Preface

The sixth edition updates the information and bibliography provided in the previous versions and includes a reorganization of various chapters.

The 2017 Global Burden of Disease study revealed that musculoskeletal disorders are the second biggest contributor to disability worldwide.¹ The United States currently spends more money on healthcare per person than any other country globally, with current projections indicating that the United States will spend more than 20% of the gross domestic product on healthcare by 2025. As the population continues to age, musculoskeletal condition treatments and their subsequent expenses will also increase. This financial burden will increase pressure on the orthopaedic clinician to provide value for money—achievement of a health outcome relative to the costs incurred. Gone are the days when a clinician could rely on an expensive shotgun approach to treatment. Instead, the emphasis must now be placed on outcomes such as patient satisfaction and accurate measures of clinical outcomes, for it is the consistent measurement and reporting of clinical outcomes that are the most powerful tools in moving toward a value-based system.²

All clinicians should commit to being lifelong students of their profession and should strive toward a process of continual self-education. Part of this process involves utilizing the expertise of more experienced clinicians by spending the early years of practice in an environment surrounded by a staff of varying levels of clinical and life experiences, both of which can serve as valuable resources. The clinician can also improve by investing time in reading relevant material, attending continuing education courses, completing home study courses, watching videos specializing in techniques, and observing exceptional clinicians. Exceptional clinicians demonstrate excellent technical skills, combined with excellent people skills, including interest, acceptance, and empathy.

One must also never forget that the patient can serve as the most valuable resource. Each interaction with a patient is an opportunity to increase knowledge, skill, and understanding. Integral to this relationship is patient confidentiality. Patient confidentiality must always be strictly adhered to. Except when discussing the patient's condition with other clinicians with the object of teaching or learning, the clinician should not discuss the patient's condition without their permission.

Much about becoming a clinician is communicating with the patient, the patient's family, and the other healthcare team members. The nonverbal cues are especially important because they often are performed subconsciously. Special attention needs to be paid to cultural diversity and nonverbal communication such as voice volume, postures, gestures, and eye contact. The appearance of the clinician is also important if a professional image is to be projected.

The APTA's current vision statement, "Transforming society by optimizing movement to improve the human experience," highlights the fact that the "physical therapy profession will define and promote the movement system as the foundation for optimizing movement to improve the health of society."²

To that end, this book aims to provide the reader with a systematic and evidence-based approach to the examination and intervention of the orthopaedic patient as an expert on the movement system. Such an approach must be eclectic because no single method works all of the time. Thus, this book attempts to incorporate the most reliable concepts currently available.

I hope that this book will be the best available textbook, guide, review, and reference for healthcare students and clinicians involved in the care of the orthopaedic population.