Author Archives: Laura Budd

Week 12 – Functional Exercise, Gym Drop-In & Phone Calls

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7th February – 13th February

  • Hours: 15

Main Theme Addressed During Phone Calls

  • Thoughts and feelings around continuing with their rehabilitation independently.
  • How was the programme helped each participant individually.

Functional Exercise Class

  • ((45s  x 15s rest) x 3 followed by a 30 second rest) x 3
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.
  • Increase of 15 seconds during working phase due to familiarity of new exercises.

Drop-in Session

  • Once again, this was a fairly hands-off session in terms of guidance from me. All participants were happy with their training and looked confident doing so. They required no prompting from me which indicates that they would be capable of continuing their training sessions without guided support.

Analysis & Evaluation 

  • All participants, excluding one, reported improvements since starting the programme. Improvements noted were; improved energy levels, reduced fatigue, improved sense of wellbeing, decreased breathlessness and an increased exercise capacity.
  • Many reported that it was having a group of people going through something very similar to them that helped their recovery. They felt they were surrounded by people who understood what they were going through and that it was nice to be on a programme where people didn’t just think they were ‘making up’ their symptoms.
  • One participant ran 5k the weekend before our final week and he was delighted. One of his goals was to return to running but he never expected to be this far along already. At the very beginning of the programme this participant was completing 1 mile walks and suffering from fatigue on a daily basis. We focused on the 10% rule with his walks and only increased his walking distance or time if he felt he was able to, in accordance with his fatigue. When we reintroduced running, which was only a few weeks ago, we looked at doing 30 secs of running to 90 secs of walking. This worked well and then participant was then happy to control his pacing from this point onwards. To have run a continuous 5k at this stage does seem like a steep increase and it is more than likely his incremental adjustments were too large. However, the participant noted that there were no ill effects after the run so we could have potentially been erring on the side of caution previously.
  • Interestingly, the patient above seems to have made a spontaneous recovery. He is also not the first one I have seen do so. There has been a handful of participants that I have worked with over the past year who at any stage during their recovery seem to make such a steep improvement in such a short space of time that they appear to have improved overnight. Very little is still known about long covid and why some people make fast recoveries than other is still unknown. However, it is known that the more symptoms you present with during the acute infection the more likely you are to develop long covid (Sudre, et al., 2021). Furthermore, being over the age of 50 and having pre-existing health conditions – mental of physical -increased the risk of developing long covid (Crook, et al., 2021). Therefore, maybe having less of these risk factors may contribute to faster or even spontaneous recovery if the correct strategies, such as pacing, are put in place to allow optimal healing.

Conclusion 

  • It has been a great challenge to work with people experiencing symptoms of long covid. It doesn’t exactly fit in with what we have been learning but there is an overlap in the knowledges and skills. For example, I have been able to use my exercise knowledge to create appropriate activities for the group and individuals. However, I have probably learned more from the experience than what I took to it. I think before the rehab programme I didn’t really consider psychosocial factors as important. This is likely because learning anatomy, pathologies and rehabilitation was such a challenge to me that I prioritised it over the psychology of rehabilitation. However, I have learned that this can be such a determining factor to successful rehabilitation. If a person doesn’t believe what you or they are doing will help them, then they are less likely to adhere and/or see positive results.
  • Moving forward, with all my rehab, I will be working with patients to explain the benefits and the underpinnings of treatment so they fully understand why they are doing or receiving a certain course of treatment.

 

Revisiting Reflection

  • Crook, H., Raza, S., Nowell, J., Young, M., & Edison, P. (2021). Long covid-mechanisms, risk factors, and management. BMJ (Clinical research ed.), 374, n1648. https://doi.org/10.1136/bmj.n1648

  • Sudre, C. H., Murray, B., Varsavsky, T., Graham, M. S., Penfold, R. S., Bowyer, R. C., Pujol, J. C., Klaser, K., Antonelli, M., Canas, L. S., Molteni, E., Modat, M., Jorge Cardoso, M., May, A., Ganesh, S., Davies, R., Nguyen, L. H., Drew, D. A., Astley, C. M., Joshi, A. D., … Steves, C. J. (2021). Attributes and predictors of long COVID. Nature medicine, 27(4), 626–631. https://doi.org/10.1038/s41591-021-01292-y

Suspected WAD

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Monday 14th March 2022

Hours: 3

Patient presentations:

  1. Netball player with suspected WAD
  2. Football player – lateral ankle sprain

Reflection Focus

  • Suspected WAD – Grade 2

Reflection Model

  • Gibbs Reflective Cycle 1988

What Happened?

