Week 4 Flashcards
What are the things that a patients want?
• To be taken seriously
• An understandable explanation of what is wrong
• Patient-centered communication (seeking patients’ perspectives/
preferences
• Reassurance and a favorable prognosis
• To be told what can be done (self and provider)
What are the things that a clinician want?
- Focus on function
- Program adherence
- Increased activity level/return to work
What are the things that lead to improved health outcomes?
Affective Bond \+ Agreement on • Goals • Interventions
What are the characteristics of establishing the framework of patient treatment?
Tell the patient what to expect:
- History
- Examination
- Discussion of the diagnosis/prognosis
- Joint decision about the course of therapy
What are the components of the language of patient-centered care?
• Begin with compassion/caring • Actively Listen - Restatement - Reflection • Sample reflective “leads”
What are the things not to say/do with a patient?
- Don’t discount the patient’s expressed beliefs
- Don’t directly criticize a patient’ actions/decisions.
- Don’t become defensive.
What are the characteristics of moving patients from pain toward function?
Establishing Collaborative Goals - patient priorities Setting appropriate expectations - Prognosis - PT vs pt roles Selecting treatment approach(es)
What are the psychosocial
concerns a patient can present with?
- Catastrophizing
- Fear Avoidance
- Depression
What are the characteristics of making referrals?
Structured communication: SBAR format • Situation • Background • Assessment • Recommendation
What happens next after a patient referral?
Medication and/or “talk therapy” • Cognitive Behavioral Therapy - Automatic thoughts/emotions - Impact on function • Motivational Interviewing - Barriers to function - Patient-driven • Traditional psychotherapy
What are the components of patient active intervention?
- Graded Exposure
- Graded Activity
What is graded exposure?
Gradual resumption of feared activities
What is graded activity?
Quota-based restoration of function regardless of symptoms
What are the characteristics of pain as a biomarker?
Lack or limited correlation between:
• Inflammatory markers and neuropathic pain
• Cystatin C levels in cerebrospinal fluid for postherpetic neuralgia
• Cystatin C levels in women experiencing labor
• Cardiac markers and chest pain associated with myocardial infarction
What are some of the clinical measures of pain?
- Visual Analogue Scale
- Numeric Pain Rating Scale
- Body Diagram
- Brief Pain Inventory
- McGill Pain Questionnaire
- Pain Pressure Threshold
What are some words used to describe patients with heightened pain behavior?
- Malingering
- Maladaptive behavior
- Symptom magnification
- Secondary gain
What are the characteristics of the Visual Analogue Scale (VAS)?
• Single or Multiple Item Scale
Current, Best, Worst, etc.
• Recall period, varies
What are the characteristics of the Numeric Pain Rating Scale (NPRS)?
• 0 is no pain and 10 is worst possible pain
• Most commonly an 11 point Likert scale
• Can be administered verbally and by telephone
• Acceptability:
Chronic pain patients prefer the NPRS over other measures of pain intensity due to comprehensibility and ease of completion
- Groups of chronic low back pain and symptomatic hip and knee OA have found the NPRS as inadequate
What is the reliability, validity, and Ability to Detect Change of the Visual Analogue Scale (VAS)?
Reliability
ICC= 0.97 (95% CI= 0.96-0.98)
R=0.94 for literate patients, r=0.71 for illiterate patients
Validity
Criterion validity cannot be established
High correlation with disease specific measures of disability
Validated as ratio scale: 4 cm to 2 cm can be interpreted as a 50% reduction
Ability to Detect Change
Minimum Clinically Important Difference (MCID)
- 1 cm in patients with rheumatoid arthritis
- 37 cm in patients with rotator cuff disease
- 0 cm for adequate pain control in emergency department
What is the reliability, validity, and Ability to Detect Change of the Numeric Pain Rating Scale (NPRS)?
Reliability
R=0.96 in patients with rheumatoid arthritis
Validity
Highly correlated with VAS (0.86-0.95)
Ability to Detect Change (MCID)
2 points in low back pain
3 points or 27% reduction
2.17 points in post-operative and non-operative shoulders
What are pain drawings used for?
- Psychological evaluations
- Documentation of symptom location
- Diagnosis of lumbar disc disease
- Changes in pain
- Prediction of treatment outcome
What are the methods of interpretation of pain drawings?
- Documentation of body regions
* Grid methods
What are the characteristics of the McGill Pain Questionnaire (MPQ)?
Quantitative profile of pain:
• Sensory-discriminative
• Motivational-affective
• Cognitive-evaluative
What are the components of the McGill Pain Questionnaire (MPQ)?
- Diagnosis
- Medication
- Pain history
- Present pain pattern
- Accompanying symptoms
- Modifying factors: agg and eas
- Effects of Pain
- List of words
