Self Management Flashcards
Define ‘self management’
- the way a person PROACTIVELY plans + manages their life for their HEALTH, WELL BEING, and QoL when living with 1+ chronic conditions
Whats the recommended amount of physical activity (18-64 yrs) for gen pop?
150-300 mins of moderate intensity OR 75-150 of high intensity
- mm strengthening exercises on at least 2 days/week
(these guidelines are for gen pop and few people get this; even lower for people with neuro conditioning)
Describe the physical activity behaviours of people with: MS PD Stroke Brain injury
PD = 33% less active than older adults MS = moderately less active than gen pop Stroke = 50% of steps/day of gen pop TBI = only 8% get the recommended amount of PA (compared to 50% of gen pop)
Winward et al (2011) ran a study that provided PD pt’s all the resources (staff, money etc) to pursue an exercise program without supervision. What were their findings?
- out of the 60 sessions they were meant to do, subjects on average did only 15!
- not surprisingly, didn’t get any of the benefits of exercise d/t low compliance
TAKE HOME POINT: not enough to give people exercise - they need more support
List some challenges to self management in people with neuro conditions
Cognitive
Decline
Disappointment *in not being able to do what they should be able to
Difficulty *in asking for help when they need it
Fatigue
Mental health (apathy/anxiety/depression) *both as a reaction to and as a result of the disease
Set backs
List barriers to exercise in neuro subjects
F.F.I.L.L.D F - fatigue/apathy/depression F - fear of falling I - impairments L - lack of time L - low outcome expectation (they don't think exercise will do anything) D - disappointment with performance
List facilitators to exercise in neuro subjects
E.S.C.A.A
E - easy access to venue S - self efficacy* C - college education A - age A - accountable
*more of a factor than disability in determining adherence to exercise
Define self efficacy
What increases it?
The belief in your capabilities to overcome personal, social, and environmental barriers
What increases it? M.E.S.S
M - modelling (seeing someone else do what you want to do)
E - education
S - social persuasion (eg. group activity)
S - success (if you’ve had success in the past more likely to think you can do it again)
What decreases SE?
Failure
Disappointment
List some behaviour change techniques to increase PA
G.R.I.P ‘E.M
G = goal setting R = review (skype/phone calls etc) I = individualised exercises (something they're interested in) P = PA status baseline E = education M = self monitoring (log books, pedometers etc) B = barries/facilitators to PA
van der Ploeg et al (2006) incorporated counselling/behavior change techniques into physical activity compared to usual care for stroke, TBI, chronic LBP pts. What did they find?
Counselling group:
2x likely to participate in sport
1.5x likely to meet PA guidelines 9 weeks post discharge
Also more likely to meet guidelines 1 yr post follow up
What was the ParkFIT trial and what’d they find?
- conducted in Netherlands
- subjects were PD pts
- compared ParkFit program (usual physio + counselling + activity monitoring with fitbit) to ParkSafe program which was usual physio (and this was pretty good too!)
- ParkFit group saw 9% INCREASE in activity over 2 yrs vs usual care saw 3% DECREASE
Turner et al (2016) looked at motivational interviewing and telehealth coaching in MS pt’s vs home based exercise alone. What did they find?
- in the coaching group - they saw an increase in fitness, reduction in depression, and reduction in fatigue
What is the evidence for dance?
- improves balance, endurance, motor impairment, and reduces falls
- but studies did show varied attrition rate 14% - 50% - mostly due to developing co-morbidities
Technology - pros
- provides feedback/motivation
- informs therapist of pt’s activity level
- facilitate goal setting
- be part of the exercise (Wii, Xbox etc)