  • Patient’s 2nd visit to clinic – I observed her first visit whilst she was treated by another therapist.
  • Patient fell during a game of netball and fell backwards. She was unsure if the back on her neck hit the opposing player first of if she hit the ground first.
  • Reporting pain and tightness during flexion and extension – extension is particularly painful. After the initial injury she was taken off the field of play and concussion was ruled out by a therapist on site.
  • Pain leads up to the occiput and the patient is also complaining of tightness in UFT.
  • Reported headaches and dizziness after the trauma but this dissipated within 2 days
  • Patient is now 3 weeks post-trauma – according to the Quebec Task Force classification system the patient fits into the grade 2 classification. As she has decreased ROM and can pin point an area of tenderness on her neck.

  • Treatment was STM and MET to relieve UFT tightness – effleurage and petrissage. Pt reported slight improvement in regards ride sided tightness.
  • MET of UFT – pt experienced a painful tightness.
  • Pin and stretch technique not tolerated due to pain.
  • Exercises – Chin tucks against gravity and chin tucks with flexion.
  • Discussed DSE as patient reported that sitting for long periods at her desk aggravate symptoms.

 What were you thinking and feeling? 

  • This is the first time in clinic I can say that I genuinely felt tightness in a muscle compared to the muscle on the opposite side. The patients R UFT had obvious and palpable increased tone/tension. The treatment I offered seemed mildly effective. Other treatments that I thought would be beneficial; however, could not be tolerated due to pain. This was frustrating, I am sure for the patient also, but I didn’t want to invoke too much pain that it promoted further guarding.

Analysis and Evaluation

  • I remembering being taught about whiplash but I couldn’t really remember anything in regards to treatment. In this instance I just applied the basics of rehabilitation – I identified the patients main complaint and treated accordingly. A systematic review in 2012, found that evidence for treating grade 2 WAD is limited and of low quality; however, active interventions seemed to be more favourable for patient outcomes (Rushton, et al., 2011). Therefore, it is possible that the prescriptive exercises may yield improvements – the patient did report that symptoms had improved since her first visit and she had been keeping up with her exercise prescription.

 Conclusion 

  • I think I still have a lot of work to do in regards to acquiring the knowledge and skills to treat WAD. The literature I found on this seemed dated and so I wonder if this resulted in academics publishing more high quality evidence for this pathology.
  • I am going to do some further reading before I next see the patient (March 24th) to ascertain how I could change the treatment plan in order for relive her pain and discomfort.

Revisiting Reflection

 

 

References

  • Rushton, A.B., Wright, C.C., Heneghan, N.R., Eveleigh, G., Calvert, M.J., & Freemantle, N. (2011). Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ Open, 1.

Lateral Ankle Sprain

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Monday 28th February 2022

Hours: 3

Patient presentations:

  1. Netball player with suspected whiplash
  2. Football player – lateral ankle sprain

Reflection Focus

  • Lateral ankle sprain

Reflection Model

  • Gibbs Reflective Cycle 1988

What Happened?

  • Football player presenting with intermittent pain and weakness of the right ankle after being tackled 3.5 weeks ago during a game a football.
  • Patient was able to walk after injury so did not suspect a break or fracture.
  • PoP at site of the tackle (anterior ankle – talus) and PoP over lateral ligament complex (ATFL & CFL).
  • Plantar flexion was the most uncomfortable movement for the participant. ROM was symmetrical compared to uninjured side.
  • Prescribed ROM exercises to maintain ROM, seated and standing calf raises to begin strengthening around the joint and single leg balance to work on postural stability.

 What were you thinking and feeling? 

