Interventions in MSK Flashcards
patient centered care is focused around
individual context
effective communication
shared decision-making
what two things correlate to outcomes
patient expectations and rapport
increased therapeutic alliance leads to
increased patient confidence in PT
better outcomes
what is an aspect of therapeutic alliance that is often overlooked
documentation can lead to better inter-therapist treatment
5 overarching themes from patient perspective regarding therapeutic alliance
meeting a competent and warm therapist
being understood as a whole person
feeling appreciated, tolerated, and supported
gaining new strength/hope for the future
overcoming initial fears and apprehension
6 overarching themes from therapist point of view regarding therapeutic alliance
balancing technical with interpersonal
showing genuine desire to understand
openly supporting client agency
adjusting to create a sense of safety
paying attention to body language
providing helpful experiences during the first session
findings of history/examination that indicate high severity
high pain (>7/10)
consistent pain through night/rest
pain before end ROM
high disability
interventions focused on high severity
minimization of physical stress
activity modification
monitor impairments
findings of history/examination that indicate moderate severity
moderate pain (4-6/10)
intermittent night/rest pain
pain at ROM
AROM similar to PROM
moderate disability
interventions for moderate severity
mild-moderate physical stress
addressing impairments
basic level functional activity restoration
findings of history/examination that indicate low severity
low pain (<3/10)
absent night or rest pain
minimal pain with overpressure
AROM = PROM
low disability
interventions for low severity
moderate-high physical stress
address impairments
high-demand functional activity restoration
what is one of the most forgotten interventions
education
explain patient education on pain
reflection that pain is not always a true representation of the state of tissue
instead, it is the nervous system’s interpretation of the threat of injury
what can pain be modulated by? why are these important?
psychological factors
- fear avoidance, catastrophizing, expectations, cognition, beliefs
–> NEED TO BE SCREENED
x amount of CPGs encourage education
- what specifically do they encourage regarding education?
10
self management and active treatments
informing/reassuring patients about condition/management
types of patient education
biomedical/biomechanical
general advice
pain neuroscience
cognitive behavioral principles
biomedical education definition
providing in-depth, pathoanatomical explanations for specific cause of patient’s pain
biomechanical education definition
role of positions, postures, movements that are related to patient’s pain
what form of education is nonadvisable for patients?
biomedical/biomechanical
what is general advice
reassurance of favorable prognosis
promotion of activity / mvmt
graded activity
paired education and activity
what is a principle associated with general advice
acting as usual, slight backing off initially
definition of PNE
pain neuroscience education
providing patients with concept of pain symptoms that are comprehensible and reassuring
what is a very important aspect of PNE
explaining that pain isn’t always an accurate representation of tissue
pain is the body’s response to possible threat
the more you are in pain, the better the brain gets at producing the pain signal
what is cognitive behavioral therapy
form of talk therapy that can identify and develop skills to change negative thoughts/behaviors
goal of CBT
changing thoughts, emotions, and behaviors related to pain
improving coping strategies
putting discomfort in a better context
how to facilitate effective self-management
1 - help patient identify their barriers / goals
2 - assist in identification of optimal strategies to reduce or avoid irritation of symptoms through problem solving
3 - support patient to identify ways to measure the effectiveness of self-management
what effect do passive self-management approaches have
can increase likelihood of pain behavior and disabilities
how to approach patient education
make an educated diagnosis
establish tailored pt education with learning focused on perceptual inconsistencies
plan and provide individual/group education
assess acquired skills/knowledge and adjust as needed
when recommending physical activity, it is important to remember
general exercise is good
- regular performance has more benefits
no need to recommend highly specific exercise, general does just fine
encourage management of pain in different modes in conjunction with exercise
what is important to educate the pt on when recommending exercise?
that there will be some form of pain and that is normal, but do what is tolerable
what is important to remember about inflammation stage vs proliferative stage of healing
inflammation - loading can cause disruption in this phase
proliferation = load promotes optimal regeneration and tissue will respond to the load placed on them
what is mechanotherapy
tissue will respond to the load placed on them
remodeling and protein synthesis relationship
> protein synthesis = more contractile proteins and more dense myofiber
PEACE & LOVE
Protection
Elevation
Avoidance of anti-inflammatories
Compression
Education
Load
Optimism
Vascularization
Exercise
using the ICF, what categories are related to ____________ interventions
- foundational
- performative
- functional
foundational = body structure/function
performance = activity limitations
functional = participation restrictions
exercise progression
1 - normalize dysfunctional structure
2 - correct muscle/movement balance
3 - increase proprioception and facilitate subcortical reorganization
4 - improve endurance in coordinated movement
activity guidelines
moderate intensity for at least 150 min a week (or 75 min vigorous)
and
muscle strengthening at least 2 days a week
components of physical fitness
cardiorespiratory
musculoskeletal
flexibility
balance
speed
how does load and recovery affect capacity?
appropriate dosage of load and recovery leads to increased capacity/threshold for exercise
when is manual therapy typically done
early on in therapy in adjunct with other treatments
what are the typical applications of manual therapy
reduction of pain / disability initially to get patients moving in following interventions
what is the timeline associated with most MSK guidelines and surgery
conservative care for 3-6 months prior to surgical indication
when surgery is indicated, what is the therapist’s role
education on expectations of procedure, outcomes and role of rehabilitation after
- maybe rehab prior to
risk factors that determine continuation/resumption of work
socioeconomic status
work environment
what examination factors affect continuation/resumption of work
self-reported measures
psychological factors
job demands
performance measures
interventions that can facilitate continuation/resumption of work
graded, modified or transitional work
ergonomic consultation
psychologically informed practice
education / communication/ coordination
progressive graded exercise
