Have you ever wondered how you could better quantify a scar in your documentation?

Tina Allen, PT, PRPC has been a physical therapist since 1993 and has specialized exclusively in pelvic health in all genders and throughout the patient's life span for the past 28 years. She works at the University of Washington Medical Center in a multidisciplinary Pelvic Health Clinic where she collaborates with physicians to optimize patient recovery. Join Tina in her upcoming course Manual Therapy of the Abdominal Wall scheduled for November 18, 2023.

One option in our written documentation is to include information on pain, pigmentation, pliability, surface area, height, and patient-reported functional limits due to the scar. This can be time consuming and is difficult to replicate between sessions. As practitioners, we need to be able to show specific gains for insurance and to assist patients (and ourselves) in recognizing gains.

Did you know you can also utilize grading scales that originally were developed for usage with Burn survivors?

We could simply utilize a visual analog scale, but by using a scar assessment tool we can use one simple scale to quantify multiple factors affecting function for the patient. One such scar assessment tool is the Patient and Observer Scar Assessment Scale (POSAS version 2.0). The POSAS is free to access for clinical use and includes both a patient reporting form and a clinician reporting form. 

Your patient can utilize the POSAS to report on their current experience of scar symptoms including location, pain presence, scar sensation and restrictions in movement/activity. While as the Clinician questionnaire includes rating from 1-10 regarding vascularity, pigmentation, thickness, relief, pliability, and surface area. 

In the clinical environment, we often must justify our interventions with outcome measures, and to be able to add to the research supporting our interventions. In the case of scar management utilizing tools such as the POSAS goes a long way for us as rehab professionals.

 Other scales include Manchester Scar Scale, The Stony Brook Scar Evaluation Scale and the Vancouver Scale.

 Data from 2015 shows that 28% of pregnancies in developed countries end in C-section, and in April 2022 the American College of Surgeons reported that four-million abdominal surgeries are performed per year in the US. It is unclear why some patients develop painful scars or functional limitations from their scars, but those that do can benefit from Rehab Therapy interventions. Our rehabilitation skills in evaluation, movement education, and manual therapy can facilitate patients in their return to function.

By utilizing the above scales practitioners can assist with quantification of limitations while showing gains achieved from interventions.

Manual Therapy is a way for the clinician to manage tissue tension, holding patterns, and movement restrictions that have developed. Techniques learned in the foundational course, Manual Therapy for the Abdominal Wall, can be applied to the rest of the body and used as a building block for more specialized manual interventions. In the course we address observation and evaluation skills of the myofascial system including scar that assist the clinician in rating forms such as the POSOS scale. Participants in this course will learn to utilize the abdominal wall as a way to build and refine foundational skills of touch, loading, unloading and to address myofascial and functional restrictions.

References:

1. https://www.posas.nl/.
2. Deflorin, C., Hohenauer, E., Stoop, R., Van Daele, U., Clijsen, R., & Taeymans, J. (2020). Physical management of scar tissue: a systematic review and meta-analysis. The Journal of Alternative and Complementary Medicine, 26(10), 854-865.
3. Olszewska, K., Ptak, A., Rusak, A., Dębiec-Bąk, A., & Stefańska, M. Changes in the scar tissue structure after cesarean section as a result of manual therapy. Advances in clinical and experimental medicine: official organ Wroclaw Medical University.
4. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/press-releases/2022/machine-learning-and-patient-outcomes/.

Manual Therapy Allows a Patient to Move Better - An Interview with Tina Allen

Manual Therapy for the Abdominal WallManual Therapy for the Abdominal Wall

 Price: $225.00          Experience Level: Beginner          Contact Hours: 7 hours

Course Date: November 18, 2023  

Description: This remote course is designed to provide an introduction to the basics of myofascial techniques and applying them to the abdominal wall. This course is intended for the pelvic rehab therapist who may be new to palpation and manual therapy techniques, or who wants to refine their skills of discriminate touch. These myofascial techniques can be utilized to assist with treatment of abdominal scars, endometriosis, IC/PBS and abdominal wall restrictions that impact pelvic girdle dysfunction.