  • I was quite confident that the patient was presenting with a lateral ankle sprain (LAS). He was reporting pain when he ‘misplaced’ his foot and that sometimes it feels like her has never used his foot before. To me, this suggested instability of the ankle a common reason for, and also a consequence, of a LAS. Further supporting this, is that the patient feels he cannot perform more complex sporting tasks, such as change of direction, and plantarflexion was painful.
  • I was a bit unsure of the pain experienced around the talus; however, when he mentioned that this was where the opponent tackled him I believed that this was just a lingering effect of the blunt trauma. However, I have the patient booked in for a follow-up so will continue to monitor this.
  • The patients single leg balance on both legs was poor. Therefore, he may have potentially been an at-risk individual identified a pre-participant screening, if this happened on his football team. However, this was a contact injury out of the participants control – his ankle was forced into plantarflexion/inversion so, it is likely this injury would have occurred with or without prehab.

Analysis and Evaluation

  • A recent systmatic review has reported that exercise based rehabilitation of lateral ankle sprains reduced the rate of re-injury by 40% (Wagemans, et al., 2022). However, it also reported that there was no favourable protocol to dictate exercise selection, intensity or volume. Therefore, I intend to use my knowledge around LAS to help rehabilitate this patient and prescribe exercise on symptom presentation. I am happy with the single leg balance prescription; however, I would like to move onto eversion movements as this movement counteracts those likely to cause a LAS.

 Conclusion 

  • Overall, I was really happy with how I handled this situation. Previously, I haven’t been particularly confident with the ankle; however I think I am improving with my ability to stay calm and rationalise a treatment plan.

Revisiting Reflection

 

 

References

  • Wagemans, J., Bleakley, C., Taeymans, J., Schurz, A. P., Kuppens, K., Baur, H., & Vissers, D. (2022). Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. PloS one, 17(2), e0262023. https://doi.org/10.1371/journal.pone.0262023

Health Fair – Massage

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13th December 2021

Hours: 4

Reflection Model

  • Gibbs Reflective Cycle 1988

What Happened?

  • Attended a health fair to share information about the work we do at Marjon Sport and Health Clinic and to offer short massages to the junior rates.
  • It was a really small room and once we had our beds unfolded it seemed even smaller. There were lots of other health services in the same room as us also sharing what work they do and some even had equipment like ourselves, e.g. wattbike and technogym treadmill.
  • Once the groups started to come in, the room became very loud and not everyone was eager to recieve a massage. The first individual I had was only willing to take his boots off and roll his trousers up so I did some very basic effleurage and petrissage on the calf complex. His colleagues then stole his boots and he was sat on the bed unsure of what to do next.
  • As the day progressed, some were keen to have a back massage. However, we didn’t have time for consultations before hand nor could we really hear what the person was saying.

 What were you thinking and feeling? 

  • I felt really overwhelmed by the situation as I couldn’t see how we were going to successfully offer any massage with such a busy room.

Analysis & Evaluation

  • The junior rates seemed to have a great day and it was a great opportunity to talk to the ERI who works with them. However, time was limited on both these accounts so there wasn’t much depth.
  • The opportunity highlighted to me that I prefer a ‘controlled’ clinical setting. I have always known I don’t want to work pitch-side due to needing stability rather than travel. I have never been able to volunteer to massage at events such as marathons due to other commitments; however, I feel the set up experienced on this day highlights that I would unlikely enjoy the chaotic nature that these events may bring.

 Conclusion 

  • I feel I operated the best I possibly could in the situation that presented to us on the day. However, not being able to do consults and treating an area that didn’t necessarily need treatment is a first for me on the course. Massage can have a therapeutic effect of stimulating the parasympathetic nervous systems and causing a relaxation response (Weerapong, et al., 2005). Therefore, there may still have been some benefit to the massage that we performed on the day.

Revisiting Reflection

 

 

References

  • Weerapong, P., Hume, P. A., & Kolt, G. S. (2005). The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports medicine (Auckland, N.Z.), 35(3), 235–256. https://doi.org/10.2165/00007256-200535030-00004

 

Week 11 – Functional Exercise Class & Gym Drop-In

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31st January – 6th February

  • Hours: 15

No phone calls this week

  • The reasoning behind no phone calls this week is to allow participants the opportunity to experience what a week will be like without that 1-1 tailored support. However, they have the safety of knowing that if they need further advice and support they have the following weeks to ask questions they may not have thought of previously.
  • It is also not a week of having support completely removed as I am still there during the gym drop-in and to teach the group class. So any immediate concerns can be addressed if necessary.
  • Most participants respond well to this set-up. Many of them state that they miss their weekly phone call; however, there is never really a complaint of feeling they can’t continue their rehabilitation independently.

