Monday 14th June 2021
Hours: 4 (Observational)
Patient presentations:
- Hip Replacement and Glute Medius Impingement
- Patella Tendinopathy
- Calcific Tendinitis
- Shoulder Capsular Release
Reflection Focus
- Calcific Tendinitis
Reflection Model
- The ERA cycle (Jasper, 2013)
Experience
- This was the patient’s first physio appointment since having a steroid injection administered to treat calcific tendinitis. At this stage the patient was not happy with the results as she stated her ROM was limited and painful. The clinician iterated that she still needed to give the steroid injection time to work as it was ‘early days.’ The majority of this session was spent talking to the patient about returning to work and how she was coping day to day.
Reflection
- This was a patient who seemed to be really struggling with her pain. Her mood was low and as a result she had been offered anti-depressants by her GP. She had refused them in the interim; however, it was obvious that the patient was struggling to deal with her pain and reduced function. This is likely why the clinician spent time talking about work and her general day to day life. He didn’t necessarily offer specific guidance on these matters but he just let her air out how she was feeling. This highlighted how the psychosocial elements of MSK practice are just as important to address as the physical components. The patient left feeling much more at ease after her conversation with the clinician and iterated she would continue with the previously prescribed exercises in the hope she would be better the next time she had an appointment.
- I think it is quite possible that if the session had been lead any differently that the patient may have continued to feel particularly low about her recovery and potentially not adhere to her rehabilitation as she was not seeing any progress. As a result, I found it interesting that the clinician didn’t have a specific tool as his disposal to track adherence to rehabilitation. However on further investigation, there is a lack of agreement of high quality measurement tools for exercise adherence within MSK rehabilitation (Hall., et al. 2015; McLean., et al. 2017.)
Action
- The evidence I found for measuring adherence to rehabilitation are slightly outdated. So, I am interested to see if there have been any developments within this sphere. Equally, if I find examples of how to monitor adherence I will likely implement these into my practice. As this experience has highlighted that non-adherence could indicate a psychosocial factor that needs to be addressed.
Revisiting Reflection
References
- Sionnadh McLean, Melanie A. Holden, Tanzila Potia, Melanie Gee, Ross Mallett, Sadiq Bhanbhro, Helen Parsons and Kirstie Haywood. (2017). Quality and acceptability of measures of exercise adherence in musculoskeletal settings: a systematic review, Rheumatology, Volume 56, Issue 3, March 2017, Pages 426–438, https://doi.org/10.1093/rheumatology/kew422
- Amanda M. Hall, Steven J. Kamper, Marian Hernon, Katie Hughes, Gráinne Kelly, Chris Lonsdale, Deirdre A. Hurley and Raymond Ostelo. (2015). Measurement Tools for Adherence to Non-Pharmacologic Self-Management Treatment for Chronic Musculoskeletal Conditions: A Systematic Review,
Archives of Physical Medicine and Rehabilitation,
Volume 96, Issue 3, 552-562, https://doi.org/10.1016/j.apmr.2014.07.405.