Effective self management

Title:

Effective self Management. Physiotherapy perspective Part 1 and 2

CPD hours: 3

If you are using a mobile device please scroll down to the end of this page to watch the videos

Starts 27th March 2020

Ends: Ongoing. You can access the reading material

and watch the session at any time.

1-Read the learning materials.

2-Watch the live session at primephysiouk Facebook page

3-MCQ test Link

Part 2 :

Watch an example of a real online physiotherapy session

delivered by:

Dr Mahmoud Saad and Dr Heba Fouad

senior tutors at Primephysio Training UK

Join the live session on

Saturday 18th of April 08:00 pm GMT. 10:00 pm Mecca time

Learning Materials:

Setting the scene:

The patient’s active participation in treatment and rehabilitation represents a cultural change in clinical practise as well as a major change in physiotherapist and patient roles (Sanders, Foster, Bishop, and Ong, 2013; Shaw and DeForge, 2012; Trede, 2012).

Individually tailored treatment plans, as well as programs encouraging patients to share their knowledge in collaboration with their physiotherapists, are today considered to be essential in establishing meaningful and efficient treatment processes (Billek-Sawhney, Reicherter, Sheets Yatta, and Duranko, 2012; Cooper, Smith, and Hancock, 2008; Martin, Williams, Haskard, and DiMatteo, 2005; Siegert, McPherson, and Taylor, 2004).

Healthcare professionals are required to be attentive to patient perspectives and to collaborate with them in making choices reflecting patient values. All these actions are directed at achieving meaningful treatment goals and action steps (Larsson and Gard, 2006; Lequerica, Donnell, and Tate, 2009; Stewart et al., 2003; Womack, 2012).

Patients, in turn, are expected to be autonomous, knowledgeable and active information seekers in relation to their health, treatment options and especially in their relationships with the professionals treating them (Briggs and Jordan 2010; Bury and Taylor, 2008). In line with these trends, health policymakers in many countries are promoting what has come to be conceptualized as patient-centred care (Morgan and Yoder, 201; Sanders, Foster, Bishop, and Ong, 2013; Wiig et al., 2013).

The discussion in this section is mainly based on the findings of 4 systematic review as well as clinical observation of the author:

Scholl, Zill, Härter, and Dirmaier, 2014
MacDermid, Bello-Haas, and Law, 2014
Morgan and Yoder, 2012
Pelzang, 2010

Self-management and patient-centred care :

Patient-centred care has three key dimensions that are specifically important for physiotherapy practice:

1-Consideration of patient perspective through addressing the needs of the patient care and treatment program.

The patient is not only to be thought of as representing a set of diagnoses, but rather as an individual to be allied with whose voice is to be heard.

2-The second dimension involves processes empowering patients and involving them in programs for promoting their own health. This could be achieved via:

a-Provide the patient with the required information about health issues relevant to their situation so that they can reflect on treatment options and make informed decisions.

b-Provide the patient with simple, tailored and evidence-based various forms of self-management strategies.

3-Adopt a holistic approach of management where the clinician views the patient as a whole person with a history, personality, and social history not as troubled joint or spine.

Clinical takeaway messages :

Here are a few tips that have been well noted clinically and reported in the literature as effective strategies to improve patient-centred care and self-management in particular:

From the physiotherapists perspective :

Patients who will get the most out of the self-management program are those who:

a-Embrace the therapist’s message

b-Show a willingness both to change behaviour through self-training and to use trial and error to acquire skills

c-Understand that they must challenge themselves.

From the patient's perspective:

a-Good, friendly, therapeutic relationship is a key

b- Offering simple strategies to change relevant behaviour and mood are always appreciated e.g.

Tips to improve physical activities
Tips to change harmful eating, sitting habits
Tips to stay motivated and positive

c-Patients would engage more with management strategies that include Simple exercises that could be performed anywhere and anytime.

d- Visual materials are always preferred over written ones.

Exercise sheets are not always the best options, it is a 2D tool, it does not capture the whole picture of the exercise prescription process.
Written information is always but is not the preferred style of all patients.
USE THE PATIENT MOBILE phone to record a video of the patient during the session while he is performing the exercise and give comments, modify and provide answers for the common questions: e.g.

1-number of repetition?

2- when? i.e. morning evening, every hour or two etc..

3-what shall I do if I feel pain?

4-modification

5-progression and regression

Clinical commentary:

The number of repetition:

there is no right and wrong here. Follow your clinical reasoning.

But remember, when we deal with mechanical problems following a ''little but often approach'' does make more sense. 5-10 times every hour or so, make it habit rather than homework. To do the exercise a few times but throughout the day would prevent the accumulation of mechanical loading and hence producing symptoms.

When:

Give your patient some freedom here, but again, ''little but often approach'' is a logical answer.

Modification:

Simple tips can make a difference. We can spend days discussing this point, simply follow your clinical sense. Here are a few clinical examples:

Few degrees of hip external rotation can make squatting pain-free.
Slight self anteroposterior mobilisation of the Glenohumeral joint (GHJ) can make help ROM exercises and rotator cuff activation exercises less symptomatic and hence encourage compliance.
Shrugging off the shoulder can help ROM exercise of the cervical spine
Self thoracic mobilisation prior to GHJ ROM exercises can ease off the end range pain

Progression and regression:

Use the traffic light system. The slide below explains how clinicians could use the model of the traffic light to empower the patient decision in term of when to regress or progress the exercise. Remember, use different parameters to progress or regress e.g. number of repetition, intensity, resistance if applicable, wight or non-weight bearing, Loaded standing or sitting ' or unloaded 'lying'.

Course editor:

Mahmoud Saad

Chartered Physiotherapist.UK

Associate senior Lecture.Sheffield Hallam University.UK

Fellow Higher Education Academy

Msuclsoekeltal clinical specialist NHS.UK

Chairman. Orthopaedic Manual Therapy Academy. www.omtae.org

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