The Importance of Documenting Client Progress in Massage Therapy

diana-thompsonAs a massage therapist focused on wellness and complementary health care, you do more than just help your clients relax. You help them feel better and often times overcome pain.

Sometimes a single session can be enough to relieve your client of a nagging issue. Other times, however, you need to set up a treatment plan to help your clients get better. This is when you may want to pay close attention to client progress.

We wanted to get more more information on tracking client progress from an expert, so naturally we turned to Diana Thompson. Diana is a past President of the Massage Therapy Foundation and a respected practitioner and educator. We were thrilled to speak with her and would like to share her thoughts with our readers.

Massamio: How did you get started in massage therapy?

Diana: I began doing massage in college for club athletes. My plan was to go into sports medicine, so I took classes in athletic training, kinesiology, and coaching. I was a shot putter on the track team and played on a club rugby team and spent a lot of time in the training room. Rugby players got injured all the time and did not have access to the training room like the sanctioned athletes did, so I took what I learned and applied it to taping, icing, and massage.

Massamio: What are some of the areas of treatment you specialize in?

Diana: Originally, I only did sports massage. My childhood dream was to be on the medical team at the Olympics and in 1996 I fulfilled that dream as a massage therapist for track and field. But in the ’80’s I was in two horrible car accidents two years apart. Neither car had seat belts and I shattered the windshield with my head twice. As a result, I was exposed to another purpose for massage therapy‹a treatment for whiplash, head injuries and eventually chronic pain. Now, most of my patients have chronic pain or are undergoing surgery. I do a lot of manual lymph drainage pre and post surgery and fascial release on scars.

Massamio: Why do you think it’s important to track client progress?

Diana: It is essential to track patient progress. When people wake up in pain or experience pain every day they loose perspective on their progress. All they know is they are still in pain. It is up to me to track their progress through ADLs and demonstrate it through pain charts, graphs, etc., so people can experience the contrasts of more pain/less pain. In the contrast, people can make better choices and contribute to their progress.

Massamio: How has tracking client progress helped you grow your practice?

Diana: People see how effective massage therapy is in their healing and in their quality of life. If they are focusing just on getting to no pain, which is not always tangible for those living with chronic pain conditions, they feel nothing is working and often give up. Massage offers relief and tracking that progress is the key to maintaining hope that more permanent relief is possible.

Massamio: What tools do you use for tracking client progress?

Diana: The easiest tool to use is a 0-10 scale to rate pain and function. This can be assessed verbally and often, and can be graphed to demonstrate progress over time. The visual analog scale is similar but is a line of continuum without numbers. Rather, it has no pain (or full function) on one end and the worst pain possible (bedridden) on the other. People mark a line between the two values to denote where their pain level (or function) is currently. The nifty thing is that the line is 10 centimeters long, so one can measure where the mark falls and still graph the progress on a scale of 0-10. In addition to these simple scales, there are many scales that provide descriptions of daily activities, asking the user to check a phrase that most accurately describes their ability to perform the activity. These include the Functional Rating Index, the Oswestry or Vernon-Mior Pain and Disability Index to mane a few.

Massamio: What advice do you have for a massage therapist who is interested in
getting better at tracking client progress?

Diana: Start with one patient this week that has pain and some loss of normal function and ask them to rate their pain and function on a scale of 0 (no pain) and 10 (worst pain imaginable). Next, pick one more person and do the same thing. Keep it up each time the person returns, ask them to rate their pain and function, and begin comparing the numbers to previous sessions. If you add one person per week, you gradually get better at tracking and eventually you will be tracking progress for everyone.

Another idea is to download a measurement tool and use it as part of the intake process. With each new client, you include this measurement tool with the health history form. Every 4-6 sessions, you give them another copy of the measurement tool for them to fill out. Gradually you collect enough data to show progress.

Massamio: What resources are available to help massage therapists track client
progress more effectively?

Diana: My favorite website for finding measurement tools is www.outcomesdatabase.org. This is a comprehensive listing of measurement tools for various needs, with physical, psychological, social, and spiritual measures. I have done quite a bit of investigation into measurement tools and have handpicked some specifically appropriate for most massage practices. Those can be found in my book, Hands Heal: Communication, Documentation and Insurance Billing for Manual Therapists, 4th edition.

Massamio: How has tracking client progress helped you integrate with the medical
community?

Diana: All health care providers are expected to chart treatment sessions and communicate medical necessity for the care provided. This is done in two ways: charting symptoms and assessment findings that affirm the condition exists, and charting progress that demonstrates the treatment was effective for helping resolve the condition.

Massamio: What do massage therapists need to know before tracking client
progress?

Diana: The best thing to know is that there are two different types of charting. Tracking progress can be very different when providing wellness or preventative massage verses treatment massage. If someone is seeking massage therapy and they have a medical condition, it is easy to track progress by measuring each symptom’s expression: pain, limited movement, swelling, etc. When people seek massage and are healthy, there are no symptoms to measure progress by. However, most people are affected by stress and use massage as a way to keep stress from making them sick.

In these cases, it is important to ask questions about how stress is affecting them, for example, with regard to sleep. Track sleep by quantifying the number of hours they sleep in comparison with their usual nights’ sleep (6 hours on a bad night vs. 8 hours on a good night, or 6/8), track the number of times they wake in the night and how long it takes them to fall back to sleep. You can also qualify their sleep by rating how rested/fatigued they feel upon waking on a scale of 0-10. Recognizing that not every one is in pain when they come for a massage is helpful in successfully applying measurement tools.

Massamio: Anything else you would like to add?

Diana: It might be hard to get started with tracking progress, but once you do, clients/patients will check in with you about how they are doing in comparison with last year at this time, for example, and come to rely on you as an integral part of their health and wellness routine.

Diana L. Thompson, LMP, a licensed massage therapist for over 25 years, has a private practice in Seattle, WA, (called Hands Heal) treating acute and chronic sort tissue disorders and specializing in post-operative care.  She authored “Hands Heal: Communication, Documentation and Insurance Billing for Manual Therapists”, fourth edition, and has a regular column in Massage and Bodywork Magazine titled Somatic Research. Diana lectures at massage, acupuncture, midwifery, chiropractic, physician and physical therapy conferences internationally and is a consultant for massage therapy research with The Research Institute at Group Health in Seattle. She is a past President of the Massage Therapy Foundation, a philanthropic non-profit organization whose mission is to advance the knowledge and practice of massage therapy by supporting scientific research, education, and community service.