Announcement

Collapse
No announcement yet.

Pot-Pourri

Collapse
This is a sticky topic.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • These two pieces will likely create some waves in the fitness/exercise/nutrition communities...

    As someone that "trains" I am not threatened by these articles. It reflects my clinical message. I'm sure many will be off-put or threatened by what they write.

    https://sciencebasedmedicine.org/move/

    http://thesciencept.com/i-dont-exercise/
    "The views expressed here are my own and do not reflect the views of my employer."

    Comment


    • Originally posted by Johnny_Nada View Post
      What about surgery/PT vs. natural history? Willing to bet there is no difference.

      Comment


      • Hopefully we find out quicker for the hip than we did for the knee.

        http://bjsm.bmj.com/content/early/20...widget_default
        "The views expressed here are my own and do not reflect the views of my employer."

        Comment


        • Scheduling...that's right...scheduling patients.

          A topic that has come up more than a couple times in the last few weeks from colleagues. I hear many of them asking/saying "we don't have room for any more/we're all booked up. What do we do?"

          I think there are a few common methods with scheduling:

          1. Put them on the books for 2-3 visits per week for multiple weeks, sometimes 6-8 weeks at a time. Because thats how you've always done things.
          2. Put them on the books for 2-3 visits per week for multiple weeks to create a full "looking" scheduling....CYA for low volumes, reduce visits of supervisors and managers
          3. Do what the patient or doctor wants...put them on the books for 2-3 visits per week for multiple weeks....
          4. Stick to the evidence....expect things to open up....

          more later....
          "The views expressed here are my own and do not reflect the views of my employer."

          Comment


          • Jo Bowyer
            Jo Bowyer commented
            Editing a comment
            Why are they scheduling them without waiting to see what happened as a result of the last session?

        • Patient presents with status post MVA. How do you schedule? Less, not more...maybe not at all...
          https://bodyinmind.org/targeted-ther...cute-whiplash/

          Patient presents with acute low back pain. How do you schedule? Less, not more
          https://www.researchgate.net/profile...-therapies.pdf

          Patient presents with shoulder pain. How do you schedule? Less, not more
          http://www.physiotherapyjournal.com/...059-X/abstract

          Patient presents post-THA. How do you schedule? Maybe not at all?
          https://journals.lww.com/jbjsjournal...tal_Hip.4.aspx

          Patient presents post-TKA. How do you schedule? Less, not more
          https://link.springer.com/article/10...167-016-4231-x

          Patient presents with Hip OA. How do you schedule? Less, not more
          https://jamanetwork.com/journals/jam...rticle/1872817

          Its a painful question to ask but are we effective for this individual and/or their presentation?
          "The views expressed here are my own and do not reflect the views of my employer."

          Comment


          • You know Jo, that's one heck of a good question....one I don't think many ask...
            "The views expressed here are my own and do not reflect the views of my employer."

            Comment


            • I'm going to make an overgeneralization based on no evidence or science whatsoever, but I think I may be onto something here:

              If an adult patient presents with the primary complaint of pain and begins, at any point, to cry during the initial consult, they will benefit from multidisciplinary care. There is way more than "pain" going on.
              "The views expressed here are my own and do not reflect the views of my employer."

              Comment


              • Originally posted by Johnny_Nada View Post
                I'm going to make an overgeneralization based on no evidence or science whatsoever, but I think I may be onto something here:

                If an adult patient presents with the primary complaint of pain and begins, at any point, to cry during the initial consult, they will benefit from multidisciplinary care. There is way more than "pain" going on.
                I don't disagree, but it's not unusual with my demographic, especially if they've been "around the houses" looking for help.

                Is there way more than pain going on though? It's a horrible way to live and pervades everything, and as we are the persuaders re moving and loading, we are the go to guys.

                They are not dissimilar to the dizzy patients who are also having a lousy time especially if they don't know where / when they might vomit. (Some of my pain patients vomit.) They also have to get out of the house and do stuff in order to improve. The pain /dizzyness may not go, but they can get on with their lives.

                The physioterrorist label was around when I was a student in the '70s and for a good reason, symptom control was poor in comparison to nowadays, and they had to find a lot within themselves in order to make progress. Strangely, more often than not, it was said with a note of affection and respect.

                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • Jo Bowyer
                  Jo Bowyer commented
                  Editing a comment
                  Just finished with a patient who cried during the discussion at the end of the session, it probably happens 2-3 times weekly with the type of pain patients I see. In this case it was because of her realisation of how much she had to do/change in order to improve. I pointed out that she didn't have to do it all at once.

              • Is "explaining pain" the new muscle of the month? It seems many people are have a significant financial incentive to the topic. There are countless groups and individuals showing up to get a piece of the dollar...I mean pie. "

                Take this course, listen to this podcast, get mentoring from me, I'll be in (insert city) so sign up now."

