Monday 24th May 2021
Hours: 4 (Observational)
Patient presentations:
- Knee Replacement
- Subacromial Decompression
- Knee Replacement
Reflection Focus
- Knee Replacement – Focus on Patient Attitudes
Reflection Model
- The ERA cycle (Jasper, 2013)
Experience
- Two female patients were seen on this day. They were similar in age and were also the same amount of time, give or take a day or two, post-op TKR. Despite their similarities, they were at very different stages of their rehabilitation process. One was still walking with the aid of a crutch whilst the other was progressing onto single-leg glute bridges and walking unaided.
Reflection
- It seemed that the patient who was progressing onto more complex tasks was more internally motivated to complete her post-op rehab exercises. She completed the exercises more often than prescribed and was asking. ‘when can I go hill walking again?’ However, when the other patient was asked by the clinician, ‘what is it you would like to get back to doing?’ she didn’t have anything in mind. The patient seemed quite reliant on her husband and stated that he was doing a lot more tasks to help her. When the clinician then iterated that the exercises would help her get back to doing some of those tasks she didn’t seem very optimistic and admitted to not completing her rehab as often as she should because she didn’t have the time. The patient expressed that she was not happy with the progress she had made to date and thought she would forever walk with a stick from now on. Although I suspected the patients lack of optimism was contributing to a slower recovery process, this was confirmed on further reading. A study by Lopez-Olivio., et al. found that low optimism, among other psycho-social factors, resulted in poorer patient reported outcomes on function and pain after a TKR (2020).
- This experience highlighted the importance of psycho-social factors and their role in the recovery process. It is clearly one of the many reasons rehabilitation needs to be patient centred. The patient struggling to adhere to her rehab clearly needed further support and encouragement as she was lacking the intrinsic motivation the other patient seemed to possess.
Action
- During revision sessions, I have been very focused on perfecting the objective assessment. However, this situation highlights the importance of understanding a person’s motivation and end-goals. When in clinic, I will try to spot any other behaviours that indicate a positive or negative attitude towards the rehabilitation process or injury, as these are likely going to as informative about their recovery as the objective information.
Revisiting Reflection
- Upon further investigation, I found an article detailing the seven principles of rehabilitation. One of the principles is compliance and iterates that athletes should be made aware of the rehabilitation content and the expected outcome. I have been ensuring I implement this in practice but in addition I also make it a shared decision making process. By involving the client in the decision making process I am aiming for them to become intrinsically motivated to comply with their programme. This is also known as self-determination which is likely to increase adherence/compliance to a programme (Chan, et al, 2011).
References
- Lopez-Olivo, M.A., Ingleshwar, A., Landon, G.C., Siff, S.J., Barbo, A., Lin, H.Y. & Suarez-Almazor, M.E. (2020). Psychosocial Determinants of Total Knee Arthroplasty Outcomes Two Years After Surgery. ACR Open Rheumatology, 2, 573-581. https://doi.org/10.1002/acr2.11178
- Derwin King-Chung Chan, Martin S. Hagger, Christopher M. Spray. (2011). Treatment motivation for rehabilitation after a sport injury: Application of the trans-contextual model, Psychology of Sport and Exercise, 12(2), 83-92. https://doi.org/10.1016/j.psychsport.2010.08.005.