Functional Exercise Class

  • ((30s secs x 3 followed by a 30 second rest) x 3) x 3
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.
  • There is a slight regression in intensity this week due to the change in exercise. Previously, the participants have been completing the same exercises each with only the duration increasing. Due to the change in exercise, it was important to reduce the intensity to allow them to adjust to the new exercise. The theory underlying this decision was from Blanchard and Glasgow (2014).

  • The diagram from their paper highlights a staged progression to rehabilitation.

  • Over the past 11 weeks, I have introduced 3 different types of exercise with small increases in intensity over time. As there are always variations, participants may choose to complete a simplified version of an exercise when the intensity increases or choose to remain at their current level with or without an intensity increase. As week 11’s class had new, but familiar movements, it was still important to remain in-keeping with this staged progression and therefore, reduce the time to prevent too steep a progression.

Drop-in Session

  • I remained very hands-off during this session as it was about the participants coming and completing their rehabilitation independently. I was still there to talk with the participants on a social basis and if anyone had any questions they of course knew I was there to help.
  • The cohort did extremely well and were even able to appropriately substitute exercises if the kit they were familiar with using was unavailable. E.g. BW squats instead of leg press.

Analysis & Evaluation 

  • Most of the participants report that the class feels more challenging, even though the intensity has been reduced. Therefore, choosing to lower the intensity was the correct approach in this instance. Many also reflect on how far they have come at this stage and note that they would not have been able to complete this class at the early stages of rehabilitation.
  • I think at this stage it is really important to ensure that participants aren’t given something so challenging that it overwhelms them and makes them feel as though they potentially haven’t made any progress.

Conclusion 

  • As the programme comes to an end, I am taking more of a hands off approach to give participants an insight into carrying on their rehabilitation after the programme comes to an end. However, I am still applying principles of rehabilitation to the elements that I am still heavily involved in and considering participant response the adjustments made this week were suitable.

 

Revisiting Reflection

  • Blanchard. S., & Glasgow., P. (2014). A theoretical model to describe progressions and regressions for exercise rehabilitation. Physical Therapy in Sport, 15(3), 131-135. https://doi.org/10.1016/j.ptsp.2014.05.001

Week 10 – Cardio Class & Phone Calls

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24th January – 30th January

  • Hours: 15

Main Theme Addressed During Phone Calls

  • 2 participants starting to feel like themselves anymore and rarely think about long-covid
  • 1 participant opened up to have been dealing with a breast cancer scare since Christmas.

Cardio Class

  • ((45s secs x 2 followed by a 30 second rest) x 3) x 3
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.

 

Analysis & Evaluation 

  • Interestingly, two of the participants who have started to feel much better as the two participants whose attendance is a bit up and down. One more so than the other but attendance isn’t what it once was. As they both started to report in phone calls that they started to feel better other things started to take priority, e.g. taking kids to a football match or taking the kids to football.
  • I found myself really conflicted with both these participants as I felt I needed to encourage them to maintain their rehabilitation in order to ensure they were stable. I didn’t want either of them to do too much one day and then experience a relapse. However, the things they were doing instead of the programme were elements of their life that they missed due to their long covid so, I felt their progress needed to be celebrated.
  • We have been taught that rehabilitation should be patient-centred and fit the patient’s lifestyle. And, unlike many sports injury, there isn’t a set protocol on how to successfully rehabilitate people living with long COVID. As the activities that these participants were doing, required an energy expenditure that they were not capable of before then there is no reason for me to assume that ‘unstructured’ exercise doesn’t hold a place in their rehabilitation. Especially, when I consider the psycho-social impact COVID can have on participants. It is worth noting that limited social support or family support has been shown to be a barrier to adherence (Jack, et al., 2010); however, in this instance it seemed actually having that support hindered their adherence. Both of these participants reported extremely supportive families and that they wanted to get back to feeling normal with them again.
  • Another participant this week opened up about a breast cancer scare she has been dealing with since Christmas. She initially told me via email and we then discussed how she was at her weekly 1-1 phone call. Naturally, the scare had been weighing on her mind – her biopsy was coming up soon and she was dreading the thought of having to deal with cancer on top of her long covid. I just listened to what the participant had to say and refrained from offering advice in this situation. During our EWB training, when dealing with significant EWB concerns that are beyond our scope of practice we are to practice repeat back what the participant has said, thanking them for sharing the information and asking questions such as, ‘ is there anything you would like me to do know that you have shared this with me?’ The participant confirmed that she just wanted to keep me informed and that she would need a some time off from exercise as he biopsy fell the day before an exercise class. This particular participant has reported no improvements in her fatigue since starting the programme. However, she has also been quick to reject any possibility of time off work or trying to slow down. So, I did wonder if since the scare started if she has been trying to keep herself busy so she would be distracted and maybe not think about it as much. Situations like this, highlight that rehabilitation needs to be flexible when it is called for. Many participants worry that if they don’t attend for whatever reason that we would remove the from the programme. However, as this situation and also the previous two highlight, there are many reasons to justify non-attendance. I think the important thing is ensuring that attendance doesn’t start to diminish entirely.

