, although these two categories are technically not ICD categories (see Preface). b, Also includes older drivers, tests and measures.
When interpreting the table, the reader should be aware of the types of conditions that may be listed under the various disease categories used by ICD-10. For example, “Medical Devices” may mean latex toys, contact lenses, an unstable joint arthroplasty, or equipment that emits electromagnetic interference. Vulnerable tissue may imply immature epiphyseal plates, superficial peripheral nerves, or unprotected eye exposure to ultraviolet radiation. Injury can include acute trauma, burns, and open wounds such as pressure ulcers. Blood usually implies bleeding but may also include immunological problems and sensitivities/allergies in some cases. A fuller description of these concerns can be found in each chapter.
Figure A lists the total number of concerns for 62 physical rehabilitation interventions in order of magnitude. On the left, two debridement procedures offer relatively few concerns, whereas on the far right, therapeutic massage contains more than 60 total concerns from various sources. Please note that individual sources typically list far fewer concerns (see figure C), suggesting that sources do not always agree on precautions.
Figure B reorganizes the same information, but grouped by modality. In this way, the reader can get a sense of which interventions within each area of rehabilitation note the greatest number of patient concerns. For example, for physical agents, electrical stimulation and complementary and alternative medicine, hydrotherapy, neuromuscular electrical stimulation, and acupuncture list the greatest number of concerns, respectively.
Figure C shows the average number of concerns for interventions, in order of magnitude. Average means that if one source lists 15 concerns and another lists five concerns, the average for this intervention will be 10. The reader will notice that the number of average concerns is far less than the total number presented in Figure A. For example, although the total number of concerns for hydrotherapy is more than 40 (Figure A), the average number per source is a little more than 20 (Figure C; second vertical bar on far right). The larger number of concerns under Figure A can be attributed to individual sources contributing somewhat different concerns for a particular intervention that results in a larger list of guidelines overall.
Figure D lists the number of disease categories that may be a concern for a particular intervention. A useful way to think about this graph is to observe the number of systems a clinician may need to screen (i.e., systems review) when considering a patient for a particular intervention. For example, a clinician may only need to review three systems before dispensing a compression garment, but many more (16 systems) before prescribing neuromuscular electrical stimulation (NMES). Further reading and more graphs can be found at the end of this book in the Appendix.
Related
Contraindications in Physical Rehabilitation Doing No Harm
