L14: Overview of management

Question 1

What are 4 misconceptions of a back injury?

Answer 1

1. If it hurts, it must have been injured
2. If its injured, it needs rest to heal
3. If its injured something I did or someone else did must have caused it
4. I can do something to make sure it never happens again

Question 2

How we manage in spinal pain is very _____ (similar/different) to other body parts

Answer 2

different

Question 3

As health professionals we need to take _______________ into consideration when deciding what to say or which treatment to provide or how we explain the treatments we provide. _______ with appropriate explanations are critical Communication and partnership are key

Answer 3

potentially negative consequences; reassurance;

Question 4

What are 3 things we can do as physios to change negative beliefs from patients with lower back pain?

Answer 4

1. shape their beliefs and better contextualise what is happening to their body (e.g. rarely is tissue damage the biggest concern)
2. eliminate fears that everyday activities are dangerous even if they are difficult initially
3. empower patients to regain control through active selfmanagement strategies such as physical activity.

Question 5

Participants report being advised to manage their pain by: “adopting certain postures” and “strengthening specific muscles” which can reinforce beliefs that their spine is ‘vulnerable’. The explanatory model that insufficient muscular support results in a vulnerable spine can have a ________.

Answer 5

dramatic impact

Your back is weak, unstable, need to strengthen

Question 6

“______” strategies may result in increased vigilance, worry, frustration, and guilt for patients with low back pain

Answer 6

protection

Question 7

What are 3 quotes that come out o interviews about what professionals tell them (negative and misguided beliefs stay with the patient for a long term –> affect their management..etc)

Answer 7

1. “I’ve been tested by various different physios, and Pilates, and I’m apparently ridiculously weak…. I had an abortion because I didn’t think I could have a baby. I didn’t think I could handle it…carrying it”
2. “Do all those things that the physio told me to do. Or not to do…. She’s told me more about what not to do, rather than what to do”.
3. “Lots of reassurance from the [doctor]…made me feel like, “don’t panic —you know, this is OK, you’ll be fine, it’s not the start of something awful”

Question 8

What are messages from the patient about physios?

Answer 8

ADD

Question 9

Health care providers with elevated _______ beliefs advised limitation of work and activities to their patients

Answer 9

fear avoidance

Question 10

Beliefs among physiotherapists about back pain and disability were found to correlate with their _____- to patients

Answer 10

recommendations

Question 11

Therapists who reinforce patients’ unhelpful beliefs tend to increase spinal ________ and contribute to the development of ______ disability

Answer 11

vigilance; chronic

Question 12

What are messages from the patient about physios?

Answer 12

Question 13

What are 2 other things that affect outcomes?

Answer 13

1. Physio’s enthusiasm
2. Expectation of treatment

Question 14

_______ practitioners and their optimism or pessimism can have an active effect on the outcome

Answer 14

Enthusiastic

Question 15

The ______ of a treatment shapes the patient’s pain experience

Answer 15

expectation

Question 16

Expectation is a significant _____ factor in musculoskeletal pain and is often underestimated by physiotherapists

Answer 16

prognostic

Question 17

Avoiding or ignoring the patient’s preferences, expectations and previous experiences can ______ (positively/have no/negative) influence outcomes

Answer 17

negatively

Question 18

What are 8 factors that influence the outcomes of treatment?

Answer 18

1. giving clear prognostic information
2. effectively explaining the condition
3. active listening and verbal expressions of support and encouragement
   
   • Asking if the patient has anything needs for modifications
4. humour and sympathy
5. empathetic and communicative discussion
6. partnership statements
7. paraphrasing
8. requests for the patient’s opinion

Question 19

______ SHOULD be used in the management of LBP

Answer 19

Exercise

Question 20

What is the benefit of returning back to work as soon as possible?

Answer 20

Even if they can’t go back to straight away –> try and find out what can be modified to help get back to work faster

Setting - helpful for engaging (while working form home not as good as work somewhere else but still better than no work

Question 21

What are 3 purposes of education for patient?

Answer 21

1. teach patients to self-manage their condition
2. encourage continuing with normal activities (work etc)
3. the nature of LBP

Question 22

Physiotherapists with a biomedical orientation and high levels of ________ beliefs are less likely to adhere to low back pain treatment guidelines

Answer 22

fear avoidance

Question 23

_____ given SHOULD be tailored to the individuals needs

Answer 23

Exercise

Question 24

Manual therapy / Manipulation is helpful – especially when used in combination with _____ and _____.

Answer 24

education; exercise

Question 25

When prescribing exercise, it is important to make it _____ and _____ while still being _____>

Answer 25

Tolerable; accessible

Question 26

What are 3 things that clinicians should not utilize patient education and counseling strategies for?

Answer 26

1. increase the perceived threat or fear
2. promote extended bed-rest
3. provide in-depth, patho-anatomical explanations for the ‘specific’

Question 27

What are 6 things that patient education and counseling strategies for patients with low back pain should emphasize?

Answer 27

1. understanding of the structural strength inherent in the human spine
2. the neuroscience behind pain perception
   
   • Why they are getting a higher level of pain
3. the favourable prognosis
   
   • Vast majority have significant recovery in 1-2 weeks 80-90% have full recovery within 4-6 weeks
4. the use of active pain coping strategies that decrease fear and catastrophizing
5. the early resumption of normal or vocational activities, even with pain
6. the importance of improvement in activity levels, not just pain relief
   
   • Not have to have no pain to go back to work

Question 28

When do you consider manual therapy?

