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 

Recommended reading and reference list:
  1. Barello S, Graffigna G, Vegni E 2014 The challenges of conceptualizing patient engagement in health care: A lexicographic literature review. Journal of Participatory Medicine 6: e9.

  2. Bickerton J, Procter S, Johnson B, Medina A 2011 Socio- phenomenology and conversation analysis: Interpreting video lifeworld healthcare interactions. Nursing Philosophy 12: 271–281.

  3. Billek-Sawhney B, Reicherter EA, Sheets Yatta B, Duranko, SG 2012 Health literacy: Physical therapists’ perspectives. Internet Journal of Allied Health Sciences and Practice 10: 2.

  4. Briggs AM, Jordan J 2010 The importance of health literacy in physiotherapy practice. Journal of Physiotherapy 56: 149–151.

  5. Caeiro C, Cruz EB, Pereia CM 2014 Arts, literature and reflective writing as educational strategies to promote narrative reasoning capabilities among physiotherapy students. Physiotherapy Theory and Practice 30: 572–580.

  6. Caladine L 2013 Physiotherapists construction of their role in patient education. International Journal of Practice-based Learning in Health and Social Care 1: 37–49.

  7. Constand MK, MacDermid JC, Bello-Haas VD, Law M 2014 Scoping review of patient-centred care approaches in healthcare. BMC Health Services Research 14: 271.

  8. Cooper K, Smith BH, Hancock E 2008 Patient-centeredness in physiotherapy from the perspective of the chronic low back pain patient. Physiotherapy 94: 244–252.

  9. Dahlberg K, Todres L, Galvin K 2009 Lifeworld-led health- care is more than patient-led care: An existential view of well-being. Medicine, Health Care and Philosophy 12: 265–271.

  10. Dwyer SC, Buckle DL 2009 The space between: On being an insider-outsider in qualitative research. International Journal of Qualitative Methods 8: 54–63.

  11. Effing TW, Bourbeau J, Verkoulen J, Apter JA, Coultas D, Meek P, Van der Valk P, Partridge MR, Van der Pelen J 2012 Self-management programmes for COPD: Moving forward. Chronic Respiratory Disease 9: 27–35.

  12. Elwood S, Martin D 2000 “Placing” interviews: Location and scales of power in qualitative research. Professional Geographer 52: 649–57.

  13. French S, Sim J 2004 Introduction. In: French S, Sim J (eds) Physiotherapy: A Psychosocial Approach. Edinburgh, Elsevier.

  14. Frisch A, Camerini L, Diviani N, Schulz PJ 2012 Defining and measuring health literacy: How can we profit from other literacy domains? Health Promotion International 27: 117–126.

  15. Greenfield BH, Jensen GM 2010 Understanding the lived experiences of patients: Application of a phenomenological approach to ethics. Physical Therapy 90: 1185–1197.

  16. Golafshani N 2003 Understanding reliability and validity in qualitative research. Qualitative Report 8: 597–607.

  17. Hibbard JH, Greene J 2013 What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs 32: 207–214.

  18. Hofmeyer AT, Scott CM 2007 Moral geography of focus groups with participants who have pre-existing relationships in the workplace. International Journal of Qualitative Methods 6: 69–79.

  19. Holstein JA, Gubrium JF 2008 Interpretive practice and social action. In: Denzin NK, Lincoln YS (eds) Strategies of qualitative inquiry, pp 173–202. Thousand Oaks, CA, Sage.

  20. Jordan JE, Buchbinder R, Briggs AM, Elsworth GR, Busija L, Batterham R, Osborne RH 2013 The health literacy management scale (HeLMS): A measure of an individual’s capacity to seek, understand and use health information within the healthcare setting. Patient Education and Counseling 91: 228–235.

  21. Kitzinger J 2005 Focus group research: Using group dynamics to explore perceptions, experiences and understandings. In: Holloway I (ed) Qualitative Research in Health Care, pp 56–69. Maidenhead, Open University Press.

  22. Knight KM, McGowan L, Dickens C, Bundy C 2006 A systematic review of motivational interviewing in physical health care settings. British Journal of Health Psychology 11: 319–332.

  23. Krueger RA, Casey MA 2000 Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA, Sage. Larsson I, Gard G 2006 Conceptions of physiotherapy knowledge among Swedish physiotherapists: A phenomenographic study. Physiotherapy 92: 110–115

  24. Lequerica AH, Donnell CS, Tate DG 2009 Patient engagement in rehabilitation therapy: Physical and occupational therapist impressions. Disability and Rehabilitation 31: 753–760.

