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Reassessing Patient Conditions
When reassessing, consider the important elements that will guide you through the treatment process.
Capture impairments, treatment options, benefits, and risks throughout the assessment.
Importance of Education in Treatment
Education must be included in every single treatment.
Focus on the type and scope of education targeted towards:
The problem at hand
Psychosocial aspects
Activity modification
Pain Management Strategies
First, target pain through activity modification.
Example: If osteoarthritis causes pain during a HIIT (High-Intensity Interval Training) class, avoid HIIT exercises, particularly movements causing strain such as squats.
Educate about substitutive pain reduction strategies like:
Using an ice pack post-exercise
Taking hot showers with a heat pack for relief
Focus on self-management of pain through education.
Acknowledge that some patients may lack basic fitness knowledge (e.g., what a dumbbell is).
Evidence-Based Treatments
The most evidence-based treatment options include:
Exercise
Focus on enhancing range of motion initially.
Future sessions may target strengthening.
Education and Exercise Combination
Make sure that all treatment sessions incorporate education with exercise prescriptions.
Physical Examination Considerations
Provide updates and corrections if necessary regarding physical examination findings:
In Case A, delete ambiguous assessments such as "five out of ten" muscle mass observations.
In Case B, correct left-right confusions in balance tests and strength testing.
Addressing Comorbidities
For example, a patient with COPD may experience breathing difficulties and inactivity due to knee pain.
It’s critical to address comorbid conditions in physical therapy:
Integrate exercises that consider shortness of breath and joint discomfort.
Morning Stiffness Management
For patients experiencing stiffness that worsens in the morning, advise:
Performing mobility exercises immediately upon waking or before getting out of bed.
Using heat applications to manage morning stiffness effectively.
Assessment Details
Ensure information on living situations is gathered.
Example: Knowing a patient lives in a two-story house can impact their treatment plan.
Observations and Impairments
Common physiological impairments to note:
Low muscle mass
Knee pain reported by patients
Inability to perform a single-leg balance successfully
Practical assessments should document:
Active movements, such as restrictions in knee flexion and extension ranges (e.g., inability to extend knee beyond -22 degrees).
Specific Treatment Modalities
Address joint stiffness through recommended treatment strategies like:
Passive accessory movements
Strengthening exercises for quads and glutes
Discuss the importance of observing improvement in range of motion from targeted treatments.
Patient Education on Osteoarthritis
Educate patients about:
Prognosis of osteoarthritis and the importance of an active lifestyle.
The rationale for exercise, with reference to muscular support for joint stability.
Inform patients that weight loss has quantifiable benefits on joint load, as each kilogram lost equates to a specific decrease in force on the joint with every step taken.
Treatment Risks and Adjustments
Discuss possible risks associated with treatment including:
Flare-ups in symptoms due to new exercises.
Educate about pacing, encouraging patients to exercise within a tolerable pain threshold (e.g., no more than four out of ten).
Addressing Patient Concerns
Instruct patients regarding sleeping positions to minimize pain while resting:
Shift to sleeping positions that alleviate stress on the affected side.
Suggest utilizing pillows for proper alignment.
Gathering Feedback and Building Compliance
Utilize education sessions to build a trusting relationship.
Create opportunities for patients to express pain levels and adapt treatment accordingly.
Ensure treatment sessions allow for the development of patient independence and self-management skills.