Abstract
I am excited by the readily increasing number of novel applications of ultrasound for direct use in patient care. As a research scientist and occupational therapist who specializes in treating patients with upper extremity injuries and disorders, I have experienced how the rapid technological advancements in musculoskeletal sonography and other point-of-care applications for imaging have created ample opportunities to advance clinical practice beyond diagnostics. Along with the growing innovative uses of ultrasound for point-of-care, an increasing number of clinicians from varied disciplines have been integrating ultrasound into patient care.1,2 In rehabilitation settings, therapists are applying ultrasound in direct interventions to evaluate tissue response to intervention, to assess the progression of healing tissues, to guide clinical reasoning for both monitoring and managing patients, and as a tool for visual biofeedback and patient education.1,3–5
The broadening of ultrasound’s use beyond diagnostics to point-of-care applications and interventions that directly engage patients is opportune given current health care trends are shifting toward client-centered care, precision medicine, and holistic practices. Client-centered care involves embracing a set of values and principles, including respect, human dignity, and the belief that clients are the experts regarding their own lives. 6 Another more recent approach to disease prevention, health promotion, and individualized treatment of conditions is precision medicine, an initiative set forth by the National Institutes of Health (NIH) that focuses on a patient’s genetic profile and predisposition, environment, emotional and psychological state, and lifestyle choices into the preventive medicine plan of care. 7 While client-centered care is not a novel concept and precision medicine is still nascent, these approaches to care are paramount as health care systems are currently reforming toward a value-based system that prioritizes the quality of care that patients receive and emphasizes patient outcomes. Ultrasound can serve as an invaluable tool to aid clinicians in carrying out patient-centered care and precision medicine directives by providing opportunities for patients to engage in their recovery. This approach to using ultrasound as part of a holistic practice can enhance the quality of care that patients experience along with improving health care outcomes by addressing patients’ overall health and wellness.8,9
There are substantial opportunities for the use of ultrasound to support these directives in current health care. One of the increasingly popular point-of-care utilizations of musculoskeletal sonography is as a visual biofeedback tool. Sonographic biofeedback is accomplished by showing patients their own specific anatomy through a live sonographic image, followed by active muscle contraction of the imaged structures. This visual feedback allows patients to make a direct connection between the mind and body, whereby they can understand exactly which structures are moving due to muscle activation and how it feels to move their body. This technique is especially useful for patients with unilateral injuries, as patients can not only view but also perceive potential dissimilarities between their affected and nonaffected sides. Allowing patients to experience visual biofeedback with real-time sonographic images can facilitate correct muscle activation, which is particularly useful when employing exercise-based interventions. Learning how to relax and contract the appropriate muscles with visual biofeedback may also encourage patients to independently carry over recommended exercises and may even help them generalize these skills to functional activities. Several studies support the use of ultrasound for visual biofeedback, as it has been especially beneficial when applied to the rehabilitation of people with lower back pain and females with pelvic dysfunction.1,3
Another innovative application of musculoskeletal sonography to direct patient care is to serve as a tool to assist patient education, equipping patients with knowledge regarding the anatomical structures involved in their injury. Beyond understanding their anatomy, dynamic motion allows patients to directly view the real-time interactions among their anatomical structures and demonstrates how these interactions have been affected by both pathology and subsequent interventions. Similar to sonography’s use as a diagnostic tool, clinicians operating within their scope of practice can use imaging to demonstrate and explain to patients the underlying factors that are likely associated with or contributing to the symptoms that they are experiencing, such as pain or limited range of motion. After directly viewing an injury, patients can recall this information when performing exercises or corresponding functional activities, thereby enhancing their experience of participating in these interventions or activities as well as serving as a catalyst for engaging in their recovery. The ability to directly view the structures involved in injury along with the pathophysiology can also help patients not only appreciate but also trust the effectiveness of clinician-recommended interventions, exercises, and home programs. Furthermore, when used this way, ultrasound can help facilitate the development of a collaborative relationship between patient and health care provider, which may also foster patient adherence to recommendations made by their health care provider.
As patients gain greater insight of the anatomical structures involved in their pathology in combination with a visual explanation of reported symptoms, patients may experience an increased sense of embodiment of their injury. Embodiment counters traditional Western medicine by rejecting the antiquated perspective of Cartesian dualism, whereby reconciling the relationship between mind and body as almost inseparable. Using this perspective of embodiment, fusing the conscious experience with a physical injury can enhance patients’ recovery and well-being by simultaneously addressing both physical and psychological states. When clinicians facilitate a more mindful experience using ultrasound to understand their injury, patients are supported to reconstruct, reevaluate, and gain control of their symptoms.10,11 This deeper understanding, increased awareness, and broader perception of symptoms can also encourage patients to successfully manage their symptoms and gain an increased sense of self-efficacy in their recovery process. As clinicians, promoting self-efficacy should be a priority as it improves patients’ functional outcomes,12,13 management of symptoms, 14 and adherence to home programs. 15
While other health care providers are the primary users of these point-of-care applications, there are numerous opportunities for sonographers to integrate these types of techniques into more traditional clinical diagnostic practices to directly engage patients. Sonographers should not feel constrained and instead should embrace these concepts of client-centered, holistic, and precision approached care. For example, equipment that now offers dual screens, which are primarily meant to support physician and sonographer procedures, may be just as beneficial when used to involve and engage patients in the scanning process. By looking for these types of opportunities in daily practice, sonographers can begin fostering a more client-engaged environment that can improve the patient experience of receiving sonography as well as advance the quality of care that all medical providers are giving.