 

Conclusion 

  • I have always assumed that people don’t adhere to rehabilitation because they don’t understand why it is relevant to them, they find it boring or they don’t see results quickly enough. However, adherence is much more nuances than that. This week has shown me that actually non-adherence may be a sign of successful rehabilitation that requires further progression or it may be a sign of more complex matters at hand that need to be addressed above their current rehabilitation programme. I think the challenge then lies in having these participants return to the programme on a consistent basis. Non-adherence, although not ideal, is sometimes not avoidable; however, it is important to get people back on track once this has happened and have a shared discussion about how this may look for them going forwards.

 

Revisiting Reflection

  • Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220–228. https://doi.org/10.1016/j.math.2009.12.004

Week 9 – Strength Class, Drop-In Session and Phone Calls

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17th January – 23rd January

  • Hours: 15

Main Theme Addressed During Phone Calls

  • Trying to be aware of small improvements over a larger scale of time
  • 2 x discussions around returning to work
  • One participant paused due an elevated RHR and BP

Cardio Class

  • (45 secs on (90 secs if singe leg), 15 seconds off x 3, followed by a 45 second rest) x 5
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.

Drop-in Session

  • Cohort are fairly confident in using the facilities now.
  • Offered additional exercises, e.g. tricep extension using the cable machine, and variations of exercises, e.g. underhand lat pulldown as opposed to the ‘traditional’ overhand grip.
  • 2 participants stay for the full 2 hours – however, they have buddied up together so have lots of rest between different exercises and have not been experiencing any negative effects post-session.

Analysis & Evaluation 

  • One discussion around returning to work involved the participant expressing their real want to get back to the workplace; however, occupational health and management are being very cautious and have yet to give him the go ahead. This participant notes that he is making small improvements over such an extended length of time that it is difficult to notice them. However, being able to exercise without significant exacerbations of his symptoms is a good indicator that he could start a phased return to work as previously any form of exertion resulted in excessive and debilitating proximal fatigue.
  • Another discussion around this same topic involved the participant expressing the level of recovery they wish to be at before they return to work. This participant received semi-regular calls from her workplace to check-in and see how she was feeling. This participant was really firm with work and stated that she would not be returning to work until she could, on a regular basis, wake up early, do some house work, have coffee with a friend, go to the gym, make dinner and stay up until 9/10pm without, ‘feeling like the walking dead the next day.’ Her work are very supportive and as the participant is making progress agreed that all was moving in the right direction. I praised the participant for this as I have seen many participants or know many participants have returned to work far too early in their recovery. A number of people in the past have said to me, once they have taken time off work, that they feel better and will definitely go back at the end of their sick-note. I always celebrate the fact that they are feeling better with them; however, I do warn them that they may need more time before going back to work. This is because most people who are off work have the capacity to pace, plan and prioritise more effectively; therefore, their energy expenditure in comparison to a working day is markedly reduced. Rather than shift in their thinking to,  ‘I know need to stabilise at baseline and then make small incremental increases to my energy expenditure overtime to prepare myself for going back to work.’ they tend to think, ‘I feel better, I should go back to work.’ The latter sees many people go back to work and struggle and/or off work again due to going back too soon. When I ask people why do they struggle through or why do they put so much pressure on themselves the answer normally falls into one of the following: guilt or financial concerns. When their reason falls into guilt I remind them that their sick-note is to declare that they are off sick from work not off sick from their life. Many people who have guilt about not being at work wouldn’t want to be seen doing what my participant described this week as they worry what people from work would say if they saw them, e.g. if she is healthy enough to go out to dinner/gym then why isn’t she at work. I try and work with these participants to challenge their thinking and put themselves first; however it can be difficult as it is a deeply rooted belief that they hold.

