Sometimes our clients see our value or worth in time spent with “hands on” or doing active rehabilitation – in a dollars per minute sense. It is easy for us to fall into this trap too – we want to think that we are giving the best value for money to the person in front of us. However, we know that in the acute situation, helping the client to achieve the best possible understanding of their condition is undoubtedly going to lead to better outcomes and less chance that the condition will progress to a chronic situation. Achieving this takes time in the form of “bums on seats” – you might firstly be spending a lot of time listening to their story, then be drawing diagrams, writing dot point notes about your diagnosis and management plan and explaining the anticipated prognosis for the condition. This time is really important as it helps to set up expectations – you need to see it as an investment. Additionally, research tells us that when clients are interviewed about their experiences with a health practitioner 12 months after the initial event, they are five times more likely to report that they are satisfied with their treatment when a broader approach (such as those using active modalities and where expectations and goals are set from the start and some element of CBT are involved ) is taken, compared to manual therapy and exercise alone1.
In the chronic situation, taking a wider and multimodal approach is imperative to achieving better outcomes. Treating a chronic condition using manual therapy alone is very likely to be ineffective. However if you plan to include some elements of thought modification, cognitive behavioural therapy or a referral to a psychologist, you need to include some really solid education about the physiological changes that occur in chronic pain. Studies tell us that this is important in helping people to reconceptualise their problem, (2) and from there the client can have a good understanding of why these elements are important to the whole process and their acceptance and uptake of these modalities is likely to be much higher than it otherwise would be. It also helps to avoid the client taking away the impression that you think that their pain is not real or is all in their head. If you can also include some information about how physical rehabilitation can also help to reverse some of the changes that we see in the nervous system in chronic pain, you will also get better levels of commitment to these components of your management plan.
Our value to our clients and the community as a whole is not limited to what we can achieve with our hands or our exercise programs. Advice, reassurance, education and a good management plan play a massive role in recovery of acute conditions and management of chronic conditions.
- Vibe Fersum, K., O’Sullivan, P., Skouen, J., Smith, A., & Kvale, A. (2013). Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: A randomized controlled trial. European Journal of Pain. 17,6, 916-928.
- Moseley, L., Nicholas, M., & Hodges, P. (2004). A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain, 20 (5), 324-330.