We are open!
We are open!
Theme 1: Clinician/Therapist Interpersonal and Communication Skills
1. Active listening. One of the most common aspects to emerge regarding clinician/therapist communication skills was active listening. Both clinician/therapists and patients felt that it was important to listen and to allow patients to tell their stories. This approach allowed a bond to develop between the patient and the therapist, as the patients felt that they were valued. Patients were unhappy when they were interrupted and could not tell their story. Patients also felt that not just listening but also understanding what the patient was saying was very important.
2. Empathy. Patient’s felt it was important for clinician/therapist to realize how much of an impact pain could have on their lives and for clinician/therapist to empathize with them about this issue. We found and the research tells us that, lack of empathy was a major barrier to a positive interaction, and patients did not develop a bond with therapists who could not empathize with them.
3. Friendliness. Patients believed that being able to chat with their clinician/therapist in a friendly manner was important for positive interaction. Talking with the clinician/therapist in an open way helped deepen the relationship between the patient and the clinician/therapist. Clinician/therapist mentioned that a pleasant greeting from their clinician/therapist every day encouraged further interaction. Both clinician/therapist and patients mentioned that having a sense of humor was another way to develop a positive relationship. Patients found it difficult to engage with clinician/therapist when they were not as friendly, and the interaction suffered as a consequence.
4. Encouragement. Motivation and encouragement helped patients feel that the clinician/therapist cared about them and that they had a strong relationship with their clinician/therapist. These skills were important for many reasons, as the encouragement motivated some patients to adhere to the prescribed rehabilitation and strive to improve. The reassurance also provided emotional support to patients, which further deepened the bond between the patient and the clinician/therapist as they shared personal feelings and experiences.
5. Confidence. Patients reported that feeling confident in their clinician/therapist was an important factor and meant that they could respect their clinician/therapist and trust his or her opinion. However, some patients felt that their clinician/therapist was too confident and behaved in an arrogant manner, which was a significant barrier to a positive patient-clinician/therapist interaction.
Theme 2: Therapist Practical Skills
1. Patient education. Patients felt more comfortable when they knew what their treatment plan was and felt interaction with their therapist was enhanced as a result. On the other hand, patients did not like when the education given to them was technical and felt that this factor had a negative impact on the patient-clinician/therapist relationship
2. Clinician/therapist expertise and training. Patients believed it was vital that clinician/therapist possessed excellent technical ability and skills. This expertise and training enhanced the trust between the clinician/therapist and patient, and patients felt they could rely on their clinician/therapist, which helped develop a positive interaction.
Theme 3: Individualized Patient- Centered Care
1. Individualized. Patients reported that they felt a stronger bond with their clinician/therapist when their treatment was individualized and related specifically to their presentation. Patients appreciated when their clinician/therapist made an effort to adjust the treatment when they experienced problems and made it easier for them. Patients who did not receive individual care and reported being treated like just another patient felt they did not have a positive interaction. At SquareONE Rehabilitation we acknowledged the need to provide individual care for each patient and to answer any specific questions that the patient may have as opposed to providing generic information.
2. Taking patient opinion and preference into consideration. SquareONE Rehabilitation felt it was important to consider the patient’s point of view and opinions. This consideration encouraged patients to engage in the treatment process and interact with their clinician/therapist. It also showed patients that their opinions were important to the clinician/therapist, which encouraged a better interaction between the clinician/therapist and patient and helped form a stronger bond. We experienced that patients found it annoying when their clinician/therapist ignored their preferences and abilities when prescribing exercises, which had a negative impact on the patient-clinician/therapist interaction.
Theme 4: Organizational and Environmental Factors
1. Time. At SquareONE Rehabilitation we give our patients time to describe their problem, and having the time to be listened to. This is an essential factor in positive patient-clinician/therapist interactions. Patients appreciated having the time to sit down and interact with someone and not being rushed during appointments.
Program Design Summary
THE THREE PHASES OF OUR ACTIVE REHABILITATION PROGRAM
Phase 1: GPP (general physical preparation)
· Warm-up/Cardiac Output
· Controlled Articular Rotations
· Activation/Dynamic Exercise
· Dynamic Neuromuscular Stab.
· Strength Level 1 (Prep Phase)
· Passive Stretch/Recovery
Phase 2: is made up of the same components as phase 1 with the exception the strength lift level 1 is replaced with strength lift level 2. Basically we are loading the fundamental positions they learned from phase 1.
