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I love these videos
I have had some good feedback from patients when they watch these -
This is great! Where do you find these videos? I wish I showed this to my patient last night. I can’t wait to share this with her!
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I’ve used the pain video a handful of times and it really helped with changing the pts’ perspective on their pain. Those videos also help me quite a bit with my pt ed in regards to condensing information and structuring the presentation better.
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I LOVE this video. My parents are overweight, inactive, and on the road to some serious health consequences. I sent this to them and will see how it goes with follow up.
Oksana – Dr. Evans has a number of such videos that you can browse through on you tube. He has one specifically on low back pain.
Although I love these videos, due to my new exposure to them I have yet to use them clinically. Thus, I am still trying to figure out when it would be appropriate.
My suspicion is that the videos only have limited effectiveness as a stand alone intervention (e.g, my parents are probably unlikely to change based on this 10 min video alone), but can be a helpful way to introduce someone to new concepts/ideas/research, and serve as a platform from which to routinely follow up/individualize the application.
It really ought be incumbent upon us that before we discharge anyone, we do our best to see to it that they are regularly exercising. EVEN IF they seem not to have central sensitization/pain catastrophizing type presentation, we are doing our patients and the entire medical community a disservice not to push people to becoming active.
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What a great video! Thanks for sharing. Dr. Evans has a nice presence and is easy to understand and follow along with.
One of the hardest obstacles that we have as busy individuals with jobs, families, personal responsibilities, is figuring out HOW to fit in exercise. With most of our background training as physical therapists, we have a natural inclination to get out and be active most days despite how busy we are. We know how important is it and we know how to do it. For others, it is insanely overwhelming when you know you have to be active but you have no idea how to do it. A lot of people can’t get a personal trainer due to cost and time, a lot of people are intimidated by gyms, a lot of people have no idea what exercises are actually safe and effective, and there are too many reasons why exercise can be placed at the bottom of the priority list. To incorporate something into daily life, it needs to be important, manageable, and effective. We can’t force anyone to do anything, but we can be an example ourselves and emphasize how exercise can be all three of those things.
Why I love this video is that it breaks down how relatively little time each day we can dedicate to exercise daily and how huge the effects can be. 10 minutes, three times a day. So much more manageable than committing an hour, 3-4 times a week.
To answer your question, for some of our at-risk or chronic patients maybe there isn’t a better exercise program over another. Just getting out there and doing something active for 30 minutes a day (in 10, 15, 30 minute intervals) can reduce your risk for some scary consequences but also IMPROVE your current quality of life. Whatever it may be: walking, jogging, cycling, stair climbing, dancing, tennis, golf, cardio equipment, swimming, yardwork, yoga, crossfit, exercise videos, stretching, just something to get out of sitting can have great effects on the mind and body.
Certainly we see lot of risk factors such as obesity, HTN, hyperlipidemia, smoker, etc. in our clinic, but I think one of the biggest trends we see is anxiety and stress. I’m so glad he added that in there because that’s something we can all relate to. We’re even seeing kids of high school age coming in for neck/back pain because of how much stress they’re under with studying and getting into college. I have a couple high school females on my schedule that fit this trend and whom I want to show this to now.
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Based on what Eric talked about last weekend, how would you introduce the video to the patient? In addition, would you just give them the link and hope they watched or would you ask them questions about the video when they come back? What kind of questions would you ask them?
Read this article and see if there are some points you can take from it that would help you have that conversation. -
AJ thanks for posting that article!
I’d make sure to educate the pt on the basics and how it relates to them specifically and then tell them about the videos as a way to either learn more about the subject or supplement what we spoke about in the clinic, as well as for future review.I’d definitely ask what they thought about the video and what they took away from it. The article suggests asking open ended questions and I feel like that’s helped a lot in changing my practice. Especially if they didn’t do their HEP, or in this case watched the video, how they react to those questions is quite telling and helps guide how to approach them about those subjects. What’s worked best for me when it comes to these conversations, is asking them about their daily routine and what they think is feasible. Especially if they already talk about enjoying going for walks, or biking etc. I just ask them what they would have to do to make that part of their routine and try to problem solve with them.