  25. Levasseur M 2010 Do rehabilitation professionals need to consider their clients’ health literacy for effective practice? Clinical Rehabilitation 24: 756–765.

  26. Lévesque M, Hovey RB, Bedos C 2013 Advancing patient-centred care through transformative educational leadership: A critical review of health care professional preparation for patient-centred care. Journal of Healthcare Leadership 5: 35–46.

  27. Lincoln Y, Guba E 1995 Naturalistic Inquiry. Beverly Hills, CA, Sage.

  28. Lindqvist I, Engardt M, Garnhalm L, Poland F, Richardson B 2006 Physiotherapy students’ professional identity on the edge of working life. Medical Teacher 28: 270–276.

  29. Lindqvist I, Engardt M, Richardson B 2010 Learning to be a physiotherapist: A meta-synthesis of qualitative studies. Physiotherapy Research 15: 103–110.

  30. Mårtensson L, Hensing G 2012 Health literacy–a heterogeneous phenomenon: A literature review. Scandinavian Journal of Caring Sciences 26: 151–160.

  31. Martin LR, Williams SL, Haskard KB, DiMatteo MR 2005 The challenge of patient adherence. Journal of Therapeutics and Clinical Risk Management 1: 189–199.

  32. Miller WR, Rollnick S 2002 Motivational Interviewing. Preparing People for Change, 2nd edn. New York, The Guilford Press.

  33. Mitchell GJ, Cross N, Wilson M, Biernacki S, Wong W, Adib W, Rush D 2013 Complexity and health coaching: Synergies in nursing. Nursing in Research and Practice 2013: 238620.

  34. Morgan DL 2012 Focus groups and social interaction. In: Gubrium J, Holstein J, Marvasti A, McKinney K (eds) The SAGE Handbook of Interview Research, 2nd edn, pp 161–176. Thousand Oaks, CA, Sage

  35. Nicholls DA 2014 Social Determinants of Health and Physiotherapy. Critical Physiotherapy Network Website. http://www.criticalphysio.net/2014/08/22/social-determinants-of-health-and-physiotherapy-2/

  36. Nicholls DA, Gibson GE 2010 The body and physiotherapy. Physiotherapy Theory and Practice 26: 497–509.

  37. Nicholls DA, Gibson GE 2012 Editorial. Physiotherapy Theory and Practice 28: 418–419.

  38. Nutbeam D 2000 Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 15: 259–267.

  39. Patton MQ 2002 Qualitative Evaluation Methods. Thousand Oaks, CA, Sage.

  40. Pelzang R 2010 Time to learn: Understanding patient-centred care. British Journal of Nursing 19: 912–917.

  41. Sanders T, Foster NE, Bishop A, Ong BN 2013 Biopsychosocial care and the physiotherapy encounter: Physiotherapists’ accounts of back pain consultations. BMC Musculoskeletal Disorders 14: 65.

  42. Scholl I, Zill J, Härter M, Dirmaier J 2014 An integrative model of patient-centeredness – A systematic review and concept analysis. Plos One 9: e107828.

  43. Schwartz B 2000 Self-determination: The tyranny of freedom. American Psychologist 55: 79–88.

  44. Schwellnus H, King B, Thompson L 2015 Client-centred coaching in the paediatric health professions: A critical scoping review. Disability and Rehabilitation 37: 1305– 1315.

  45. Shaw JA, DeForge RT 2012 Physiotherapy as bricolage: Theorizing expert practice. Physiotherapy Theory and Practice 28: 420–427.

  46. Siegert RJ, McPherson KM, Taylor W 2004 Toward a cognitive-effective model of goal-setting in rehabilitation: Is self- regulation theory a key step? Disability and Rehabilitation 20: 1175–1183.

  47. Sørensen K, Van den Broucke S, Fullam L, Doyle G, Slonska Z, Brand H, (HLS-EU) Consortium Health Literacy Project European 2012 Health literacy and public health: A systematic and integration of definitions and models. BMC Public Health 12: 80.

  48. Stewart M, Brown JB, Weston WW, McWhinny I, MacWilliam C, Freeman T 2003 Patient-Centred Medicine. Transforming the Clinical Method, 2nd edn. Oxford, Radcliff Medical Press

  49. Womack JL 2012 The relationship between client-centred goal-setting and treatment outcomes. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 22: 28–35

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