Episode 9

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body logic physiotherapy empowering people to achieve better health welcome to episode 9 of the empowered beyond pain podcast proudly brought to you by body logic physiotherapy this is the final episode with jennifer passoud from arthritis and osteoporosis western australia as a guest host and today jennifer and dr jp canero discuss when a consultation with a surgeon is appropriate can care for osteoarthritis be done via online video consultations and tips and advice as well as where to find more good quality resources we hope you’re enjoying this osteoarthritis mini-series please remember this conversation was a few weeks ago during the peak of the coronavirus pandemic in perth and circumstances have changed since then wherever you are in the world we hope you’re safe looking after yourself and those around you and remembering to ask is there more to pain than damage thank you jp so what i heard came coming through really strongly about um what consumers can do to manage this is is weight management being a very high importance and not facing participation in enjoyable things including exercise to continue with those things and to adopt normal movement patterns and more protective behaviors and i’m just thinking about patients that have got really quite advanced changes of osteoarthritis on imaging coupled with quite severe functional deficits and high levels of pain for the companies that is everyone appropriate for non-conservative sorry for conservative management or are there some patients that really would be appropriate for reviewing an orthopedic surgeon yeah so that’s a that’s a great question and a really important one to be addressed um so what the guidelines tells us is that every patient that has near white should trial non non-surgical care before considering surgery and the level of activity and the level of education the level of weight loss that they need to do will be individualized we see many patients come into the clinic they have quite advanced osteoarthritic changes and functional limitation but a lot of these patients have only been taking being offered a very passive approach towards managing that condition and what we know is that joint replacements knee replacements they can be really effective right they can be they can be life changing for many people but we also know that about one in five patients may not have a significant change or be the same after surgery and that is really tricky the other thing that is quite a staggering statistic is that when we look at the number of patients that are offered and actually go through with a joint replacement they have never been offered what is considered guideline recommended care and maybe a lot of these patients have been offered exercise and weight loss but they go into a consult and they are told that their knee is bone and bone and they should be careful with that joint and they will need a knee replacement so who in the in a clear mind would actually try and exercise on that knee they will try to preserve the joint and not exercise so there is this mismatch between how we convey the message and what we tell patients to do so if i tell someone that they have bone on bone and immediately after i tell them to exercise it creates a lot of confusion for the patients so what i’m trying to say is that every patient should be offered even if they have advanced in your way they should be offered an opportunity to understand what that means to have a review and see if there if there are factors in their life that can facilitate that process and try to regain some movement and learn some new habits uh for their knee does that mean that everyone will then not go on and have surgery no that’s not what i’m saying but one of the things that we know is that surgery can be really useful for patients that have child and exhausted good non-surgical care right and that what that means is that it’s not only active but it has the right dose and the right dose is regular graduated activation of your body plus or minus weight loss having a really good understanding of what the condition is if you exhausted that and you’ve done that for enough time and you haven’t achieved your goals then surgery may be appropriate for you now one of the things that we also know is that the predictors of outcome for surgery are they are positive for patients that have more advanced oa changes they have good mental health and they don’t have a weight problem so those patients they can do well now the interesting thing is that the same study will show to us that patients that have the opposite so they have low levels of changes in their in their radiology in their imaging they have poor mental health and they are obese or they have weight problems that they don’t tend to respond as well from surgery so that group of patients offering them good education weight loss and a graduated exercise program may not divert them from having surgery but may provide them with a better outcome after surgery so if we can if i can summarize that because there’s a bit of information in it is that surgery is an option and it can be a good option for many patients now non-surgical approach is if i dare to say mandatory to every patient with a pain related to neo-way once they exhausted that good care with the underpinning principles that we’ve been talking about here today then surgery may be appropriate but for those that have those particular obstacles of mental health and weight and low levels of changes in in their in their structure uh they may need combined care they may need help with their mental health they may need help with their with their weight and they actually may need a longer program to then make a decision about having surgery or not thanks jp um i’m just thinking about the current situation that we have with the covid19 pandemic and