Hey guys
I have had two similar and interesting patients who I have been treating over the past two weeks, both sustained fractures to their ankles. They were both managed conservatively and have been WBAT not long after their injuries. I’ve found them both challenging and interesting to treat.
So I have a request in regards to your suggestions on how to educate patients in regards to exercise prescription and compliance.
My follow up appointments with these patients proved engaging. Immediately following my hands on treatment both showed good results and were happy with the treatment and management I suggested. Both however came back in a lot worse pain and with a lot more stiffness!! Obviously I was not only concerned that my treatment had done this but also quite curious as to what activities they had completed over the past week. My first patient told me she had needed to move office in the week and had been carrying heavy boxes on and off for eight hours a few days before. The other one had a inspection for her house and had not only spent a whole weekend cleaning but also being an avid softballer and wanting to return to her sport tried to go for a run!! I found this very interesting (and I must admit I had to smile), because both of them had then avoided the home exercise program I prescribed due to the pain and both were wondering why they were worse.
I educated both patients in regards to what they should and shouldn’t be doing in regards to exercise, rest and activity. It’s hard to say whether they have taken it all on board but I’m sure I’ll find out this week. If anyone has any suggestions on how to approach this situation I would be happy to hear them.
Hope you are all enjoying your placements!
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2 comments:
Hi Heidi,
I don't think that we can ever really have any control over what a patient of ours will do when they're not being treated. I think it comes down to personality, and individual circumstances.
All we can do it what you did really, educate the patient on the amount of activity that is appropriate for them, and advise them about the possible consequences of doing too much. This can be difficult, as the last thing we want to do is to scare the person into doing nothing at all. I had a patient on a placement last year who had fractured his clavicle falling off his bike, it was managed with an ORIF, and he was advised to not use his arm until returning for his follow up in 6 weeks. He started riding his bike again as soon as the pain subsided, ripped the plate and screws out of the bone, and ended up back in. We had to be very careful when advising him of the risks of doing to much again, as he had sustained such a serious injury he was at risk of being overly cautious of his arm, resulting in shoulder problems.
I think imforming the patients that the home exercise program is important, and that they should try to keep activity other than this to a mimimum until their next visit may help, and emphasising the importance and benefit of keeping the optimal level of activity.
Hope this helps, enjoy the last few days :-)
James
Hi Heidi. I agree with what you did and I don’t think that there is anything else that you could have done. As physios we can never forget that our patients have a life outside and that they don’t really know what is too much and what is too little in terms of exercise, if we don’t tell them specifically. I think that is the time when our education plays a really important role, particularly in their prognosis. Sometimes what seems to be common sense for us, not necessarily is for our patients. We do need to rationalize our manual therapy, explain the importance of the home exercise program and rest, but we can never forget to give advice to what the can and cannot do during their activities of daily living. Other important thing is to write in your notes that you gave the advice and education about that, so if the patient gets worse you can cover your side. Obviously we can’t control what they decide to do outside the clinic, but at least you explained to them what they should/shouldn’t do and record that. If they decide to don’t comply with treatment, management and advice, that’s is not your fault and you can also tell them that their prognosis will possibly be worse/slower.
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