Monday 11th Ocotber 2021
Hours: 4
Patient presentations:
- Patella Tendinopathy
- Suspected Rotator Cuff Disease
Reflection Focus
- Suspected Rotator Cuff Disease
Reflection Model
- Gibbs Reflective Cycle 1988
What Happened?
- Patient reporting slight discomfort in UFT and pain over the deltoid area during external rotation and abduction. Her symptoms are now intermittent rather than constant.
- The patient received some HBE on her previous visit but as she hadn’t adhered to them as regularly as she would have liked she did not want to change these. Agreed this was a good idea as the little she has been doing was already making an impact so an increase in adherence may resolve her symptoms.
- Patient requested STM for UFT – completed MET on UFT via PIR and NMT for TrPs.
What were you thinking and feeling?
- I was happy with the patient’s progress. I hadn’t prescribed her HBE; however, they included stretching which has been shown to reduce pain associated with TrPs (Page 2012), which is something the patient was suffering with.
What was good and bad about the experience?
- Although the treatment was appropriate in this instance I should have asked what had impacted her adherence to HBE. For example, if it was due to her being busy I may have been able to condense the prescription.
Analysis
- By not asking what were her barriers to rehabilitation adherence I may have left this patient with an exercise prescription they wouldn’t benefit from as they wouldn’t do it. Adhereance to HBE is a key component to the success of many unsupervised rehabilitation programmes; however, there is a significant lack of valid a reliable tools to measure adherence (Bollen, et al., 2014).
Conclusion
- I rely solely on a patient’s honesty and recall when reviewing adherence and this is likely going to produce some errors in communication. Patient’s may over or under estimate their adherence if they haven’t been noting it down. Also, patients may not be honest for fear of judgement due to lack of adherence. Therefore, I am going to search for valid and reliable tools that may be useful for assessing adherence of prescribe HBE.
Revisiting Reflection
References
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A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties