Case Study Introductions & Protocols
Copyright © August 2006 Ted Nissen
TABLE OF
CONTENTS
1 Introduction. 1
2 Case Study Unstructured Protocol 2
3 Case Study Structured Protocol 3
1.1.1
Massage therapy is unlike other forms
of therapy. We do not dispense medications, herbs or other systemic remedies or
order laboratory tests (Western &
Eastern Medicine). We do not perform surgery. We do not do low amplitude high velocity
adjustments (Chiropractic). We may do some therapeutic exercise but that is not
our primary focus. In short we have our hands, our sensitive touch and gentle
manipulations to both treat and guide treatment. We may share some assessment
techniques (Orthopedic Tests) with other professions (Chiropractic, Physical
Therapy, Orthopedic Medicine). We spend considerably more time with our clients
than the other modalities aforementioned. This may assist the massage therapist
in detecting subtle signs of problems in the body. Much like Weh islanders
foresaw the Sumatra Tsunami (Dec 2004) by observing natural signs massage
therapists and Eastern practitioners have a unique naturalistic assessment
perspective which although without the usual objective measurements can be just
as effective in warning of unusual body signs. Western Medicine has
increasingly accepted the non-objective eastern methods of assessment because
they result in effective curative treatment.
1.1.2
Typically our clients (Orthopedic
Massage) come to us in pain. Oftentimes they have engaged in overly intense
activity, novel activity, or repetitive activity. A relatively small area of
soft tissue may be involved in causing their clients pain. An important
therapeutic effect of massage therapy may be increased circulation to damaged
soft tissue. General massage techniques often will help resolve these problems
thru reflexive stimulation and improved circulation to the local area.
Sometimes treatment to specific soft tissue may be indicated and more effective
as both a palliative and or curative remedy. To determine which area of soft
tissue to treat, a variety of tissue tension tests (Orthopedic Tests) may be
used. By placing various degrees of tension the problem area may be identified.
Palpation and identifying referral patterns may also useful in locating
problems quite distant from symptom manifestation. Typically physicians who
refer patients are general practitioners providing general diagnostic
assessment, which is insufficient in locating specific soft tissues to treat.
For example a physician may implicate a strain or sprain in a muscle or
ligament without specifying the exact location of the problem. Oftentimes the
Orthopedic massage therapist will perform several tissue tension tests to
locate the specific lesion.
1.1.3
Once the tissue is located and
properly treated it is often true that no further therapy is indicated
oftentimes in many fewer visits than expected. Surgeries have been averted,
Physical Therapy deemed unnecessary. Cost savings to both the client, insurance
company, and employer may be realized. In short, Community benefit results when
conservative non-invasive massage therapy is tried as a first treatment
strategy.
1.2 Rationale for Case Studies
1.2.1
Assessment can be time consuming and
is not always a part of the therapeutic treatment. Clients are not always able
to pay for assessment services (97001/97002) and yet effective treatment may
depend on it. Assessment Services could be bundled under other categories such
as massage therapy (97124) but reimbursement may not be sufficient to warrant
service provision.
1.2.2
The purpose of these studies is to
outline the possible public and insurance benefits derived from effective
assessment/reassessment, and medical massage treatment. If benefits are noted
this may suggest the effectiveness of medical massage assessment and treatment.
1.2.3
These anecdotal studies may also shed
light on how often medical massage therapists and other practitioners (M.D.,
Chiro, PT) concur in their assessments. This further supports the notion that
medical massage assessments are effective warranting unique insurance
reimbursement under the 97001/97002 codes.
1.2.4
This may be useful to include in an
article to a massage magazine, summary paper to our political representatives
in Washington if we have them, meetings with insurance company officials, or to
representatives who visit AMA meetings (AMA CPT review cmte meeting).
1.3 Hypothesis
1.3.1
The cost benefit analysis will
demonstrate significant savings over the areas measured namely; Surgery,
Disability, Sick leave, and differential inter-professional costs.
1.3.2
A high correlation will be found
between massage therapist assessments and that of other professionals namely;
Physician, Chiropractor, and Physical Therapist.
2.1 Summary of Protocol
2.1.1
Just go to the online form, print it
out in landscape orientation. Fill in your identifying information (be sure to
include your E-Mail or you will receive an error message when you send it
online.) Pick a case that you want to include. Complete the cost benefit
analysis and concurrence analysis. Complete the case description and you are
done.
2.2
Protocol (Process) (The red
indicates how long it should take to complete each step)
2.2.2
Print the form from your browser
usually by going to the file menu and clicking print. Also click the
instructions button on the online form for more printing instructions. (2 minutes)
2.2.3
Read the form completion instructions
with the following link Instructions: http://www.anatomyfacts.com/Forms/casestudyi.htm
Be sure to include your E-Mail in the appropriate box before sending the form
otherwise you will receive a send error message. (5 minutes)
2.2.5
Use the hard copy form to record case
study information (30 minutes)
2.2.6
Finish filling out the form online
(copy information from paper to online form) including your identifying
information. Unstructured Case Study http://www.anatomyfacts.com/Forms/casestudy.htm
(3 minutes)
2.2.7
Press the send button to send me the
information. Be sure to put your E-Mail address otherwise the form won’t be
sent to me.
2.2.8 Total Time= 45 Minutes
3.1