                We now have (Just to name a few)

                "Explain Pain"
                "Therapeutic Neuroscience Education"
                "Know Pain"
                "Pain-ed"
                "Modern Pain Care"
                "Pain Cloud"
                "Pain summit"

                Heck, if you show up at the right conference or course you can see them all.

                I have been "explaining pain" in the clinic for a while now. I've observed many patients make nice turnarounds in their recovery just by understanding it was okay to go on living. Its these folks I think just needed the right person with re-assurance. To me, it didn't take "pain science" or "TNE." Just a simple message and context of "you're okay."

                What I've yet to glean from the so-called "leading experts" (meaning most active on social media) is the "right person, wrong time, wrong place" patient. The individual without the ability or willingness (not sure which one) to step back and actually think in a critical and open fashion. The individual without the ability or unwillingness (not sure which one) to look in the mirror or inside oneself. Truth be told, I've learned I help more people outside of "work" than on the clock. People listen sitting across a table when the only purpose is conversation and discussion. Meeting me or attending a "visit" with me in the context of "healthcare" creates a "what are you going to do TO me" environment. I'm seeing/observing the patient is placed into a passive role.

                Going out for coffee, meeting in public creates an equality, openness that "healthcare" seems to destroy. Maybe this is how we help the "right person." Take them out of healthcare ("place") on their own "time."

                Of course the "pie" I spoke of before won't be as big or as tasty this way....







                "The views expressed here are my own and do not reflect the views of my employer."

                Comment


                • I'm quite keen on home visits, I'm the guest in their territory, the dizzy patients cope better, and the home has endless possibilities for rehab for pain, dizziness and deconditioning.

                  Re 'how to do it' / learn my fabby new recycled technique, the adverts I see have the same effect as coriander. I put my hands up to being a mentor for money, but only when they book a treatment slot. Like the patients, I try to get them onto emails asap.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • Context: Therapist treating patient

                    (Therapist applying manual therapy to patient with LBP)

                    Therapist: "Pain science, science of pain, neuroplasticity, brain, input, output, etc, etc"

                    Patient: "So this manual therapy stuff and education? Does it help?"

                    Therapist: oh ya! The evidence is real strong. We have RCT's showing its effective.

                    Patient: OH WOW! Really? So this will really help with my pain?

                    Therapist: No. But your straight leg raise will get better.

                    Patient: huh?

                    https://www.tandfonline.com/doi/full...7.2016.1231860
                    "The views expressed here are my own and do not reflect the views of my employer."

                    Comment


                    • continued....."but if you exercise as well your pain will likely improve..."

                      Comment


                      • Sometimes it doesn't improve, but if you move you can get on with your life, I am trying to persuade one of my morphine users to walk the dog further than the end of the street.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • Originally posted by Johnny_Nada View Post
                          Context: Therapist treating patient

                          (Therapist applying manual therapy to patient with LBP)

                          Therapist: "Pain science, science of pain, neuroplasticity, brain, input, output, etc, etc"

                          Patient: "So this manual therapy stuff and education? Does it help?"

                          Therapist: oh ya! The evidence is real strong. We have RCT's showing its effective.

                          Patient: OH WOW! Really? So this will really help with my pain?

                          Therapist: No. But your straight leg raise will get better.

                          Patient: huh?

                          https://www.tandfonline.com/doi/full...7.2016.1231860
                          TNE is probably interesting to some patients. I think telling them that pain does not equal damage is very important. Other than that I don't really see the utility in it. The more complicated you get in your explanation, the less most patients understand. It probably helps a lot with therapeutic alliance and makes the therapist seem smart and knowledgeable. I see this all the time with my colleagues mostly biomechanical explanations for everything. The patient has no idea wtf they are talking about but it makes them seem smart. The patient is more likely to be compliant and continue to attend therapy. Six weeks later they feel better, mostly because of regression to the mean, natural history etc. The patient attributes it to the smart/knowledgeable therapist. The process repeats. I don't think it's any different for those who use TNE despite it being less wrong then the biomechanical explanations.
                          Last edited by FrustratedNewGrad; 22-03-2018, 02:52 AM.

                          Comment


                          • The process repeats. I don't think it's any different for those who use TNE despite it being less wrong then the biomechanical explanations.
                            It is possible that TNE leads to increased self efficacy, especially when tailored to the individual and their co morbidities.

                            My patients can email me (for which I don't charge), some of them can sort themselves out following an email dialogue.

                            Some will always prefer to come in and be examined, others send in messages via friends they have referred, saying that they haven't been in for years because they don't need to.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment

                            Working...
                            X