 

Conclusion 

  • I find it interesting that I have some people who don’t stress about not being back at work at all and others who have such an overwhelming sense of guilt who push themselves to return before they are ready. From this experience, I am going to explore any evidence that might exist on returning to work after a period of absence and what psycho-social factors play a role in this decision.

 

Revisiting Reflection

  • On further investigation, I found the NHS offers guidance and support about returning to work – therefore, I will ensure I offer this to participants who may be struggling alongside advise of planning, pacing and prioritising.
  • I found that the UK Government has acknowledged that psychosocial factors may impede an employees return to work. Fear of social stigmatisation, anxiety, depression and PTSD are quite common in those living with long covid. Therefore, it has been suggested that returning to work and moderate physical activity could be beneficial to those who have poor mental wellbeing. In terms of returning to work, it has been suggested that the employee have more control over the situation to reduce psychological distress or symptoms. I think in the future it would be beneficial to share this information with participants as some feel like have no say or guidance in their phased return process.

Week 8 – Mobility Class, Phone Calls and Gym Drop-In

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10th January – 16th January

  • Hours: 15

Main Theme Addressed During Phone Calls

  • Thoughts, feelings and questions from week 7’s gym drop-in.
  • Discussing specific exercises that may benefit particular individuals
    • For example, calf raises for marathon runner and patient suffering from proximal fatigue.
  • One patient, who has never, used the gym before was really lacking confidence and wasn’t sure if she would come again this week.
  • All participants who attended the gym and/or class in person noted a real difference in motivation and enjoyment.

Mobility Class

  • ((45s secs x 2 followed by a 30 second rest) x 3) x 3
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.

Gym Drop-In Session

  • The participant who was lacking confidence joined me as I delivered another gym induction for a participant who couldn’t attend the week previously. She printed off the gym programme I provided during week 7 to carry around with her. After trying a couple pieces of equipment things started to click into place and she stated that she understood everything a bit more so felt more confident. I had to leave her and the individual who hadn’t completed the gym induction previously to help some of the other participants during the drop-in. When I came back she was mid-way through demonstrating how the leg extension worked to her fellow participant. After this the participant seemed to have found some confidence and happily approached some more equipment without needing my direct support.

Analysis & Evaluation 

  • I was really keen to individualise programmes as best as possible for patients – not only to address specific concerns individuals may have e.g. knee pain, but also to keep the gym sessions relevant to their recovery goals. For example, the marathon runner would like to get back to running so I wanted to show him some strength and conditioning he could do to support his return to running e.g. calf raises. My aim here was to hopefully keep the individuals motivated to attend gym sessions as it is relevant to what they are looking to achieve from the programme. This was also the week that this participant introduced run/walk into his exercise routine – he completed 1km using a run/walk strategy. He noted that he was a bit more breathless and wheezy than he expected but he forgot to take his inhaler (asthmatic) prior, which he used to always do. Therefore, I encouraged him to try again next week with the inhaler to see if that makes his breathing easier.
  • The participants noted that it was really nice and enjoyable to meet everyone in person and it lifted their spirits. This highlights that the virtual/telerehabilitation component of the programme, although beneficial for most, maybe wasn’t as enjoyable as the face-to-face component of the programme. Many noted that even though you are in a group setting during the virtual phase you feel like you are going it alone still but when you meet everyone in person you feel like you have more of a support network and a chance to form meaningful bonds with others who need your help and support too. This highlights both the benefits and drawbacks to telerehabilitation and potentially also group v individual rehabilitation. For example, telerehabilitation can be completed successfully in the convenience of your own home; however, it lacks the same social experience as face-to-face that people quite often prefer. Furthermore, group rehabilitation can provide a wider support network that might not be as easily accessible as individual rehabilitation. However, group rehabilitation can make it slighter harder for the therapist to individualise parts of the session. This is why I spend time working with individuals during the drop-in session as it is a chance to tackle the drawback of group rehabilitation.

