Domain | Recommendation | Comments |
---|---|---|
Experience | 1 | Not all centres have this many patients but may still provide a local service? it is difficult to be so dogmatic with numbers |
Competence | The number of treatments required is too high for a small country | |
Many little centres are not able to fulfill these criteria | ||
Quantity is not always reflecting quality | ||
Experience is important but it is not the only thing behind correct clinical decisions | ||
This is an ideal, but if there is a good CPO and the MD do not fulfill this recommendation is this important? | ||
My concern is availability of master physicians (there aren't in some countries) | ||
You cannot prohibit prescriptions by graduated MDs | ||
2 | Experience is important but it is not the only thing behind correct clinical decisions | |
This can be a problem for little centres or to recruit new CPOs | ||
My concern is availability of master physicians (there aren't in some countries) | ||
You cannot prohibit construction by licensed CPOs | ||
Team work for private professionals can be a problem | ||
Behaviours | 3 | Working as a team is difficult when you are not in the same place |
The team must include PTs specialized in the field | ||
Ideally the physician, orthotist and therapist should be seeing patients together in a clinic setting but outside of the clinic/hospital based programs this occurs very rarely | ||
Although ideal, I believe this will seriously impede the development of scoliosis interest in US by independent individual professionals (CPO and PT). This will run the risk of scoliosis only being able to be treated by bigger institutions and "directed" by MD. It could really impede the motivation of new and very strong independents from getting involved with scoliosis and with SOSORT. I believe you can have for instance a MD who is supportive of conservative management and refers to a very good CPO and appropriately defers the brace making and corrections to the very skilled CPO. | ||
Quite frankly, although the MD is important in diagnosis and especially in medical differential diagnosis, once he/she is done with that job, MUCH of the remaining hands-on conservative management is the responsibility of the CPO (and PT). These people should be allowed to have some degree of independence. In order to attract and retain really great CPOs, and PTs, these people will want to over time be more than just "technicians" They will want to have a decision making and larger role in the overall management of the case... Of course along side the MD is best, but not under the order of the MD... | ||
4 | To increase compliance MDs shouldn't change during treatment | |
Sometimes psychologists can be useful | ||
Also PTs have an important role in this | ||
Sometimes CPOs can create problems if they do not satisfy previous recommendations | ||
Compliance is a problem when you receive negative messages inside the team | ||
5 | If CPO knows his work is the MD that has to discuss with him | |
CPOs should lead this action and not MDs | ||
In North America ortho surgeons do not write details of prescription | ||
US physicians are not trained in giving details of brace prescription and this should be done together by CPO and MD | ||
If an MD is not convinced and committed he should send the patient to another MD for treatment | ||
In some brace prescriptions you don't need to give details | ||
Any action to promote compliance should be not manipulative (e.g. "if you do not wear a brace you will finish in a chair"...) | ||
Don't mix compliance with prescription | ||
Prescription | 6 | If CPO knows his work is the MD that has to discuss with him |
CPOs should lead this action and not MDs | ||
In North America ortho surgeons do not write details of prescription | ||
US physicians are not trained in giving details of brace prescription and this should be done together by CPO and MD | ||
If an MD is not convinced and committed he should send the patient to another MD for treatment | ||
In some brace prescriptions you don't need to give details | ||
Any action to promote compliance should be not manipulative (e.g. "if you do not wear a brace you will finish in a chair"...) | ||
Don't mix compliance with prescription | ||
Construction | 7 | In US details are not given by the MDs |
Don't mix compliance with construction | ||
About compliance CPOs have not to act autonomously but eventually support the action of MDs | ||
Any action to promote compliance should be not manipulative (e.g. "if you do not wear a brace you will finish in a chair"...) | ||
Brace check | 8 | MD has to check and the CPO only for his competence |
This is lead by CPO and MD is not necessary | ||
It's possible that the check by MD is not immediate | ||
The other members of the team should give their comments (PTs) | ||
What does "check aesthetic correction" mean? | ||
9 | We do not check braces but patients in brace | |
Clinical variance (no consensus) | ||
1.I check only clinically, rarely radiographically | ||
2.I check only radiographically | ||
3.I check radiographically only the first brace | ||
4.I check always radiographically a new brace | ||
The eventual radiographic check should be postponed one month after brace wearing | ||
We need more details on eventual x-ray check to have a standard | ||
Who evaluate the brace? | ||
Follow-up | 10 | If PT treatment is twice a week, it is a waste of time to check every time |
PTs usually are not well prepared: this recommendation is possible only in Scoliosis Centres | ||
This is not research, is only clinics | ||
11 | Follow-up must be maximum in 3 months, in growth spurt in 2 months (push loosening) | |
Controls in 3 months in case of: 1. first brace; 2. growth spurt; 3. progressive curve; 4. atypical curve; 5. predicted poor compliance; 6. request of other team members (CPO, PT) | ||
It's important to give protocols or use recalls | ||
12 | MDs have rarely enough time and knowledge: this should be responsibility of CPOs, that can judge it better | |
This must be respected by Health National Services | ||
Some braces allow more adjustability and should be chosen | ||
Sometimes in specific braces less than 3 months is necessary | ||
Correction is another reason to change a brace | ||
13 | Control should be made by MDs (CPOs should intervene autonomously only if the brace breaks) | |
MD & CPOs should check the braces together | ||
It's enough that one of the team (MD, PT, CPO) checks the brace regularly (every 2–3 months) | ||
The problem is growth and not time: I suggest every 2–3 cm. or kg. | ||
First braces should be checked after 1 month | ||
Efficacy can be checked only through x-rays and this is not possible every 2–3 months | ||
14 | It's not possible because PTs are not inside the hospital team | |
PTs usually are not well prepared | ||
Sometimes PTs tell the patient something wrong ! | ||
If PT treatment is twice a week it is a waste of time | ||
PTs should tell to physicians and not patients | ||
This is not research, is only clinics | ||
General comments | SOSORT should offer training for MDs, CPOs and PTs | |
It's better to compromise for compliance than to be very stiff and loose the patient | ||
SOSORT should develop methods to detect scoliosis (idiopathic and so on) as a brochure especially for general practitioner and pediatrician | ||
PTs should be trained in assessment of brace fit | ||
We need guidelines on x-ray assessment | ||
We need a group to evaluate brace efficacy and, at the same efficacy, brace compliance | ||
We need a way to certify MDs, CPOs and PTs prepared in scoliosis treatment | ||
We need objective questionnaires to evaluate psychological impact of treatments |