Phase 3 - SPP (specific preparatory phase for work): The focus in this phase is the transfer of exercise into work specific training. We will focus on strength endurance. We will use lower intensities thereby increasing frequency thus the focus is on tolerance/endurance. Education and knowledge of the RTW process is important.
Strength level 1 consist of 10 movement patterns and level 2 are example exercises.
1. Hip Hinge (ex. deadlift)
2. Squat (ex. goblet squat
3. Lunge (ex. forward/lateral lunge)
4. Horizontal Push (ex. bench press)
5. Vertical Push (ex. overhead work)
6. Horizontal pull (ex. rows)
7. Vertical Pull (ex. chin up)
8. Loaded Carries (ex. carries/sled)
9. Anti Rotation (ex. bird dogs/pallof)
10. Isometric (ex. Front/side planks)
Please refer to the Occupational Rehabilitation Manual for details regarding the three phases of the active portion of our programing.
It is our experience that patients who receive education in conjunction with exercise tend to have a better attitude towards the rehabilitation program. The patient who has a perception of increase disability will be hindered in their recovery. Changing their beliefs, education and reassuring them that movement is required for health, is the first steps to patient recovery.
All of our educational programs consist of spinal anatomy, pain science, and first aid for acute recurrences, body mechanics and exercises. We place the most important areas to cover into four categories. First, reassurance that the natural history of most pain syndromes is toward a speedy resolution. Second, body mechanics that are universally applicable. Third, the importance of focusing on function and reducing the patient’s fear about movement are critical to success. Finally, explaining the difference between “hurt vs. harm” so the patient is less likely to immobilize themselves and become deconditioned in their attempt to achieve pain relief. For chronic and high-risk patients a biopsychosocial approach is definitely indicated. Exercise, education and encouragement are the mainstays of our success.
Carefully explaining that hurt does not equal harm is an important prelude to rehabilitation. In chronic pain management it is essential to focus on control and not cure. We do this by placing ourselves in the role of helper rather than healer. Reassuring patients that their problem is pain sensitive structures and not a sign of something pathological is an important step in patient education.
At SquareONE Rehabilitation we employ a Cognitive Functional Therapy (CFT) approach. This strategy targets the beliefs, fears and associated behaviors (both movement and lifestyle) of each individual. It leads the patient to be mindful that pain is not a reflection of damage, but rather sensitized structure that is fueled by hyper vigilance and negative beliefs, fear, lost hope, anxiety and avoidance, linked to maladaptive (provocative) movement and lifestyle behaviors.
Patients need to know the exact goals of exercises. When proper goal setting is accomplished and these goals are accepted, patient adherence and compliance is easier to achieve. At SquareONE Rehabilitation each patient is required to keep a diary of his/her program, which the team evaluates on a weekly basis. This helps us monitor the patients subjective and motivational levels and thus make necessary changes.
This consists of four interventions;
1. Informational strategies are employed to ensure patients receive clear instructions, emphasizing the importance of regular and consistent exercise in reducing episodes. Our therapists also explain to the patient that rehabilitation depends in large part on the patients’ attitude and behavior.
2. Reinforcement is used by the therapists giving positive feedback and commending the patient for their efforts, i.e. rewards for exercise compliance.
3. At SquareONE Rehabilitation the patient signs a “treatment contract”. The contract explains who we are and what we the clinic is responsible for and what you the patient is responsible for. There is much information regarding what you can do as a patient to help yourself in this rehabilitation process. Patients are asked to post the treatments contract in a prominent place at home to remind them of the exercises.
4. Finally, patients are involved more in their care by reporting all exercises they have done in their exercise diary. At the completion of the program they will be given a home exercise program.
The positive effects of compliance-improving measures usually evaporate rapidly after treatment has stopped. We strive for long-term goals. We do this by changing a persons perception and attitude but also by taking the patient seriously. Studies have shown that long-term compliance cannot be achieved by bringing pressure to bear on the patient or displaying one’s full authority, rather, we must dismantle prejudices and give patients the feeling that they are being taken seriously and that the therapist is aware of their suffering.
These manual's were created by Dr. Capitano, DC. It’s a culmination of his 25 years of work in the field of Disability Medicine. This document has been developed to address the specific barriers faced by persons who consider themselves to be disabled from there occupation either partially or totally.
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