1. What do we do in physiotherapy
A Physio’s guide to condition management in primary care
2nd May 2019
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2. Caring, Learning and Growing
Aims
ensure care is patient centred
screen for red flag conditions
undertake a physical examination
assess psychosocial factors
monitor patient progress against patient led goals
provide education/information
address physical activity/exercise
use manual therapy only as an adjunct to other treatments
offer high quality non-surgical care prior to surgery and after
try to keep patients at work
This will have been done by yourselves, but as clinicians it is our duty of care to do check especially with long waiting times.
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3. Caring, Learning and Growing
Objectives
Overall rehabilitation package for chronic and acute conditions.
Identifying with lifestyle choices which may be barriers to recovery.
Helping with strategies to overcome these this can include patient led goal setting, pacing advice and graded exposure.
Functional rehabilitation ( including range of movement, proprioception muscle lengthening and strengthening for lower limb
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4. Caring, Learning and Growing
How do we do this
Tailored rehabilitation, advice, education, exercise, goal setting, onward referral, +/- manual therapy – no longer stand alone treatments, cognitive behavioural therapy, signposting to other resources.
Rehab – this may include, improving ROM, propioception, muscle length and strength
Advise/education on their ailment /condition
Reassurance ++
Education on benefits of activity
Strategies to engage in rehab/exercise – pacing, graded exposure, baseline setting, managing flare ups.
Hands on treatment with exercise/rehab programme
Goal setting.
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5. Caring, Learning and Growing
Who does well
Patients ready to engage in rehab
Post surgical/trauma
Acute soft tissue injuries
knees OA +, PFJ pain
Shoulders
Spines
Heart sink patients ?
( though it is up to us to motivate them)
Post surgical – building good relationship with consultants- following their protocols
Trauma – post ortho r/v
Acute soft tissue injuries – advise and educate on healing times and expected outcomes during rehab
OA depending on compliance/advice and education re OA – I always tell them OA not a life sentence, joints like moving , benefits of activity etc. PFJ pain – again about advise/reassurance, education and rehabilitation specific to that individual.
Shoulders – bulk of what we we see are SIS,frozen shoulders, cuff tears, also post surgical, labral tears and acute instabilites. Nerve injuries more complicated, can respond but no as good outcome.
Spine – Low and medium on Start back score High risk barriers to recovery and may need more psychological input.
Heart sink patients – if we can get the on board and motivate can get good results, often need other input ie pain management, psychology, podiatry, GP re medication r/v, - if we can overcome barriers to exercise can do really well.
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6. The power of conversation https://vimeo.com/277280317
Using the message
The power of conversation
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7. Caring, Learning and Growing
Visual aids can help reassure that some pain is normal, pacing will stop flare ups, his applies to OA, chronic pain, post surgical and many more, avoiding the boom and bust but encouraging some activity
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8. Where can we refer/signpost
North Yorkshire Sport Escape pain Strong and steady Ryedaleforum.org for 50+ walking groups exercise classes ( yoga/keep fit. Gentle exercise and bowling) Park run – Dalby Forest ( 5km) Couch to 5k App
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9. Caring, Learning and Growing
To provide empowerment to our patients to take control of their conditions
We can do this through education on conditions, advice on self management, tailored exercises where needed, and encouragement.
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