 

Conclusion 

  • From the feedback this week, I am going to explore ways in which to boost motivation and morale during the telerehabilitation stage of the programme.
  • Psychosocial support is a key component of rehabilitation (Wade. 2020). There are many techniques that can be used to provide this support, such as rehabilitation in a group setting. I enjoy working with participants on a one to one basis; however, this experience and literature has highlighted that group rehabilitation is a useful strategy for helping individuals with their psychosocial needs. I feel this is particularly true of COVID-19 rehabilitation as nation wide lockdowns resulted in a significant lack of social interaction with friends and family – a key component to maintaining healthy emotional wellbeing.

 

Revisiting Reflection

 

 

References

  • Wade D. T. (2020). Rehabilitation after COVID-19: an evidence-based approach. Clinical medicine (London, England), 20(4), 359–365. https://doi.org/10.7861/clinmed.2020-0353

Week 7 – Cardio Class, Gym Induction and Phone Calls

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3rd January- 9th January

  • Hours: 15

Main Theme Addressed During Phone Calls

  • Answering any further questions in regards to Week 7 transition
  • Two individuals noted that they may need to some extra guidance on keeping within their energy expenditure allowance during gym sessions. Both of these individuals either enjoy the environment and/or kit available to them and were concerned they may get too excited and increase their intensity unintentionally.

Cardio Class

  • ((45s secs x 2 followed by a 30 second rest) x 3) x 3
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.

Drop-In Session

  • Club tour
  • Group gym induction
    • Cardio, fixed resistance, functional equipment and floor space for body weight exercises.
    • Discussed appropriate durations, reps ranges and rest periods.
      • Durations for CV=3-5 minutes at a low to moderate intensity (should be able to maintain a conversation)
      • Rep ranges for resistance exercises = 10-12 with 45-60s rest (moderate intensity), 12-15 with 30-45s rest (low intensity). Depending on their capabilities or confidence would dictate what rep range they chose. I advised those who had not been in a gym environment for quite some time, or those who are reducing the intensity of the group classes, to stick with 12-15 reps at a low weight. Whereas, those who felt. a bit more confident in the gym setting, or who were improving their exercise tolerance, to try 10-12 reps at a moderate weight.
    • Generic exercise programme to guide structure

Analysis & Evaluation 

  • One participant is a physio and admits that the reason she sought this out as a career path was due to her love of physical activity and the gym environment.
  • Another participant is a marathon runner, he has gradually be increasing the duration of his walks (10% rule), in the hope that he can slowly build up to a run/walk. He is excited to make use of the treadmills.
  • I was particularly proud of both these participants during the gym induction as the entire session lasted around 90 minutes. The bulk of this was watching, learning and having a go on a couple of pieces of kit. The session generally lasts 2 hours – this is to allow participants to drop-in at any stage during this time rather than stay for 2 hours, the latter is unadvisable. At the end of the session both of the participants who stated they were worried that their eagerness might be a hinderance to their recovery, chose to leave as 90 minutes was enough for them that day. This also encouraged the rest of the group to reflect and they decided to end the session there rather than stay on and risk tipping their energy balance in the wrong direction. This day, for those two participants specifically, showed that they had really gotten to grips with listening to their body, understanding and controlling their triggers. If this wasn’t the case they would have chosen to stay on and let their excitement for the environment overrule what their body is capable of at the moment.
  • Many people on the programme describe being frustrated that their body can’t do what it used to and have often pushed it beyonds its current limits. Rather than listening to their body, they try to overrule it with what they think it should be doing as opposed to understanding where its new limits lie and working within them to allow adequate recovery. I spend a lot of my time iterating to participants that they cannot let their pre-covid brain rule their post-covid body and I feel for the participants I highlighted this week, that the message has started to sink in and they are consciously working within their new limits.