that as a consequence of that all the low category elective surgeries have been postponed um until we further understand how this will play out for those people that perhaps had knee surgery booked and that’s now been cancelled or for those people that were even contemplating surgery um even for those that want to continue managing conservatively what kind of advice could you give them to help them in this interim period while we travel through the kovic 19 problem that’s a great question jennifer so one of the things that we know is that these are the times where you want to you know stay active stay healthy and keep your mental health at check i think everyone is getting bombarded with information every day and there’s a lot of uncertainty and i can only imagine if i put myself in the shoes of a patient that felt that surgery was going to be the you know potential life-changing opportunity for them and now that’s been putting put on hold that could create a lot of distress uh and as you described before before um uh stress can alter your physiology and it’s not good for you in terms of your general health so if we look at these these circumstances if you have a plan that plan should be to stay active even in the isolation of your home or if you go outside you may be walking you may be riding your bike you may you know whatever opportunity you have and it is a time where you can go back to some of the advice you’ve been given and and try to apply that even in the safety of your home now if you don’t have a plan and or you don’t have an active plan uh and what i mean by that is maybe the way that you manage your condition up until this point is that you just you may go to the physio and the physio may do some movements with your leg and may do a bit of massage a bit of needling so it’s a really passive approach that you’re not going to have data any longer at this stage so what you need to do is to seek guidance to get an active management plan so at this point in time there are some clinics that are still open we have made a decision before um this happened last week actually we made a decision of uh shutting down a clinic for any face-to-face contact but we do have the option not just us but physiotherapy is now having the option of telehealth and that is a great way or for patients that don’t have a plan or want to review their plan to actually have a consult with a clinician to develop an active management plan and to get some guidance during this tough period and many people may not be aware of this but there have been studies particularly in the knee that demonstrates the an examination of the knee and the outcomes of knee management via telehealth is just as effective as face-to-face contact and if we think back at the beginning of our conversation what we’re talking about what are the things that patients with neoa need what are the things they need to target what are the things they need to go for it’s a really active plan and it’s a plan that can be delivered online so it’s not not everyone that will need hands-on treatment so if you’re sitting at home and you don’t have a plan my suggestion would be to get some guidance and develop a plan with someone that you can self-manage manage during this during this process so jp how can people access those services is there a requirement to um either phone in or go into the gp to get a referral through the chronic conditions management plan to then access three health services with the physiotherapist yeah yeah so we’ve been in contact with clinicians across australia and quite a few clinics are offering a reduction in in in their prices to offer the service while the uh the health system is not uh you know 100 supporting this service but we had a really rapid response from private health funds as well as medicare and workcover and icwa where they actually are supporting telehealth appointments so that’s a great step towards supporting the community community in a really tough time it from what we understand if you want to see a private physiotherapist for a telehealth consult you need to call your gp and get a referral and many clinicians in particular and some patients are seeing this as a a deterrent of of the service and and see as an obstacle but but i think it’s it’s a way of creating actually a relationship where the patient sees a gp the gp sends the patient to the physio the physio will do a consult will communicate back to the gp or the rheumatologist and so you create a team around that person so that person is not isolated seeing you know just clinicians in the in the community with no contact with the gp so i actually think it’s a it can be seen as a really positive step uh so that’s one way of doing um of course if you go into private practice you can then you know pay for the consult yourself but a lot of people are in a really tough situation uh at the moment um and but there are opportunities where you can uh communicate with someone and also at times uh if we think of there are some conditions which uh you you may need to see a physio face to face but when we’re looking particularly for chronic conditions such as knee osteoarthritis or hip or arthritis or back pain the way we we see the care being delivered to patients with those conditions uh you know lends itself so well for telehealth uh we’ve been doing this this for uh for the week now and we asked our patients about you know how do they see this uh this this change in pace where we get patients you know across the screen as opposed to sitting in front of us and although it seems a bit strange they a lot of the patients feel like they actually get what they need out of this in patients with neoai they need to understand how to move and they need to change their habits they need to get good reassurance and um and healthy lifestyle advice uh so it can be really useful for that thanks jp we’re drawing to the