Designing progressive exercise programmes for clients with low back pain UV41574 J/505/2541 Learner name: VRQ Learner number:
VTCT is the specialist awarding organisation for the Hairdressing, Beauty Therapy, Complementary Therapy, Hospitality and Catering and Sport and Active Leisure sectors, with over 45 years of experience. VTCT is an awarding body regulated by national organisations including Ofqual, SQA, DfES and CCEA. VTCT is a registered charity investing in education and skills but also giving to good causes in the area of facial disfigurement. Statement of unit achievement By signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements have been achieved under specified conditions and that the evidence gathered is authentic. This statement of unit achievement table must be completed prior to claiming certification. Unit code Date achieved Learner signature Assessor initials IV signature (if sampled) Assessor tracking table All assessors using this Record of Assessment book must complete this table. This is required for verification purposes. Assessor name Assessor signature Assessors initials Assessor number (optional)
UV41574 Designing progressive exercise programmes for clients with low back pain The aim of this unit is to develop the knowledge and understanding of correct protocol to follow when working with healthcare professionals and clients, including when to refer to others and the importance of having a named link. You will develop the skills, knowledge and understanding to screen clients and collect appropriate information to design progressive exercise programmes for clients with nonspecific low back pain. Programmes will include exercises, alternatives, modifications, monitoring and evaluating techniques appropriate to the client s needs. UV41574_v6
Level 4 Credit value 6 GLH 40 Observation(s) 1 External paper(s) 0
Designing progressive exercise programmes for clients with low back pain Learning outcomes On completion of this unit you will: 1. Be able to collect information and agree goals with clients with low back pain 2. Be able to design a progressive exercise programme for clients with low back pain 3. Understand the protocol to follow when working with healthcare professionals and clients 4. Understand how to screen and risk assess clients suffering from low back pain Evidence requirements 1. Environment Evidence for this unit may be gathered within the workplace or realistic working environment (RWE). 2. Simulation Simulation is not allowed in this unit. 3. Observation outcomes Competent performance of Observation outcomes must be demonstrated on at least one occasion. Assessor observations, witness testimonies and products of work are likely to be the most appropriate sources of performance evidence. Professional discussion may be used as supplementary evidence for those criteria that do not naturally occur. 4. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used. 5. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes in this unit. All outcomes must be achieved. 6. External paper There is no external paper requirement for this unit. 7. Case Studies This must be based on a real clinical case (i.e. a set case study patient), OR, by directly engaging with real patients (i.e. a patient undergoing cardiac rehabilitation). The case study patient must possess at least one co-morbidity in addition to the main diagnosis and should ideally present as medium-high risk according to appropriate risk stratification. 8. Optional Assessment Best practice assessment design for Level 4 Specialist Exercise instructor qualifications will require you to directly engage and interact with the relevant patient population. Suggested assessment evidence could include a log and witness testimony or selfreflective account (with documented pass/ fail criteria) of visits to: local exercise referral sessions (having been allocated relevant client/s) hospital/clinical setting (pulmonary/cardiac rehabilitation) UV41574 3
Achieving observations and range Achieving observation outcomes Your assessor will observe your performance of practical tasks. The minimum number of competent observations required is indicated in the Evidence requirements section of this unit. Criteria may not always naturally occur during a practical observation. In such instances you will be asked questions to demonstrate your competence in this area. Your assessor will document the criteria that have been achieved through professional discussion and/or oral questioning. This evidence will be recorded by your assessor in written form or by other appropriate means. Guidance for tutors and assessors You must refer to the Skills Active Guidance found under the Qualifications section of the VTCT website: http://www.vtct.org.uk/ Achieving range There is no range section that applies to this unit. Your assessor will sign off a learning outcome when all criteria have been competently achieved. Case study This must be based on a real clinical case (i.e. a set case study patient), OR, by directly engaging with real patients (i.e. a patient undergoing cardiac rehabilitation). The case study patient must possess at least one co-morbidity in addition to the main diagnosis and should ideally present as medium-high risk according to appropriate risk stratification. Case study details Date achieved Assessor initials 4 UV41574
