Message in a physio-bottle: what can we tell our patients and more importantly, how?

Ann Cools, Clinical Pearls / Friday, July 5th, 2019

Efficient communication with patients is challenging but crucial in our shared pathway through rehabilitation. There is a great body of evidence highlighting the importance of acknowledging the psycho-social and emotional context of the patient (De Baets et al. 2019), efficient communication (Bukstein et al. 2016),  shared decision making, and patient centered approach (Wijma et al. 2017, Bernhardsson et al. 2017). But what messages can we send out to our patients in the practice?

“Create positive expectations”. It has been shown that the major predictor of a negative outcome of non-operative treatment for patients with degenerative rotator cuff tears is not the size of the tear or clinical signs and symptoms, but having negative expectations from physiotherapy (Dunn et al. 2016). Switch this finding into the opposite direction, and our patient may benefit more from our intervention if they have positive expectations.

“The adherence to an exercise program is inversely proportional to the complexity it takes to perform it and the duration”. It is known that the main reason for not doing an injury prevention or rehabilitation program, is the fact that it takes too much time, and is too complicated to perform. So keep it simple, only a few exercises with minimal material, so patients have no excuse not having done the exercises, because they did not find a pulley machine or a climbing frame in their living room.

“Let the patient feel in control and responsible for their results”. Self-efficacy is a key element in treatment outcome (Littlewood et al. 2016). Inform your patients about their own responsibility to get better, let them monitor the “acceptable” pain during the exercises.

“Don’t be afraid of pain” Pain is not the enemy (Smith et al. 2017). Accepting a certain level of pain during exercises may decrease the fear avoidance behavior.

“Give constructive feedback but not too often” The quality of feedback (positive) is more relevant than the amount(Wulf et al. 2010). Don’t over-correct the patient’s performance. Feedback that emphasises successful performance and ignores less successful attempts  benefits learning, presumably because of its positive motivational effects.

De Baets L et al. The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019 Jun;33(6):980-991

Bukstein DA. Patient adherence and effective communication. Ann Allergy Asthma Immunol. 2016 Dec;117(6):613-619.

Wijma AJ et al. Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies. Physiother Theory Pract. 2017 Nov;33(11):825-840

Bernhardsson S et al. “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy. Physiother Theory Pract. 2017 Jul;33(7):535-549

Dunn W et al. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2016 Aug;25(8):1303-11

Littlewood C et al. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clin Rehabil. 2016 Jul;30(7):686-96.

Smith B et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(23):1679-1687

Wulf G et al. Motor skill learning and performance: a review of influential factors. Med Educ. 2010 Jan;44(1):75-84.

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