Defining tolerance in therapy
Shelly Mesure, MS, OTR/L
How do you define tolerance? Is tolerance measurable? Is tolerance too subjective? What about activity tolerance? We love to document how patients are improving activity tolerance, but many times that's all we state in our documentation. So what have we said? Very little.
Let's review the terms: ACTIVITY, TOLERANCE. In the documentation, have you clearly indicated the type of activity? This can be done through overall activities, such as, lower body dressing tasks. Or, it can be more specific, such as, dynamic sitting balance at edge-of-bed.
Both are aspects required to complete this task and achieve functional goals. But if a patient is unable to tolerate sitting or requires assistance to perform dynamic sitting balance, this will affect the ability to perform the lower body dressing tasks.
Have you mentioned the tolerance aspect to complete this activity? How would you measure this objectively? Tolerance is the ability to tolerate the task. So, if you're making claims that the patient has increased this ability, what aspects of the task have they increased their tolerance?
Time is a fantastic way to measure objectively. The ability to increase tolerance could be the patient's ability to demonstrate dynamic sitting balance at edge-of-bed for 3 minutes today compared with 30 seconds from yesterday. Or that they could complete all of their lower body dressing tasks within a time limit (such as less than 5 minutes) and indicate how much support was provided.
Too many times we give the generic statements of, “Patient is making gains in all areas,” or, “Patient has demonstrated increased activity tolerance.” In the first statement, have you documented what type of gains and what areas? In the second statement, have you indicated what types of activities and how have they demonstrated tolerance?
Try to avoid these types of generic statements and you'll already be on the road to better and more accurate documentation.
Shelly Mesure ("measure"), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a veteran speaker and writer on therapy and reimbursement issues.