end of our um q a time now and i’m just thinking about some final uh tips um and advice that you could leave our consumers and our health professionals with are there any national guidelines that would be really helpful to guide health professionals and consumers um around the good quality investigation management of oa me yeah so i think um you know there are some there are several national models of care for uh the management of of near way the victorian model of care which was revised in recent years has a a a really strong plan but across the states the the narrative of about how you should manage new way has an underpinning active approach towards it so quite accessible for consumers credible websites such as pain health where you can find really detailed information about osteoarthritis you can find patient stories and there are a few exercises and strategies that are provided in websites like that that’s a wa-based or funded founded website but also myjointpain.org.eu is another website that is quite it’s you know developed by really credible people and high-level researchers and clinicians in the space of osteoarthritis and and of course arthritis foundation in in wa provides several you know readily available resources uh and they are there for to answer questions and they have a really good place in the community to provide support to people with uh with near way and probably a message that i think it’s really important to it may not have come transparent through this is that having pain when you’re trying to use a joint that is source or a joint with knee osteoarthritis if you’re using that leg and it’s sore and you’re trying to exercise and you’re getting some pain that that pain does not mean you’re causing in many cases it does not mean you’re causing any harm to the joint it just means that it’s getting adapted to a new um load in the in the knee joint so they’ve done studies with people there were in a waitlist for getting a knee replacement and they offered them do you want to go and you know take a chance of doing some exercises for six weeks and and these people went through that process and a large proportion of those patients in the first week or two or even three they had an increase in their discomfort in their knee and these were exercises they were tailored to uh to their starting point and but over time as those exercises were slowly graduated and adapted to that particular person the a large proportion of the group actually notice a reduction in pain so it’s really important to understand that as you start doing some exercise in a joint that is stiff it’s the muscles are weak and it’s deconditioned and you’re a bit frightened to use the joint it is normal to have a slight increase in discomfort and but that should not be a barrier for you to continue that should be a a point where you go right i need to continue developing gradually this program and use my leg becoming more confident becoming a bit stronger and what we tend to see is that you increase the amount of things that you do and your function and you can get also reduction in pain and of course this varies in in an individual basis uh but there are some evidence to demonstrate that and these management approaches they can be delivered one-on-one and here we’re talking online at this stage but fingers crossed soon will be face to face again uh they can be delivered one-on-one but they can also be delivered in a group uh and there are some great initiatives across australia and at uh the arthritis foundation uh in wa where you can get access to uh to those uh to those programs yeah we’ll be providing those programs online hopefully we’ll go live with that next week as well um so i’d really like you to thank you jp you you are very generous of your time and sharing your expertise i appreciate the very busy time for you at the moment so thank you for uh being able to provide our consumers and our health professionals with some very sound incredible advice about how to manage knee osteoarthritis and the pain and dysfunction that’s associated with it uh we really appreciate you giving your time yeah it’s a pleasure jennifer so there you have it as always the resources discussed including links to the west australian government department of health website pain health myjointpain.org.iu and of course the arthritis and osteoporosis western australia website can be found on the show notes page for episode 9 which can be found at www.bodylogic.physio forward slash podcast for our to try today segment perhaps you can reflect on what areas of your lifestyle you could improve then find someone to share that with and keep you accountable things are usually easier as a team one of my favorite studies published in the journal of experimental social psychology looks at how steep you estimate the slant of a hill and if you’re with a close friend you estimate the slant of the hill to be less steep than if you’re alone shows how psycho social support can make things seem easier and all the more reason to find a buddy to share your goals with at the very least you can take a screenshot of this episode post it to your social media and tag us in it so we can keep you accountable our handle is at ebp podcast on facebook twitter and instagram that’s it for this week we hope you’ve enjoyed this episode of empowered beyond pain and we’ve suitably made sense of science and brought evidence into your eardrums until next week remember to ask is there more to pain than damage [Music] please note what you heard on this episode of empowered beyond pain is strictly for information purposes only and does not substitute individualized care from a trusted and licensed health professional if you would like individualised high value care for your pain sports or pelvic health problem head to the body logic website and make an appointment fee music generously provided by ferven and cash