WEEK 4 - planning and manual handling (managing risks)

Question 1

what is a problem list and why do you need it?

Answer 1

○ It is a list of problem areas that may require treatment/management/re-assessment
○ It helps you to plan and guide your patient’s management plan and prognosis
○ Problem list is prepared after completing the subjective and physical assessment
Initial step in treatment planning

Question 2

how do you develop a problem list?

Answer 2

Subjective examination findings: activity restriction, participation restriction
Physical examination findings: physical impairments

1. ACTIVITY RESTRICTION -> key difficulties encountered by an individual in executing a task or action 
2. PARTICIPATION RESTICTION -> key restrictions experienced by an individual with involvement in life situations (work, family, sport, leisure)  PHYSICAL IMPAIRMENT -> an impairment is a problem in body function or structure e.g. posture, movement patterns, soft tissue/ muscle/ joint/ neural mobility/ sensitivity

Question 3

what is goal setting?

Answer 3

• Goal setting between physiotherapists and their patients is a fundamental part of rehabilitation. It is the process of discussing, planning and documenting outcomes for a patient.
• Goal setting is used to direct interventions towards a specific outcome(s), and can also be used to evaluate the success of rehabilitation interventions
• Patient centred goal setting can improve patient engagement, improve motivation and self efficacy

Question 4

what are the types of goals?

Answer 4

1. Time based goals: Goals can be defined by time e.g. short, medium or long-term.
   – Short term goals are set to provide an immediate, achievable target.
   – Long-term goals are set to help people understand where they can expect to be in several months.
2. Activity-based goals .i.e. patient centred activity and participation goals. These goals are designed to achieve a certain activity or functional task.

Question 5

what are SMART goals?

Answer 5

S - specific - well defined, clear and unambiguous
M - measurable - specific criteria that measure progress towards the accomplishment of the goal
A - achievable - attainable and not impossible to achieve
R - realistic - within reach, realistic, and relevant
T - timely: with a clearly defined timeline, including a target date

Question 6

what is treatment planning?

Answer 6

Evidence-based planning means formulating a management plan that integrates:
> Clinical evidence
> Findings from the physical examination
> Patient values, preferences and goals (based on the subjective examination findings)

Treatment planning should:
> Be led by patients and respond to their identified recovery goals and preferences
> Be recovery-oriented and strength-focused
> Include all people involved in the patient’s health care, including the treating team and carers

Question 7

what is the clinical framework?

Answer 7

The Clinical Framework is a set of principles for the provision of health services to injured people.
1. Measure and demonstrate the effectiveness of treatment
2. Adopt a biopsychosocial approach
3. Empower the injured person to manage their injury
4. Implement goals focused on optimising function, participation and return to work
Base treatment on the best available research evidence

Question 8

what are the stages of healing?

Answer 8

DAYS 0-5: inflammatory period
- days 0-2: vascular phase
- days 3-5: cellular phase

DAYS 6-21: proliferation period
- fibroblasts start to form new collagen
- takes 21 days to reach full repair of collagen

DAYS 22+: organisation period and maturation phase

Question 9

what occurs in the inflammatory phase?
- signs
- symptoms
- management

Answer 9

symptoms:
- constant pain
- high irritability
- night pain, pain at rest
- morning stiffness
- functional impairment

signs:
- heat
- swelling
- movement limited by pain
- soft resistance through range
- muscle spasm/ guarding

management:
- active/ passive rest, RICE
- techniques short of pain or resistance
- active movement short of pain
- motor control
- education

Question 10

what occurs in the proliferation phase?
- symptoms
- signs
- management

Answer 10

symptoms:
- intermittent pain
- moderate irritability, reduced severity
- little or no night pain or pain at rest
- mechanical picture of provocation
- reduced functional improvement

signs:
- increased ROM
- pain less dominant in movement diagram
- no heat, reduced swelling
- less resistance through range
- less muscles spasm/ guarding

Management:
- encouraged graded activity
- techniques to P1 and R1
- functional movement short of pain
- motor control and early strengthening
- education about collagen weakness and need for care

Question 11

what occurs in the organisation and maturation phase?
- symptoms
- signs
- management

Answer 11

symptoms:
- pain associated with end range activity
- low irritability/ severity
- very mechanical picture of provocation
- functional impairment reducing
- potential fatigues, weakness with advanced activity

signs:
- full or near full ROM
- movement limited by resistance not pain
- firm end feel, ‘leathering’ tissue thickening
- improved motor control
- possible insufficient strength for functional tasks

management:
- passive techniques into more reistsance
- strong emphasis on self-management
- cardiovascular fitness
- strength and endurance programs
- progressive integration into function/ sports