 

Conclusion 

  • Even when you see a success like the one described this week, it doesn’t always translate to happy or please participants. I will praise them for setting boundaries and doing less to protect their energy levels whereas they may feel frustrated or limited. This highlights why rehabilitation is more than just physical recovery and the mind-set of individuals needs to be considered and addressed throughout the process.

 

Revisiting Reflection

Week 6 – Phone Calls and Mobility Class

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27th December – 2nd January

  • Hours: 15

Main Theme Addressed During Phone Calls

  • Preparing for week 7
    • What to expect in the gym
    • How the group sessions will look moving forwards
    • What facilities they can and cannot use during their recovery

Mobility Class

  • ((45s secs x 2 followed by a 30 second rest) x 3) x 5
  • The class is always symptom-led as opposed to graded exercise therapy. Participants are free to rest when needed. They can end the class early if they have reached their limit and they can reduce the amount of sets they do if necessary.

Analysis & Evaluation 

  • Phone calls during week 6 involve getting prepared for week 7. Week 7 brings a close to the ‘virtual’ component of the programme as the group session will take place in a studio and the ‘build your own’ session will take place in the gym.
  • There is naturally some anxiety around transitioning to on-site as most have some apprehension about being around a number of people in an enclosed space. However, many of them note something along the lines of, ‘at some point things have to be normal’ or ‘i need to stop avoiding things.’  Therefore, despite some concerns the consensus was positive about the transition. Interesting, one study found a very weak link between anxiety and depression and previous COVID-19 infection (Klaser, et al., 2021) which I was quite surprised about. However, this study is not exclusive to those with ‘long covid’ symptoms. Therefore, this finding may not be applicable to this particular population.
  • Furthermore, publications are crying out for a multidisciplinary approach to the multi-faceted ‘long covid’ syndrome. Mental health support is not often omitted from papers focusing on the management of ‘long covid.’ Indeed, one review paper highlighted that many people are effected emotionally after COVID-19 and previously hospitalised patients, particularly women, are at risk of developing anxiety, depression and/or PTSD (Aiyegbusi, et al., 2021).
  • On top of this health related anxiety patients may exhibit, there is also the anxiety that some people have in regards to entering a gym environment. Many are worried that they will be judged by others or that they will look silly if they make a mistake or need to ask for help. I am fairly confident in settling these worries; however, I am always mindful to programme their drop-in gym session during ‘off-peak hours’ to prevent them becoming overwhelmed. However, it is January, a well known busy period, so I have also prepared them for the possibility of it still being a busy area.

 

Conclusion 

  • I have worked in a gym setting for a number of years now and as a result do not have any worries or anxieties about being in that environment. However, I remember a time when a gym environment would be intimidating to me and I have certainly helped a lot of people grow in confidence within a gym setting. Working with those who have had COVID-19 though brings additional challenges to easing concerns. Not only am I easing their concerns about entering an enclosed space with more people than what they are used to whilst the Omicron variant is circulating the UK but I am also trying to ease some pre-existing worries about the gym environment. This can be difficult but I believe it is a crucial part of their recovery. Physical activity aids immunity, reduces inflammation and has a positive impact on mental health which are all things which could potentially speed up their recovery. Therefore, I will spend a significant period of time discussing week 7 during week 6 to calm any concerns and create a safe and positive transition for the participants.

 

Revisiting Reflection

 

References

  • Aiyegbusi, O. L., Hughes, S. E., Turner, G., Rivera, S. C., McMullan, C., Chandan, J. S., Haroon, S., Price, G., Davies, E. H., Nirantharakumar, K., Sapey, E., Calvert, M. J., & TLC Study Group (2021). Symptoms, complications and management of long COVID: a review. Journal of the Royal Society of Medicine, 114(9), 428–442. https://doi.org/10.1177/01410768211032850
  • Klaser, K., Thompson, E. J., Nguyen, L. H., Sudre, C. H., Antonelli, M., Murray, B., Canas, L. S., Molteni, E., Graham, M. S., Kerfoot, E., Chen, L., Deng, J., May, A., Hu, C., Guest, A., Selvachandran, S., Drew, D. A., Modat, M., Chan, A. T., Wolf, J., … Steves, C. J. (2021). Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app. medRxiv : the preprint server for health sciences, 2021.07.07.21260137. https://doi.org/10.1101/2021.07.07.21260137