Successfully reported this slideshow.
Your SlideShare is downloading. ×

Touching an impossible thing in physiotherapy practice

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Loading in …3
×

Check these out next

1 of 22 Ad

More Related Content

Recently uploaded (20)

Advertisement

Touching an impossible thing in physiotherapy practice

  1. 1. Touching an impossible thing in physiotherapy practice Firmansyah Purwanto Physiotherapist | Movement & Pain Specialist
  2. 2. What have we learned from COVID-19?
  3. 3. Architecture – society At its roots, architecture exists to create the physical environment in which people live, but architecture is more than just the built environment, it's also a part of our culture. It stands as a representation of how we see ourselves, as well as how we see the world.
  4. 4. History of physiotherapy practice
  5. 5. Two distinct philosophies of physiotherapy’s approach to touch 1. Touch is a bio- physical phenomenon — strong focus on tissue anatomy, physiology, pathology, kinesiology, and biomechanics 2. Touch is an entirely subjective phenomenon that can only be understood by the person experiencing it Nicholls, 2022.
  6. 6. Integrating telephysio into practice ● Initial consultation ● During the normal course of care ● Exercise progression ● Promoting wellness ● Cancelations to telephysio visit ● Full virtual care Make it all about the patient!
  7. 7. Integrating telephysio into practice In the digital arena, attitude is everything and having your providers communicate to their patients that this is new for everyone and be humble about this new delivery method will help everyone be more patient and accepting. Make it all about the patient!
  8. 8. ● MSK rehab - reduce pain & improve physical function (Low Back Pain, Hip & KneeOsteoarthritis , Post Total Arthroplasty) ● Neuro rehab – contribute to balance & physical activitylevel (multiple sclerosis) ● Cardiac rehab – reducing mortality by any cause and also seems to contribute to a better ability to exercise and health-related quality of life ● Pulmonary rehab – reducing dyspnea in patients with COPD ● Cancer rehab – reducing overweight and obesity as well as improving the physical capacity and quality of life
  9. 9. “The available evidence shows that telerehabilitation could be comparable or better than the conventional methods of rehabilitation” Seron et al. Phys Ther J. 2021
  10. 10. The challenge of telephysio implementation ● Reliability of assessment during virtual consultation? How confident are we? ● How do we treat person (in virtual)? ● Legal & ethical procedure? ● Beliefs about “physiotherapy”?
  11. 11. A careful history will lead to the diagnosis 80% of the time! Hampton et al. Br Med J. 1975
  12. 12. Listen, listen and listen!
  13. 13. Alston et al. NAM Perspectives. 2012 What matters most?
  14. 14. Stratified telephysio in MSK physio practice ● Current history ● Past history ● Medications ● Social history ● Previous imaging ● Red flags screening
  15. 15. Stratified telephysio in MSK physio practice Screening for potential radiculopathy: 3 or more = potential radiculopathy (fast tracked to face-to-face care)
  16. 16. Stratified telephysio in MSK physio practice
  17. 17. Stratified telephysio in MSK physio practice Treatment sub-group for patient at low risk of persistent pain: Criteria: Keele STarT MSK score : 0 - 4 and no potential radiculopathy Treatment Protocol: ● Advice on daily walking ● Advice on activity modification ● Teaching about self-pain management/self-coping strategies ● Education that their condition has a good prognosis
  18. 18. Stratified telephysio in MSK physio practice Treatment sub-group for patient at medium risk of persistent pain: Criteria: Keele STarT MSK score : 5 - 8 and no potential radiculopathy Treatment Protocol: ● Advice on activity modification ● Advice on to take simple pain medication (non-oral preferable) ● Teaching about self-pain management/self-coping strategies ● App-based exercise program / exercise tutorial / booklet
  19. 19. Stratified telephysio in MSK physio practice Treatment sub-group for patient at high risk of persistent pain: Criteria: Keele STarT MSK score : 9 - 12 and no potential radiculopathy Treatment Protocol: ● Advice on activity modification ● Advice on to take simple pain medication (non-oral preferable) ● Interventions to address psychological barriers to recovery – supervised graded exercise & exposure ● Teaching about self-pain management/self-coping strategies ● App-based exercise program / exercise tutorial /booklet ● Refer to specialist or psychologist if necessary
  20. 20. Stratified telephysio in MSK physio practice Treatment sub-group for patient at with potential radiculopathy Treatment Protocol: ● In person physiotherapy appointment (face-to-face care) for initial treatment ● Graded activity & exposure ● Exercise program ● Manual therapy if necessary ● Intervention to address psychological barriers to recovery ● Mixed or follow up for telephysio in the next session ● Refer to specialist or psychologist if necessary
  21. 21. The “ACES” principle of rehabilitation Lewis et al, Physiotherapy 2021.
  22. 22. Rehabilitation is about creating a story where THE PATIENT IS THE HERO, not the clinician!

×