Show Notes
A few years ago, if you asked most clinicians what they wanted AI to do, ‘write my notes’ would have been pretty high on the list. Which is fair enough; nobody became a physiotherapist because they had a deep passion for clinical documentation. AI scribes have become remarkably good at solving that problem. They listen to our consultations, turn conversations into structured notes and draft letters before we’ve finished our coffee. But after more than a decade treating patients and running clinics, I’ve come to think we’ve aimed AI at the easiest part of the problem. Whilst notes are frustrating, the bigger admin problem is everything required to deliver good care between appointments. The invisible workload of good care Think about what happens after a fairly normal MSK consultation. You might need to update the patient’s exercise program, film a new exercise, find the right video, and write down the sets, reps and loading parameters. You might want to send the patient a summary of what you think is going on, remind them of their goals and explain what progress should look like over the next few weeks. Perhaps there’s an insurer form that needs completing before another block of treatment is approved. Then there’s the patient you haven’t seen for three weeks, who you were supposed to book again in seven days. Should you message them? Has reception already tried? What were their goals again? Did they stop coming because they were better? Because they weren’t improving? Because life got busy? Or because they forgot why the next appointment mattered? None of these jobs are particularly difficult, but multiply them by twelve patients a day, five days a week, and suddenly ‘good patient care’ has generated a second job. That’s the opportunity in AI that interests me most. Not simply making the documentation of care faster, but making the delivery of good care easier. We started with clinician-centred AI The first wave of healthcare AI has understandably been clinician-centred. Documentation is repetitive, expensive and unpopular. So we built machines that could do more of it for us. Whilst that’s a win, faster notes don’t necessarily mean better care. If an AI scribe saves me 30 minutes at the end of the day, I’ve improved my working life. If AI helps my patient understand their diagnosis, remember their exercises, see their progress and stay engaged with their rehabilitation, we may have also improved their life too. All practitioners want to deliver optimal patient care, but we’re often limited in what’s achievable by the number of hours in the day. This is where AI for physiotherapy starts to become much more interesting. Exercise adherence in MSK care is hardly a solved problem. Recent reviews continue to describe uptake and adherence to exercise-based rehabilitation as suboptimal [1]. We also know that adherence isn’t simply a matter of telling someone to ‘do their exercises’. Self-efficacy, social support, goal setting, instruction and demonstration are all relevant [2]. Digital interventions aren’t a magic wand either. A systematic review and meta-analysis found that digital rehabilitation improved therapeutic exercise adherence at intermediate follow-up, but not consistently at short- or long-term follow-up [3]. So the lesson clearly isn’t to throw more technology at patients, but rather to make the care we’re already trying to provide more individualised, consistent and easier to act on. The gap between knowing and doing Most clinicians already know what good care looks like. We know patients need clarity about their condition, we understand the importance of regular goal setting, and we know progress should be measured and visible. We’re also clear on the benefits of inter-appointment check-ins and the importance of following up with patients who have dropped out of care prematurely. But there is often a gap between knowledge and execution. A busy clinician can genuinely believe in all of those things and still finish a T
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It always struck me as bizarre that sports medicine and musculoskeletal specialties deal with pain and dysfunction from head to toe in the human body, yet offer little health literacy or inclusion of the pelvic floor. Traditionally considered taboo and someone else’s remit, men and women with issues affecting the pelvic floor have largely suffered in silence. Thankfully, change is afoot, and healthcare is finally evolving. There is much more awareness, inclusion, and understanding of this unique body area and the role that it plays. For anyone playing catch up, the pelvic floor is a group of muscles spanning the base of the pelvic outlet in layers. While both men and women have a pelvic floor, the pelvic outlet is wider in females than in males and it also contains an extra orifice – the vagina [1]. That’s right, we went there. We said the ‘V’ word. Because just like vulva, or vestibule, the vagina is simply an anatomical term. It needn’t be embarrassing or taboo. Some of you will be long enough in the tooth to remember when the word ‘breast’ was taboo. However, with healthcare campaigns for breast cancer and breastfeeding, this term became an anatomical norm. We need to do the same for the pelvic floor and its related anatomy and physiology. What does the pelvic floor do? In both men and women, the pelvic floor serves to control the bladder and bowel (maintain continence), empty the bladder and bowel (voiding and defecation) and support sexual function (arousal and climax). In women, the pelvic floor also plays an important role in pelvic organ support. Remember that extra orifice I mentioned earlier…well this area is high risk for connective tissue laxity and defects meaning that the pelvic organs (bladder, uterus, rectum) can descend into the vaginal cavity causing symptoms of heaviness, pressure and a sensation of ‘something in the vagina’. What are the signs and symptoms of pelvic floor dysfunction? If the pelvic floor is not doing its job, any of its roles can become compromised. This may manifest in leaking from the bladder or bowel, inability to fully empty the bladder or bowel, pain ‘down there’, sexual dysfunction (compromised erection, dyspareunia, pain with climax) or heaviness and pressure in the vaginal region (for women) [2]. A full list of sex-specific signs and symptoms of pelvic floor dysfunction can be seen in Table 1. Table 1 - signs and symptoms of pelvic floor dysfunction in men and women Who gets pelvic floor dysfunction? Pelvic floor dysfunction can affect any man, woman or child, however it is particularly problematic for women, especially during transitional life events, such as pregnancy/childbirth and the menopause [1]. One in three women will experience pelvic floor dysfunction [3] and for those that engage in sport, the prevalence of symptoms varies according to the load demands of the activity. For example 61% of netballers leak urine [4], up to 43% of female rugby players leak [5], and 32% of gymnasts experience incontinence [6]. Structural changes associated with vaginal childbirth and aging, as well as lower levels of oestrogen to lubricate and bulk out the tissues can increase the odds of experiencing pelvic floor dysfunction. However, even young adolescent females can leak urine due to the load demands of their sport. For example, in athletics and gymnastics, stress urinary incontinence (the involuntary leakage of urine during activities involving high levels of intra-abdominal pressure) is commonly experienced. Yet no-one is doing anything about it. No one is screening. No one is signposting. No one is educating these younger athletes that pelvic floor symptoms are not to be expected and normalised. Or that they simply indicate that the sporting demands exceed the load capacity at the pelvic floor. If this was any other area of sports or MSK practice, would we settle for a load capacity that does not meet the demands of the sport?! Why is this relevant to every therapist, no matter their di
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This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com