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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 65 SETTING GOALS Communication Every client is different, with unique perceptions of wellness and goals for health. Engage each by asking questions about their life now that they have their health back. You're familiar with what they couldn't do; now ask what they want to do and work with them to integrate new activities without exacerbating their injury. People who can do everything with little or no pain may still have issues they want to address. Identify goals by exploring what they want to get out of massage. Prompt them with ideas about more restorative sleep, skills for coping with stress, increased awareness regarding posture, or noticing when stress begins rather than just dealing with the aftermath of stress. I often hear clients say they didn't know massage would work for reducing nerve pain, or that working on their feet could help their hips loosen up, or that massage would improve their attitude and self- esteem. As people's self-esteem rises, they tend to make healthier choices about their eating habits and activities. When setting goals with a client, consider the types of activities they enjoy and their values regarding family and community. Encourage clients to participate in social activities. They may discover they're not alone in striving for a healthier life. Teaming up with friends and finding classes to attend between massages will keep them on track. Functional Outcomes There are several measurement tools for charting progress over time. Progress motivates clients to commit to ongoing care. The one that's already been used in the examples above is called functional outcomes reporting. This is common throughout health care, most often used by physical and occupational therapists. It's simple, measurable, and can be modified to fit any individual. The structure used to ensure functional goals are useful is called SMART goal setting (see chart below). A common mistake in setting functional goals is not setting homework goals. These are distinctly different. You can weave homework into a functional goal, but the goal itself should focus on a specific daily activity, such as sitting at the computer working, standing on the sideline at the soccer game, walking up stairs to bed, getting into the car, working on a project under a deadline, fixing the kids' bicycles, etc. We want the goal to center around something the client really wants to enjoy—and homework is often just a means to an end. Always define success through a measure and a feeling. For example, reading two hours in a row, 3–5 days per week with no headache; waking only two times per night, 5–7 nights per week with no more than mild fatigue upon waking; or running three miles a day, three times per week with no more than 24 hours of muscle soreness afterward. Remember that measures usually involve numbers; feelings usually describe soreness or fatigue. Be careful to set goals that will be attained within 60 days or less. People need to feel successful to stay motivated. Short-term goals should be attainable within 2–3 weeks, long-term goals within 1–2 months. Help your client choose an activity they do frequently. You want to be able to measure progress on a regular basis. If they are training for a marathon, set multiple short-term goals around walk- running first, and then add mileage as you go. Always include a time-based goal. If the goal is not accomplished within the time frame selected, you can always modify it. Knowing when to celebrate is important. When each goal is accomplished, praise your client and move on to the next goal. Numerical Scales Numerical scales are easy to use. Choose a number system that starts with zero. You want to state when there is no pain as well as the presence of pain. The most commonly used scale is 0–10 and can be used for most anything. I recommend using 0–10 scales for pain, function (activities of daily living), and mood. In addition to numerical scales, there are value scales comprised of statements that describe the activities limited by pain. The smiley face is a visual scale helpful for children and those for whom English is not their first language. The Defense and Veterans Pain Rating Scale is an excellent example of combining a numerical scale, value scale (words), and a visual scale to best assist people in scoring how they feel at a point in time. 7 Most scales produce outcome measures that can be graphed over time. This is a good visual to demonstrate progress and keep clients motivated. With electronic health records more widely available, choose S Specific to activities of daily living Measurable, both quantifiable and qualifiable Attainable Relevant Time bound M A R T

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