Physiotherapy Interventions for People With Complex and Enduring Health Condition
Where the patient is being assessed:
The Persistent Physical Symptoms Service
Name: Joanna Sykes
Age: 47
Diagnosis
Persistent Lower Back Pain
Reason for Referral and History of Present Condition:
· LBP began 14 years ago when she bent forward and lifted her baby out of the cot. Immediate pain and struggled to straighten up. Had to ask a neighbour to help until her husband came home from work. Later the same day, the pain travelled into her leg and down into her foot, which also went numb. “Very scary experience”. Her husband called 999 for an ambulance when her foot went numb. Seen in A&E, given strong painkillers and set home. GP advised rest and sent for an urgent MRI. MRI showed a “Slipped Disc” at L4/5 and she was referred to Newcastle RVI for Lumbar discectomy surgery. Pt describes this as a very frightening experience due to the risks of surgery. She didn’t understand how a disc could slip and why some of it would therefore need to be removed: “if one disc could slip out, could the others slip out as well”?
· After this, very little pain in her back until her second episode of lower back pain two years later when leaning forward and lifting shopping out of the boot of her car. Slight radiation of symptoms into left buttock and thigh. Anxious that “another disc had slipped out” and would need surgery again. Complete bed rest for about ten days and within this time, her pain slowly settled.
· After this episode, she reports having around 1-2 episodes of LBP per year, which settled with approx. 1-2 weeks of bed rest
· Each episode has gotten progressively worse
· 2-3 years ago, pain gradually became more constant with flare-ups becoming more and more regular. “Never a day without pain in my back, the only variable is how much it hurts”. She worries that her spine is weak and unstable, that her spine is not properly aligned, that more discs are slipping out and that she will likely “end up in a wheelchair”.
· Pt does recognise that the increase in pain coincides with her husband’s diagnosis of fibromyalgia and her Fathers deteriorating health/memory.
· Very anxious regarding her prognosis and worried that “there might be something else going on” that has been missed
Past medical History including any previous admission to hospital:
· Migraine (started in early teens – one migraine per month on average but getting more frequent and intense over the past 2-3 years)
· Episodic lower back pain for 14 years, occasionally with left leg pain. Has been to A&E on several occasions over the years, always discharged same day with pain killers.
· Lumbar Discectomy at L5/4, 14 years ago – 5/7 stay in hospital followed by outpatient physio. Found the whole experience very frightening
· History of depression and anxiety
· Smoker – approx. 20 per day
· Slightly overweight
Drug History:
· Amitriptyline: 75 mg, once per day
· Over the counter paracetamol and ibuprofen (takes maximum dose every day)
Social History:
· Lives with husband who was diagnosed with fibromyalgia 2 years ago (currently signed off sick from work due to flare-up)
· Has 2 children aged 16 and 14
· Has an elderly Father with early signs of possible dementia (although not formally diagnosed) who lives nearby. Pt helps with housework, cooking and shopping most days because “he can’t manage on his own”. Pt’s mother died 15 years ago of lung cancer. No other family
· Doesn’t get out much and does not have any friends – she has lost touch with most of her friends over the years, blames her pain for this
· Works part-time in Tesco on the tills – does not like her job and feels “they could do more” to support her with her ongoing pain.
Education / Work History
· Left school at 18 with seven GCSE’s and two A-Levels. Did an apprenticeship in hairdressing and worked as a hairdresser full-time until her first child was born 16 year ago – describes this job as “the best job in the world”.
· Came out of work to raise her family. Tried to go back to hairdressing 12 years ago, but stopped after 3 months due to back pain flare-ups and worsening migraines – being on feet and leaning over people to cut hair made pain worse
· Stay-at-home Mum for the next 5 years, then began working in Tesco. Initially liked the job, but feels “it has changed” and now strongly dislikes her job. Due to the amount of time she has had off sick due to her pain, she does not think she would be able to get a different joband reports being “too old” for a career change
Treatment/intervention including Physiotherapy/AHP
· Investigations
o MRI Head 17 years ago: NAD (no action)
o MRI Lx 14 years ago: Disk herniation at L3/4 and L4/5, mild spondylosis at L3, L4 and L5 (had surgery and physio – see PMH)
o X-ray Lx 11 years ago: mild spondylosis and possible disk degeneration at multiple levels (referred to physio)
o MRI Lx 9 years ago: Disc dehydration and degeneration at L3/4. Annular Fissure at L2/3 (referred to physio)
o US scan left shoulder 7 years ago: Small tear in supraspinatus tendon (no surgery required – referred to physio)
o X-ray Cx 5 years ago: moderate spondylosis at multiple levels. Loss of normal curvature of the spine (referred to physio)
o MRI head 9/12 ago: NAD (referred to PPSS)
· Previous Interventions
o Several courses of physiotherapy over the years – feels that it doesn’t help anymore and is now “a complete waste of time”
o Acupuncture: helps a little at the time, but pain always returns once the course of treatment finishes (can’t afford to have acupuncture over the long-term)
o Pilates, Yoga and Tai Chi: All aggravate back and/or migraine pain
o Massage: helps for a few days, but pain always comes back
o Walking club: group walked “too far and for too long” – aggravated pain
Any previous or current involvement with other services (if applicable)
· None
Home Environmental Subjective Assessment (but not to include solutions to any issues)
· Not carried out
Brief: A written essay entitled 'A Critical Case Discussion of the Physiotherapy Management of a Person with a Long Term Condition'. Your assignment is to be based on a case study. You are to choose from 1 of 5 case studies that have been written for you.