Observations Learning outcome 1 Be able to collect information and agree goals with clients with low back pain You can: a. Collect information from clients with low back pain using appropriate methods b. Interpret and utilise information to enable planning for progressive exercise programming c. Agree Specific, Measurable, Achievable, Realistic and Time bound (SMART) goals with low back pain clients d. Record information accurately e. Follow correct procedures/protocols for confidentiality and consent *May be assessed by supplementary evidence. Observation 1 Optional Optional Date achieved Criteria questioned orally Portfolio reference Assessor initials Learner signature UV41574 5
Developing knowledge Achieving knowledge outcomes You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*: Projects Observed work Witness statements Audio-visual media Evidence of prior learning or attainment Written questions Oral questions Assignments Case studies Professional discussion Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning. When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved. Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic. *This is not an exhaustive list. 6 UV41574
Learning outcome 2 Be able to design a progressive exercise programme for clients with low back pain You can: Portfolio reference a. Select exercise activities that are appropriate for low back pain clients b. Apply the principles of Frequency, Intensity, Time and Type (FITT) to the design of progressive exercise programmes for clients with low back pain c. Integrate a range of training variables and techniques appropriate to the client s needs, following national guidelines d. Identify alternatives or modifications to individual exercise, specific to the client s needs e. Identify methods of monitoring and evaluating the status of clients with low back pain f. Record the programme in appropriate format UV41574 7
Learning outcome 3 Understand the protocol to follow when working with healthcare professionals and clients You can: Portfolio reference a. Explain the protocol to follow when dealing with: Healthcare professionals Self-referred clients b. Explain circumstances when you would refer to healthcare or fitness professionals c. Explain the importance of having an agreed link with a named healthcare professional from a secondary and/or primary care setting 8 UV41574
Learning outcome 4 Understand how to screen and risk assess clients suffering from low back pain You can: Portfolio reference a. Describe a range of pre-screening questionnaires used for clients suffering from low back pain b. Explain other methods of collecting information on clients suffering from low back pain: functional assessment physical activity levels psychological assessment reports c. Discuss the possible contra-indications and red and yellow flags that need to be taken into account for clients with low back pain d. Investigate methods currently used to monitor and evaluate the status of clients with low back pain e. Explain how to interpret information obtained from clients suffering from low back pain f. Explain how to respond appropriately to medical complications and emergencies for clients with low back pain UV41574 9
Unit content This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content. Learning outcome 1: Be able to collect information and agree goals with clients with low back pain Collect information: Appropriate methods, questionnaires, interviews, assessments, screening tools. Interpret and utilise: Interpret and utilise information, plan progressive exercise programme. Agree goals: Agree goals with low back pain client, SMART (specific, measurable, achievable, realistic, time bound). Record information: Record information (ensure accurate, legible, logical/user friendly format), use appropriate forms, in appropriate format, information can be used for official/legal purposes, used by multidisciplinary teams. Correct procedures/protocols for confidentiality and consent: Secure storage of information, use of informed consent, adhere to Data Protection Act, Freedom of Information Act, written permission to share information with other professionals. 10 UV41574
