Rene de ruiter january 2011 contact blenheimphysio@actrix co nz
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Rene de Ruiter January 2011 Contact: [email protected] A Multi-disciplinary Approach to Pain. physiotherapist since 1983 ( 27 years). Background. Progressive Goal Attainment Program 10 week duration 10 x 1 hour sessions with the help of instructor client sets goals

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A Multi-disciplinary Approach to Pain

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Rene de Ruiter

January 2011

Contact: [email protected]

A Multi-disciplinary Approach to Pain


physiotherapist since 1983 ( 27 years)

Background


Progressive Goal Attainment Program

10 week duration

10 x 1 hour sessions with the help of instructor

client sets goals

client follows work book

based on psychology

individual

PGAP


Functional Reactivation Program

6 weeks program

3x1 hour session per week

guided by physiotherapist

based at clinic, gym, pool or athletic park

reports after assessment, 3 and 6 weeks

pain is the main issue

extensions to 12 weeks if needed

physical, individual

FRP


The FRP approach is based on

Cognitive Behavioral Approach

Graded Exposure

Evidence based practice for chronic pain

FRP


Physical Fitness for Work and Independence

lack of fitness, post surgery

6 weeks program

guided by physiotherapist

based at clinic, gym, pool or athletic park

reports after assessment, 3 and 6 weeks

extensions to 12 weeks if needed

physical, individual

PFWI


single, lives with mother

not able to work because of chronic pain

depressed

in need of more operations: hips and low back

had surgery on both knees

poor life style choices: smoking, diet coke,more than 4 coffee, no exercise, no water intake, over 100kg

sister committed suicide, father died young

Jan, 25 year old female (FRP)


Tampa Scale of Kinesiophobia

McGill Pain Questionnaire

Pain Disability Index

Pain Catastrophizing Scale

Jan's scores:


Test Scores


to be able to cycle 10 km/ 30 minutes

to be able to sit down/ stand up/ sit down from the floor

to be able to lift a small child, i.e. to be able to squat 25 kg

Jan's Goal Priority Questionnaire


Goal 1 To be able to cycle 10 km / 30 min


Goal 2To be able to sit down/ stand up


Goal 3To be able to lift a small child


Aerobic Exercise

Strengthening

Flexibility and Range of Movement

Education

Home Exercise Program

Jan's 6 weeks gym program


Strengthening

walking stairs from 5x to 12x

core strength from 3 to 4

squatting from bar only to 20 kg

Jan's 6 weeks gym program

  • Aerobic Exercise

  • treadmill walking from 5 min to 30 min

  • power walking from 5 min to 30 min

  • exercycle from 5 min to cycle for transport


Education

posture

pain education

pain management

lifestyle choices

movement patterns

Jan's 6 weeks gym program

  • Flexibility and Range of Movement

  • muscle stretching

  • active joint mobilisation

  • nerve mobilisations


Jan's 6 weeks gym program

  • Home Exercise Program

  • instruction, correction, progression

  • motivation

  • goal setting


The more tests Jan will have, the more this could emphasize that something is wrong.

Waiting times also delay rehabilitation.

Tests


It is not uncommon for a client like Jan to have had:

x-rays, C.T scan, MRI, US scan, orthopedic review, psychologist review, dietitian review physiotherapist review, occupational therapist review, occupational physician review, functional capacity evaluation, workplace assessment

Tests


Pain facts

  • Pain is your body talking to you

  • Pain is a request for help

  • Pain is a messenger, don't shoot it

  • We can't see pain

  • Everybody experiences pain from time to time


Pain facts

  • Why does pain stop some people from living life to the fullest?

  • What are you doing about it?


financial or emotional dependence on pain:

no pain – no gain

uncertainty about a future without pain

difficulty pacing and loading

over-enthusiasm or overdoing it at the start of the program

expectation of immediate results

Influences to the outcome


On the last day of Jan's life, I want her to be able to look back, and say:

I have no regrets.

I had a great life.

If I had another go, I'd do it all the same.

Looking forward


Jan was on her way to becoming a sickness beneficiary.

Improving fitness and attitude to life will hopefully lead to a return to the workforce and restoration of quality of life.

Reflection


Know pain – know gain


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