Physiocongress Basel 2010 Presentation of a Major Project for Master of Rehabilitation Science

Transcription

1 Physiocongress Basel 2010 Presentation of a Major Project for Master of Rehabilitation Science Colette Widmer Leu Instructor: Sue Stanton Project Advisor: Cheryl Beach University of British Columbia 1

2 The Use of Standardized Assessments for Low Back Patients: Influence on Clinical Reasoning of Physiotherapists 2

3 Problem: Patients with chronic low back pain Measurement so far on the level of body structure or body function. A gap in assessing quantitatively activity and participation levels. A gap in assessing quantitatively the patients view on their problem. A gap in assessing the patients pain processing explicitly. 3

4 Proposition The use of standardized assessments can improve: diagnosis, planning and prognosis progress and outcome evaluation client centeredness (10, 11) 4

5 Purpose of the Project To evaluate the impact of using selected standardized assessments with longterm patients with low back pain on physiotherapists clinical reasoning. 5

6 Background No literature was found that the use of standardized assessments would support clinical reasoning processes in physiotherapy. Positive evidence was found for nursing home care (12) nursing in acute care (13) intensive care (14) occupational therapy (15) 6

7 Chosen Assessments To assess activities and participation: Chosen assessment: Oswestry Disability Index ODI (16-18) To assess a patient s pain processing strategies: Chosen assessment: Coping Strategies Questionnaire CSQ (19, 20) 7

8 Methods: Ethics Ethics approval was obtained from the Behavioural Research Ethics Board of the University of British Columbia Approval was confirmed by the hospital s supervisor of therapies and treatments Volunteering physiotherapy participants gave informed consent 8

9 Methods: Data Collection Focus group to discuss the experiences: 1. After 3 months 2. After 5 months 3. To check (contradict or confirm) the analysis Open questions Audio-recorded 9

10 Methods: Data Analysis The goal: The description of the meaning of an experience A phenomenological approach, based on Husserl s philosophy (21), following the framework of Colaizzi (22). 10

11 Methods: Data Analysis Transcription of audio-records (spoken German into written English) Reading through Looking for underlying concepts More general meanings of the significant concepts and statements Categorizing framework of meanings and emergent themes Exhaustive description of the phenomenon 11

12 Triangulation 1. Debriefing with the second researcher (Cheryl Beach) 2. Member checks with the focus group participants for verification 12

13 Paper slips of single statements are grouped into meanings, sub-categories and major themes. 13

14 Results: Major Categories 1. Direct effects on clinical reasoning and decision making 2. Influence on patient-therapist relationship 3. New insights for physiotherapists 4. Differentiated view on target population 5. Considerations when implementing questionnaires 14

15 1.. Direct Effects on Clinical Reasoning A) Initial Assessment: Subjective and Objective Evaluation B) Goal Setting e.g. Single items of ODI as goals C) Planning of Therapy, Management e.g. Referral to a psychologist, knowledge about resources D) Progress and Outcome Evaluation E) Prognosis 15

16 2. Influence on Patient-Therapist Relationship A) Positive Aspects e.g. Heightening patients responsibility, less pressure on physiotherapists B) Conflicting Issues e.g. Better understanding vs. further immersion into pain story 16

17 3. New Insights for Physiotherapists A) Positive Aspects e.g. Self-confidence B) Challenges e.g. Learning process about pain processing, uncertainty about role, knowledge gap 17

18 4. Differentiated View on Target Population e.g. ODI: almost all patients with back pain CSQ: thoughtful choice and relative high burden 18

19 5. Considerations when Implementing Questionnaires A) Organizational Issues B) Educational Issues e.g. Learning by doing 19

20 Discussion: Positive Impacts Experience: Positive influence on different clinical reasoning strategies described in the literature (25,26) 20

21 Discussion: Challenges Thoughtful application mandatory Further education in managing problematic pain processing (knowledge gap) Interdisciplinary communication enhanced, but challenging 21

22 Conclusion: Key Messages Positive influence on clinical reasoning: Integration into written practice standards Improvement of physiotherapists knowledge base in the management of chronic pain necessary Enhanced interdisciplinary communication, but better communication channels needed 22

23 Danke, Merci, Grazie, Thanks Further information: Widmer C, Beach C. Anwendung standardisierter Assessments für Kreuzschmerzpatienten: Einfluss auf das Clinical Reasoning von Physiotherapeuten. physioscience 2010; 6:

24 References 1. Oesch P, Kool J, Overberg J-A, Rigter K, Ott B, Werffeli H, et al. Kenntnisse und Anwendung von Assessments in der muskuloskelettalen Rehabilitation: Eine Umfrage in Spitälern und Rehabilitationskliniken der deutschsprachigen Schweiz. Fisio Active. 2004;5: Kirkness CS. Prevalence of outcome measure use by physiotherapists in the management of low back pain. Montreal: McGill University; Widmer C. Muskuloskelettale Messinstrumente, die das Physiotherapie Team SRO anwendet. Team- Umfrage: SRO AG; 2008 Mai, Roddey TS, Olson SL, Cook KF, Gartsman GM, Hanten W. Comparison of the University of California- Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity. Phys Ther Aug;80(8): Harris JE, MacDermid JC, Roth J. The International Classification of Functioning as an explanatory model of health after distal radius fracture: a cohort study. Health Qual Life Outcomes. 2005;3: MacDermid JC, Roth JH, McMurtry R. Predictors of time lost from work following a distal radius fracture. J Occup Rehabil Mar;17(1): Poole JL. Outcome measures for people with scleroderma: Relationships between measures of impairment and activity limitation. British Journal of Occupational Therapy. 2006;69(10): Dowrick AS, Gabbe BJ, Williamson OD, Wolfe R, Cameron PA. A comparison of self-reported and independently observed disability in an orthopedic trauma population. J Trauma Dec;61(6): Butler DS, Moseley GL. Explain Pain. 2nd ed. Adelaide: Noigroup Publications; Oesch P, Hilfiker R, Keller S, Kool J, Schädler S, Tal-Akabi A, et al. Assessments in der muskuloskelettalen Rehabilitation. Bern: Verlag Hans Huber;

25 References (continued) 11. Scherfer E. Standardisierte Tests und Assessments: Bindeglied zwischen Forschung, Praxis, Qualitätssicherung und einer ganzheitlichen Perspektive. Zeitschrift für Physiotherapeuten. 2003;55(7): Hansebo G, Kihlgren M, Ljunggren G. Review of nursing documentation in nursing home wards -- changes after intervention for individualized care. J Adv Nurs. 1999;29(6): Carr EC. Evaluating the use of a pain assessment tool and care plan: a pilot study. J Adv Nurs Dec;26(6): Puntillo KA, Stannard D, Miaskowski C, Kehrle K, Gleeson S. Use of a pain assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice: Nurses' evaluations. Heart & Lung: The Journal of Acute and Critical Care. 2002;31(4): Jackson M, Harkess J, Ellis J. Reporting patients' work abilities: How the use of standardised work assessments improved clinical practice in Fife. British Journal of Occupational Therapy. 2004;67(3): Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy Aug;66(8): Mannion AF, Junge A, Fairbank JC, Dvorak J, Grob D. Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity. Eur Spine J. 2006a Jan;15(1): Mannion AF, Junge A, Grob D, Dvorak J, Fairbank JC. Development of a German version of the Oswestry Disability Index. Part 2: sensitivity to change after spinal surgery. Eur Spine J. 2006b Jan;15(1): Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain. 1983;17(1): Verra ML, Angst F, Lehmann S, Aeschlimann A. Translation, cross-cultural adaptation, reliability, and validity of the German version of the Coping Strategies Questionnaire (CSQ-D). J Pain May;7(5):

26 References (continued) 21. Loiselle CG, Profetto-McGrath J. Canadian Essentials of Nursing Research. Philadelphia: Lippincott Williams & Wilkins; Colaizzi P. Psychological research as the phenomenologist views it. In: Valle R, King M, editors. Existential phenomenological alternatives for psychology. New York: Oxford University Press; Sanders C. Application of Colaizzi's method: Interpretation of an auditable decision trail by a novice researcher. Contemporary Nurse. 2003;14(3): Professional learning and leadership development. Action Research. New South Wales Department of Education and Training; Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM. Clinical Reasoning Strategies in Physical Therapy. Physical Therapy. 2004;84(4): Jones M, Jensen G, Edwards I. Clinical reasoning in physiotherapy. In: Higgs J, Jones M, editors. Clinical Reasoning in the health professions. 2nd ed. Oxford: Butterworth-Heinemann;