Word Count: 2000
Learning Outcomes: Your 2000 assignment is based on the intended Learning Outcomes for this module. These are:
LO1. Critically review current physiotherapy interventions for people with complex and enduring health conditions.
LO2. Demonstrate critical awareness of psychosocial factors that might influence practice when working with people with complex and enduring health conditions.
LO3. Critically evaluate strategies aimed at supporting individuals, families and carers in the management of complex and enduring health conditions.
Referencing: Use Harvard Referencing style when citing your sources within your written work
Appendices: You are to include your chosen case study as an Appendix to your assignment (this will not be included in the 2000 word count). You should refer to your case study within your assignment
Marking Criteria:
A Critical Case Discussion of The Physiotherapy Management of a Person with A Long-Term Condition
By (Name)
The Name of the Class (Course)
Professor (Tutor)
The Name of the School (University)
The City and State where it is located
The Date
Institution
Physiotherapy Interventions for People with Complex and Enduring Health Conditions
Physiotherapy interventions are research-based interventions intended to improve patients' health by improving mobility, alleviating pain, reinstating functions and preventing disability and loss of mobility. Quality physiotherapy is tailored to fit each individual's needs. It is patient-focused in that it involves setting reasonable and meaningful goals that are easy and understandable, promote adherence and allow smooth integration into everyday routine. Adapting the biopsychosocial approach, physiotherapists now appreciate that social, biological and psychological factors are significant determinants of a patient's overall well-being (Radder et al., 2020). Moreover, that pain can be caused by emotions, environmental and social factors. The efforts to alleviate pain have led to new therapy methods, i.e., pain science aims at understanding how pain occurs and how it can be managed. It has enabled physiotherapists to understand the pain phenomenon, which has enabled them to address the underlying causes of pain and make individualised treatment plans. There are a lot of techniques physiotherapist use to help patients manage pain.
Pain management techniques like hot and cold therapy, acupuncture etc., have reported tremendous outcomes in alleviating pain. Methods like exercise therapy involve using specific exercises to treat musculoskeletal, cardiopulmonary and neurological disorders. Manual therapies like massage, stretching, or joint mobilisation can help alleviate pain, improve mobility and speed up healing. Massage has been shown to reduce musculoskeletal pain caused by inflammation and reduced physical function by reducing muscle tension and fatigue and boosting positive emotions (Radder et al., 2020). Respiratory therapy aims at improving lung function and breathing in patients suffering from chronic respiratory conditions like chronic obstructive pulmonary disease, asthma, chronic bronchitis or occupational lung disease that can weaken or restrict ventilation. This therapy aims to strengthen respiratory muscles for better ventilation. Respiratory therapy is safe and practical and can benefit patients with chronic respiratory conditions. Neurological rehabilitation is beneficial for conditions like stroke, Parkinson's disease or multiple sclerosis, which impair brain function (Radder et al., 2020). Neurological rehabilitation focuses on enabling individuals with acute or chronic neurological lesions to function effectively by improving coordination and balance.