The best compliment I’ve gotten from a pt so far was from a lady I had this exact conversation with and she told me that I helped her completely change her mind set. She displayed a lot of fearful and catastrophizing behaviors and thought that because she had arthritis on imaging she was doomed. Like Eric was talking about, some of her visits were very draining (several crying sessions), but it was very rewarding to see how much it helped her and how much she had improved. The article is great, because it is so specific and I can’t wait to incorporate more of that. I’m sure if I would’ve read that article before, a lot of these sessions would’ve gone a whole lot smoother.
I often talk to pts about the progression from unconscious incompetence to unconscious competence and how that process occurs, both in regards to life style habits, movement patterns, posture etc. and I’ve had some good responses with that too.
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I just checked out several of Dr. Evan’s videos, it’s great! We constantly play videos in our clinic. I have patients who would ask me questions about those videos and it’s a great conversation piece. I do have a problem with open ended questions, I feel as though it opens up a can of worms. I’m trying to learn how to best facilitate conversations within a time frame. I like how Dr. Hall emphasizes listening to the patient and affirming their courage to share information. I’m constantly affirming patients, partially because I’m optimistic. I also see the importance of summarizing what the patient said to make sure both the patient and PT are on the same page.
If a patient has high fear with any movement then I think it would be important to introduce the video Eric showed or the pain science one. I also think it’s important to compliment the video with support groups. We’re involved with multiple fitness centers around our area and we encourage people to come. Community is important.
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AJ – thanks so much for the article post. Definitely has some helpful principles and specific communication tactics to employ when trying to help someone change.
I think that it is probable universal PT/health care provider experience that taking an authoritative approach often leads only to frustration for the clinician and maintenance of the status quo for the patient.
The more we discuss/I reflect on the subject, the more I realize how limited the Mike Evans video probably is for the patients we are mostly thinking need the video. It certainly could be helpful as a place to start some discussion, however its power in and of itself to produce change is probably extremely limited.
The pain science video, although certainly limited in and of itself as well, yet probably has more intrinsic value than the exercise video. Patients “know” that exercise is good and that they should be doing it. The video, while helpful, doesn’t in the end provide a new framework of thinking for the patient. An overly sensitive nervous system as the cause of someone’s pain vs. tissue damage, is certainly an entirely new framework of thought for most chronic pain patients.
MI seems to me like pain science education – I can see it has great value, I can name it when I see it, but to implement it into practice myself is very difficult.
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Nick – I agree that sometimes an authoritative approach can be harmful, but I think there are certainly quite a few pts who feel more comfortable with having somebody be an authoritative figure and tell them/decide for them what needs to be done. I think a lot of this is just very dependent on pts’ personalities.
One thing I still struggle with is guiding the conversation/subjective questioning to get the information I’m looking for with pts who’ll talk about everything and anything without answering the question. In those cases, I’ve learned assuming a little more authority definitely helps.I wouldn’t use the videos as a way to start discussion, but rather a supplement/review tool between visits and initiated discussions. A lot of pts know that exercise is good for them, but have no idea why it is good for them. Or some think that exercise is only for loosing weight and get offended when regular exercise is being recommended.
I think the more PT as a profession gets the public recognition/understanding of our fields of expertise, the easier these interactions will be in regards to not having to fight for buy in/ acceptance of authority or whatever it can be labeled. As of now, it seems that the simple fact that an outside source (video), especially a physician, confirms what’s being discussed during the visit helps quite a bit with buy in.
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I love the word “Empower”. Eric’s example of telling his young girl that he saw her as this confident, athletic, healthy girl really seemed to hit deep with her and her mom. The article also talks about empowering your patient with their own personal knowledge of successes in the past and embodying hope that change in possible. I think the videos are great on saying why and how exercise is great, how the body’s nervous system changes with sensitization, but I think us as therapists are going to be the link that the patient’s can make between general knowledge of the videos and how he/she and their specific story can change.
I agree with Alex in the sense that it is certainly personality dependent whether or not a patient likes a more authoritative stance, but is this more of just being confident in what you’re saying and still allowing patient autonomy versus authoritative and disregarding their perspective?
I have not personally done this in the clinic yet, but I’ve been contemplating this and maybe one of you guys have tried this already. Has anyone given this or similar videos to a patient to watch while doing any warmup/cool down on the treadmill, UBE, or stationary bike?
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Laura – great points. It was really helpful to hear about Eric’s pt.