Answer 28

thrust manipulative and mobilisation procedures to reduce pain in acute low back pain

Question 29

When do you consider centralisation and directional preference exercises?

Answer 29

repeated movements, exercises, or procedures to promote centralization to reduce symptoms in patients with acute low back pain

Question 30

When do you consider traction?

Answer 30

There is moderate evidence that clinicians should not utilize intermittent or static lumbar traction for reducing symptoms in patients with any back pain.

Question 31

What are 2 fairly ineffective back guidelines for management?

Answer 31

1. EPAs
2. lumbar support

Question 32

When do you consider exercise?

Answer 32

consider exercise to reduce low back pain and disability in patients with acute, sub-acute and chronic low back pain

Question 33

Physios should provide steps to do so and ensure the patient understands that they don’t need to be ‘_____’ to resume work and normal activity.

Answer 33

pain-free

Question 34

Physios should try and keep the individual ______ and at work if at all possible, even for a small part of the day to maintain work ____ and work _____.

Answer 34

active; habits; relationships

Question 35

Physios should provide strategies and encouragement to ________ right from initial consultation

Answer 35

self-manage

Question 36

Physios should always minimise the overtreatment for pain or reliance on _______.

Answer 36

passive modalities

Make sure that patient is aware that passive treatment is just to help with the pain is not a “cure”

Question 37

Physios should shift the focus from the symptoms (pain) to _____. Instead of asking ‘how much do you hurt?’, ask ‘what have you been managing with work/school/exercise?’.

Answer 37

function (level of activity)

Question 38

Physios should maintain an interest in ______.

Answer 38

improvements

Question 39

If another health professional is involved in treatment or management, specify a date for a progress report at the time of referral.. Why is this important?

Answer 39

Delays can be disabling

Question 40

Physios should acknowledge difficulties with activities of daily living, but don’t make the assumption that these activities should be ______.

Answer 40

avoided

Question 41

Physios should make a concerted effort to communicate that having _____ (more/less) time off work will reduce the likelihood of a successful return to work

Answer 41

more

Question 42

Physios should ensure that appropriate reasoning is given for ____ aspects

Answer 42

treatment

Question 43

Physios should be alert for beliefs that the patient should stay off work until treatment has provided a ‘_____’; watch for expectations of simple ‘techno-fixes’.

Answer 43

total cure

Question 44

Physios should promote self-responsibility and self-____. Encourage well behaviours

Answer 44

efficacy

Question 45

Physios should be prepared to ask for a second opinion ESPECIALLY where a patient is not ________ or a significant pathology is suspected, provided it does not result in a long and disabling delay

Answer 45

improving

Question 46

If barriers to return to work are identified and the problem is too complex to manage, referral to a ______ team is recommended.

Answer 46

multidisciplinary

Question 47

Should I tell the patient that they have “non-specific” low back pain? Why?

Answer 47

Medical diagnosis (between health professionals) –> NOT what is used to tell the patient.

Doesn’t really reassure patient (very “vague”)

Question 48

What are 6 things you tell the patient if you don’t say non-specific low back pain?

Answer 48

1. The segment*
2. They have not sustained a major injury (we can rule this out or any other serious causes)
   
   • Symptoms are maintained in the area and you seem move pretty well/ moving okay, while you are having some difficulty with X, Y, X and that might be contributing to the pain –> no serious conditions
3. Our findings from the physical – contributing factors
4. Why they may be getting pain/continuing to get pain
   
   • Talk about nervous system –> Changes over time
5. The good outcomes that are expected
   
   • Very common, most people have quick recovery
6. What they can do
   
   • Chances for fast recovery and decrease risk to causing persistent back pain

Question 49

Delivering an explanation of the _______ disorder is appreciated by patients and can influence their satisfaction about the care during the first visit

Answer 49

musculoskeletal

Question 50

We can be more specific…OR we can (but not necessary) tell the patient that being able to determine the exact tissue structure beyond the segment is not possible and does not help/change what we ____ or their _____

Answer 50

do; outcomes

We can never be sure –> but won’t change management and treatment plans

Question 51

What are 5 specific actions to reduce the risk of acute LBP changing into chronic LBP?

Answer 51

1. Minimise and avoid in-depth patho-anatomical or biomechanical explanations for symptoms
2. Minimise and avoid strong biomechanical reasoning for treatments (manual therapy and exercises)
3. Avoid inappropriate use of investigations and educate the patient why (simply telling the patient they don’t need imaging is not adequate)
4. Downplay the significance of age-appropriate degenerative changes if investigations have been used – ie cite research, give information
5. Identify, prescribe and encourage patient-appropriate exercise (what the patient can do, will do and can manage within their lives).

Question 52

Results of primary care trials show that _____ treatments (such as manual therapy, exercise, education and cognitive behavioural approaches) are more effective than usual or minimal care of back pain.

Answer 52

targeted

Question 53

A one-size-fits-all management approach is not ideal. Why?

Answer 53

it fails to ignore the wide variation of patient presentations and needs.

Question 54

Many attempts are made in research to identify relevant subgroups so that patients can be matched to ____ interventions with increased accuracy.

Answer 54

specific

Question 55

Reliable and valid classification of patients could lead to tailored treatments and ______ outcomes.

Answer 55

improved

Question 56

The most important finding is that _______ management (selecting treatment based on the patients presentation) shows better outcomes than ______ conventional care.

Answer 56

stratified; non-stratified

Question 57

What does best physiotherapy management of LBP look like?

Answer 57