Learning outcome 2: Be able to design a progressive exercise programme for clients with low back pain Appropriate exercise activities: Stability programme, foundation skills (e.g. neutral spine, learning to activate abdominal wall), lumbo-pelvic rhythm (hip hinging), limb movements superimposed on a stable base (crook lying, four-point kneeling position), progression with emphasis based on balance, co-ordination, ultimately to train functional movements and strength, power, flexibility, incorporate all components of fitness, exercise professional to work within scope of practice (e.g. programme to contain exercises/activities from discipline professional is qualified to prescribe). FITT principles: Apply FITT principles to progressive exercise programmes, incorporate all components of fitness, apply FITT for specific training and general exercise. Training variables/techniques: FITT principles, gravity, movement complexity, range of motion, planes of motion, balance. National guidelines: NICE guidelines, other guidelines as recommended by health care professionals. Alternatives/modifications: Specific to client s needs, progress, adapt, modify, regress, progress, modify in line with client s response (e.g. alternative positions, exercises). Methods to monitor intensity/evaluate status: For example, monitoring during exercise (e.g. RPE, body language, back pain scales, gait, client feedback (before, during and after session). Evaluation longer term: Functional assessments, questionnaires, reviews. Record programme: Programme to include (exercises, structure of session, warm-up, cool down, alternatives, modifications, intensities, timings, reps, sets), equipment needed, monitoring methods, format (programme card), using appropriate language for the client, user friendly. UV41574 11
Learning outcome 3: Understand the protocol to follow when working with healthcare professionals and clients When would you refer: Outside of scope of practice (e.g. pain relief, greater medical intervention needed, if different exercise discipline more appropriate), change in symptoms/circumstances e.g. red flags, increased pain, condition worsened, client is non-compliant with medication or treatment, any change in circumstance which resulting in uncertainty/ambiguity regarding clients suitability for exercise. Refer to: Original referrer, general practitioner, healthcare professional, exercise professional, clients can self-refer to (physiotherapist, osteopath). Protocol to follow: As per accepted protocol (for general practitioners, healthcare professionals), keep everyone involved up-to-date (multi-disciplinary), adherence to exercise referral scheme protocol, understanding of the referral protocol, if client self-refers to exercise professional (refer for diagnosis), respect professional boundaries, check appropriateness of referral, professional etiquette, communication (written, accurate recording of information). Importance of agreed link: Clear line of communication, continuity within a multi-disciplinary team, continuity of care, client confidence, client reassurance, professional to liaise with, established link, to ensure all interested parties have up-todate information. Healthcare: Diagnosis, treatment, prevention of disease, illness and other physical/mental impairments. Secondary care setting healthcare services provided by medical specialists, those who do not have first point of contact with patient (e.g. cardiologist, urologist, dermatologist), includes acute care (e.g. intensive care, childbirth). Primary care healthcare given by healthcare provider, principal point of consultation for patients (e.g. general practitioner, family physician, nurse practitioner), co-ordinates other specialists patient may need. 12 UV41574
Learning outcome 4: Understand how to screen and risk assess clients suffering from low back pain Pre-screening questionnaires: PAR-Q, medical screening, Morgan and Irwin risk stratification tool, Oswestry low back disability, Roland-Morris disability, Bournemouth, International Physical Activity questionnaire, STarT back screening tool, fear avoidance beliefs, pain scales. Other methods of collecting information: Reports, interview, observation, functional/physical assessment. Reports healthcare professional reports, referral letters, status reports. Interviews formal, informal, to gather information, motivational/adherence purposes, review process. Functional/physical assessment postural assessment (standing, seated), rising from chair, gait (walking), functional ability questionnaires, range of motion (hamstring, hip flexors), hip hinging ability, lumbopelvic rhythm, abdominal bracing, abdominal hollowing, Biering-Sorensen test. Contra-indications: Red flags existing or suspected medical conditions (symptomatic of cardiovascular disease etc.), mode of onset (trauma), non-mechanical pain, history suggestive of tumour, carcinoma or Cauda Equina Syndrome. Yellow flags psychosocial factors (depressions, fear avoidance belief, pain catastrophizing). Comorbidities obesity, cardiovascular disease. Methods of monitoring and evaluating: Pain scales, heart rates, RPE, talk test, pain questionnaires, functional/disability questionnaires. How to interpret information: Understanding results, interpretation of scores, accepted norms, implications of results. Emergencies: Cauda equina (deal with immediately, call 999). Response to medical complications/ emergencies: Refer for diagnosis/ guidance, follow emergency care plan, CALM (Calm yourself, Assess situation, Locate assistance, Make area safe). Medical complications sudden change in symptoms, loss of sensation, loss or mobility, sudden increase in pain, comorbidities (symptoms of other disease). UV41574 13
Notes Use this area for notes and diagrams 14 UV41574