I should’ve specified more… I think it’s being confident about what you say, but also assertive in the sense that maybe their beliefs are not the healthiest (or just factually incorrect). The question is, how we go about communicating that to the pt and that’s where it gets difficult. In pts who have very strong, unhealthy beliefs I try not to disregard their perspective, but gradually present them with information/a different perspective and help/guide them with coming to their own conclusions and possibly change their perspective. That way they maintain their autonomy and I think it helps if they go through that thought process and feel like they put the pieces together, vs just somebody telling them.
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Eric – thanks for the update on your patient!
What do you think brought about the change in her behavior/perception? It sounds like she did a 180… did you see this difference just between two visits, or was it over a couple of visits? It would be awesome to hear more about how she progresses!
I had an eval on Friday with Xs, Os, /s all over the mid-low back and B LEs ant and post. The eval went pretty well and we talked a lot about the neuro science/pain ed, but I’m very anxious to see how much that carried over until his next visit. Especially, because he wants to get surgery in 2 weeks. It would be great to hear how you dealt with f-u visits after seeing such improvement.
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The recent shift in management style and awareness of psychosocial aspects of patient presentations that impact our care is wonderful and it certainly is becoming more of a hot-button topic in the literature. Educating ourselves and our patients and having methods of doing this is obviously necessary. I am wondering, however, if any of you have had to discuss this aspect of assessment and care with referring physicians or surgeons, and if so, what their response has been. I was talking to a local neurosurgeon last week about this and asking if they do any assessment of psychosocial behaviors or yellow flags and take that into consideration when determining if a patient is a surgical candidate. He seemed to be aware that obviously these behaviors impact outcomes. However, his comment was that, “crazy people, can still have pathology.” I understand his comment or at least what I hope he was trying to say, but, am wondering how we can best educate other providers of this important concept and how vital it is to assess and address. Thoughts?
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I’ve only discussed this with one physician (Culbert) so far, but on several occasions regarding a handful of pts. He sees a lot of workers comp pts and all the pts I spoke to him about were WC. He’s very open to psychosocial factors because he deals with that population, but I’ve chatted with him for about 15 mins during lunch one day and he really appreciated getting the PT perspective.
I can’t say that I’ve spoken to any other physicians regarding that and I doubt that most would be as open to the topic as he was.
I’ve gotten positive feedback from a PA on one of my PNs regarding fear avoidance behaviors etc., but I heard the physician she works for doesn’t really care for psychosocial factors too much.I hope the “crazy people” comment was just poor phrasing. It’d be scary to think that a neurosurgeon says something like that, without being aware of the possible impacts.
Considering how poorly educated some pts are, even after sx consultation, I think it’s extremely important to assess and address. I’d say the best way to educate other providers is through sharing research and making it relevant to a specific patient. Especially for surgeons, pointing out improved outcomes when considering and addressing these factors should be of high interest, so I guess the presentation shoulder be tailored to show benefits to both the pt and the surgeon him/herself.
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This is a tough issue as we are certainly in a unique position to interact with these patients for longer periods of time per session and throughout their care. The idea that multiple systems need addressed and treated fits into our practice management philosophy and the product we “sell” patients. In fact, having another product to sell beyond the biomedical pole, gives us more tools to use and possibly help these patients who previously were the dreaded ones on our schedule. From a surgeon’s perspective, awareness of other factors beyond the biomedical possibilities, might only decrease the ability for them to sell their product (surgery, injections, more imaging, etc). So, perhaps, ignorance or oblivion is bliss in this situation from their perspective. You would like to think that when there is more robust research beyond the cohort studies than those available now, that practice patterns may change. However, do not hold your breath too tight. Even with RCTs with long-term follow-ups in their journal (Spine), indicating no improvement beyond therapy with an ACDF, the frequency of these surgeries is still increasing each year. I think we have to attempt to educate our referral sources and maybe find other avenues of education/marketing via pain management groups, local psychologists/counselors, support groups, etc. Here is the recent O’Sullivan article from PTJ and one I found from a spine journal (not Spine), that supports the notion of this management for chronic non-specific low back pain.
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I just read this thread and It was great.
I agree with everyone that this is a huge aspect of PT that we are finally tapping into.
I have seen a few MDs that were skeptical about the concept and said that we could be on a slippery slope to saying to much and overstepping out boundries.I feel that if we get overconfident we could go into the clinical physiology area and maybe say things that we shouldn’t.
I have seen Aaron do a great job with this and based on how Eric set up the goals with his patient he did it the correct way.
As a recent grad myself I know that we need to be careful and make sure to keep everything within our scope of practice while we help the entire patient
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