L31 Self -management

Question 1

What is the biopsychosocial framework for management of patients with neck pain and headache?

Answer 1

Question 2

What are 6 pathophysiological/biological features of biopsychosocial framework?

Answer 2

1. Pain/sensory features
2. Altered psychosocial features resulting
3. Altered articular and movement features
4. Nerve tissue: irritation, compression mechanosensitivity
5. Altered neuromuscular control; muscle properties
6. Altered postural control

Question 3

What are 5 psychological features of biopsychosocial framework?

Answer 3

Idiopathic neck pain

1. Anxiety
2. Distress
3. Depression
4. Fear avoidance behaviours
5. Poor coping skills

Important to consider….

1. Difference between idiopathic and traumatic neck pain
2. 85% of patients have no psychological problems
3. Some are normal physiological reactions to having neck pain

Question 4

What are 5 work factors of biopsychosocial framework?

Answer 4

1. Impact of computer use on musculoskeletal symptoms and productivity emerging as important issue
2. 12 month prevalence neck symptoms in office workers estimated at 50-76%
3. 60-80% office workers report recurrence of neck pain one year after initial episode (Carroll et al 2008)
4. Loss productivity –absenteeism, presenteeism

Question 5

What are 7 social factors of biopsychosocial framework?

Answer 5

1. Gender
2. Emotional problems
3. Poor job satisfaction
4. Poor physical work environment (Eg. confined working space)
5. Occupation type
6. Smoking
7. Awkward work postures

Question 6

What is the changing biopsychosocial model?

Answer 6

Question 7

What are 3 bio multimodal management approach for neck pain?

Answer 7

1. Manual therapy
2. Specific exercise
3. Patient self‐management techniques

Question 8

What are 2 psycho multimodal management approach for neck pain?

Answer 8

1. Explanation of what influences symptoms
2. Effects of stress

Question 9

What are 2 social multimodal management approach for neck pain?

Answer 9

1. Work – ergonomic advice
2. Discuss how social/lifestyle choices impact

Question 10

What is the management of neck pain when confirming cervicogenic diagnosis?

Answer 10

Confirm cervicogenic diagnosis

• History and
• 3 physical findings

Question 11

What are 5 multimodal biopsychosocial approaches in the management of neck pain?

Answer 11

1. Manual therapy (Csp and Tsp)
2. Specific exercise cervical muscles
3. Self‐ management techniques
4. Education on agg practices
5. Ergonomic

Question 12

What are 4 characteristics of self-management?

Answer 12

1. Theories and research
2. Work is a positive health behaviour for which self management skills are essential (Johnston 2013)
3. Role of clinician
   
   1. Problem solving
   2. Decision making
   3. Resource utilisation
   4. Therapeutic alliance
   5. Making an action plan
4. Mange chronic pain and disability for recurrent MS conditions

Question 13

What are 5 roles of the clinician in sel-management?

Answer 13

1. Problem solving
2. Decision making
3. Resource utilisation
4. Therapeutic alliance
5. Making an action plan

Question 14

How can you do self management?

Answer 14

1. Partnership between therapist and patient
   
   1. Individual
   2. Groups
   3. Telephone counselling
   4. Web based self‐instruction
2. May require a change in perspective from carer ‐ role

Question 15

What are self-management skills and tips?

Answer 15

Question 17

What are 8 benefits of self-management?

Answer 17

1. Decreased pain
2. Increased pain self‐efficacy
3. Decreased general disability
4. Improved psychological well‐being
   
   1. Reduced stress
   2. Depression
   3. Anxiety
   4. Catastrophisation
5. Increased positive self‐talk
6. Greater use of social support
7. Increased time physical activity
8. Increased general self‐efficacy

Question 18

What are 11 steps for self-management?

Answer 18

1. Establish rapport
2. Active listening
3. Provide information
4. Develop an action plan
5. Set realistic goals with patient (shared decision making)‐SMART
6. Non‐judgemental approach
7. Facilitate problem solving
8. Promote self‐efficacy
9. Link patients with resources
10. Keep a health record
11. Active follow up

Question 19

What are the potential threats to effective self-management?

Answer 19

Question 20

Acute WAD

Advice /education

What would your self‐management strategies

include?

Question 21

Cervical radiculopathy

Advice /education

What would your self‐management strategies

include?

Answer 21

1. Pain management:
2. Positions of comfort and relief (antalgic posture –> keep position to not change posture)
3. GP for
4. Ergonomic advice (not to aggravate)
5. Keep active
6. Comfortable sleeping positions
7. Exercise (a bit but not closing down the IF)
8. Movements into easing position –> neutral range

Question 22

Thoracic pain exacerbated by breathing

Advice /education

What would your self‐management strategies

include?

Answer 22

1. ROM exercises
2. Breathing exercises
3. SNAG (towel around + MWM = support ribs)
   
   1. Flexion, ext, rot
4. Advice
   
   1. Mechanical pain –> reduce fear
   2. Keep active

Question 23

TMJ pain and restricted mouth opening

Advice /education

What would your self‐management strategies

include?

Question 24

Question 25

Muscle and articular system involvement Advice /education What would your self‐management strategies include?

Answer 25

1. SNAGs (increase ROM + mobilisation 2. Motor control (add into everyday tasks --\> reminders to do) 3. Give demonstration (TDT --\> change your posture --\> can reduce symptoms)