Critical Evaluation and Synthesis challenging Existing Approaches
Physiotherapy, over the years, has evolved, with discoveries of many approaches toward pain management and physical rehabilitation. Many methods and interventions have been outdated due to their adverse outcomes, while new ones that are more beneficial have been invented. There is a constant need to evaluate the assumptions and theories of physiotherapy approaches base the on to ascertain their efficacy and safety (Thompson et al., 2022). Certain methods that were considered effective, e.g., electrotherapy, have been challenged due to limited evidence supporting their use. Other approaches have been embraced, e.g., exercise therapy, as they are effective for several musculoskeletal disorders. Many pain problems people face are complex and need maximum management through multidisciplinary approaches and integrated care (Coronado et al., 2020). This can be challenging due to barriers like costs pr psychological drain. Hence there is a need to evaluate approaches and integration strategies further, as many are faced with implementation challenges (Coronado et al., 2020). Physiotherapy alone, without consideration of the medical and psychological aspects of an individual, has shown poor prognoses. In combination with medication and other interventions like mindfulness techniques, it can significantly reduce risk factors and improve function and overall quality of life and prognosis (Kasia et al., 2021)
Integration of the case study
Lower back pain arising from disc herniations and other lower back pain disorders has proven over the years difficult to manage. Patients with disc herniations and spondylosis have poor neuromuscular function hence the need for an effective treatment approach (Danazumi, 2019). Treatment aims to alleviate pain, relieve muscle tension and joint stiffness, reduce disease progression and rehabilitate the patient. Picking out the best physiotherapy management is crucial for the patient's prognosis. Understanding the disease process is crucial in choosing which methods to use in order not to cause harm to the patient. Physical therapies like exercises and manual therapies involving massages, joint mobilisations or spinal manipulations in combination with other therapies like psychotherapy can help patients deal with emotional challenges associated with chronic illnesses (Danazumi, 2019). The patient's information and diagnoses require a holistic approach to management involving medication and therapies. Incorporating psychotherapy techniques like cognitive behavioural therapy with physiotherapy (Monticone et al., 2022) can help the patient manage the conditions better.
Psychosocial Factors that might Influence Practice
Psychosocial factors affect an individual's psychological and social well-being, and they define an individual in relation to their environment and how they influence their physical and mental health. Chronic illnesses can lead to a variety of psychosocial problems that may affect or influence the care given (Puhl et al., 2020.). Factors like lack of social support and low socioeconomic status, i.e., due to financial constraints, are some of the challenges that impact accessibility and adherence. Chronic stress, depression or poor work environments can lead to poor prognosis (Albus et al., 2019) as they affect an individual's will, attitude and commitment. Lack of social support from friends and healthcare can hinder effective therapy outcomes as access to information to support resources and services is lost (Alsubaie et al., 2019.). When giving treatment, consideration should be placed on the age and gender differences and also the patient's preferences. Treatment plans should include health education for both the patient and the family (Albus et al., 2019). This can help reduce the stigma associated with chronic illnesses, motivate the willingness to seek treatment, and boost adherence to treatment plans (Puhl et al., 2020.). Patients with chronic illness often have comorbidities which, if not considered, can affect the treatment outcomes.
Critical and Innovative Discussion of how Psychosocial factors can influence Practice
Psychological and social aspects of a patient's life can affect their overall treatment outcomes. 1. A patient's beliefs and attitudes impact their willingness to undergo treatment and their outcome expectations. A patient can need more motivation to participate in a treatment program from believing that their disease is incurable. On the other hand, those with positive attitudes and motivation are likely to adhere and get better results. Cultural factors about health and health care can affect attitudes towards embracing healthcare. Some cultures prefer holistic approaches, while others may be focused on atomistical interventions (Yoshikawa et al., 2020). Therefore, it is important to consider cultural backgrounds and adapt their treatment approaches. 2. Emotional state of a patient, e.g., depression and anxiety, can cause muscle tension and pain, affecting treatment therapy and adherence. 3. Patients' knowledge and understanding of their health conditions can help them cope with the condition and have better outcomes.
Integration of the case study
A comprehensive approach to address an individual's physical and mental status can help a patient attain better outcomes. Educating the patient to understand their conditions can help people cope with their conditions well to avoid conflicting information that may affect involvement (Alhowimel et al., 2022). Disc herniation and spondylosis is a progressive chronic condition with worsening symptoms and pain. Patients can be subjected to psychological stress from pain and the disease burden on their physical activities ( Fors et al., 2021). This can lead to fear of engaging in activities with the belief that such activities can lead to more injury and pain to the spine (Fors et al., 2021; Alhowimel et al., 2022). This can lead to inactivity, which in turn can worsen their conditions.
Evaluation of Strategies aimed at Supporting Individuals, Families and Carers
Individuals, families, and carers associated with chronic illnesses require different forms of support to cope with their conditions. The impact of disease on the family members can affect their quality of life and general health. Supporting these individuals requires an all-around approach to address their physical, financial, social and emotional needs (Sing et al., 2021). Incorporating people in the patient's life is a way to ensure they receive the support required. Ensuring they understand the condition is important. Educating them on the condition and availing information; through online resources and other forms of educational media like telehealth can help sensitise them and ensure access to information (Singh et al., 2021). This can reduce stress and stigma and create awareness towards the conditions. Communication between the involved persons can help with more information on factors that may hinder or improve treatment outcomes. Individuals and families can form support groups to share their experiences, challenges and motivate each other (Toledano and Domínguez., 2019). This can boost optimism and a positive attitude. This way, t...