Neuro, MSK and Elderly Flashcards
(45 cards)
1
Q
What are the impacts of back pain?
A
- Significant time off work + hobbies
- Social isolation
- Major drain on benefits
- Loss of ADLs
- Stigmatised
- Dependent on family
- Reduced libido
2
Q
Describe the chronic pain theory
A
- Also called yellow flags = things that may hinder effective recovery.
- Belief pain is secondary to serious illness.
- Negative attitude towards back pain. Environmental impacts = family attitude, work.
- Fear avoidance behaviour.
- Expectation to be passive instead of active = while active + using is better. Passive → disuse of muscles → nociceptors activated more easily → more pain felt.
- Tendency for depression = pessimistic views.
- Social or financial concerns.
3
Q
Outline the holistic approach to the management of back pain
A
MDT approach = OT, PT.
Focus on return to work instead of what they cannot do now.
START Tool for risk stratification of back pain:
- Low risk (<3): Very likely to improve so enable self-management. Education on exercise/staying active, analgesia, avoiding complementary therapy. Refer for physical therapy if not resolved by 6 weeks.
- Medium risk: Aim to facilitate return to function. Early physio referral. Promote self-management.
- High risk: Comprehensive biopsychosocial assessment. Physiotherapy & CBT referral —> identify yellow flags that will impact on recovery.
Alternative therapies (chiropractors/acupuncture/osteopath) not highly recommend by NICE for sole treatment, but can be used as an adjuvant.
4
Q
Outline the organisation of health services for people with chronic neurological problems
A
Stroke Unit:
- Integrated medical ward with special skills in the management of acute stroke.
- Main activities include: investigation of stroke, prevention of complications, secondary prevention, nursing care, rehabilitation - found to reduce death or dependency compared to care on regular ward.
- Emphasis is placed on PT/OT, SaLT, psychologists and social workers.
Other services:
- Neurological rehabilitations centres.
- Palliative care.
- Community services e.g. nursing, PT.
- Primary care services.
5
Q
Outline the organisation of health services for elderly people including the provision of social care
A
- Inpatient elderly care/geriatric wards.
- Primary care services.
- Community e.g. nurses, carers, PT/OT.
- Social care: help from paid carers, meals on wheels, home adaptations, household equipment, personal alarms, supported living services and care homes.
4 Major Themes of National Service Framework for the Elderly:
- Respect the individual: NHS services based on need, not age. Treatment is person-centred care.
- Intermediate care: Elderly people will have access to a new layer of care between primary and specialist services - at home or in designated care settings. Designed to reduce unnecessary hospital admission, increase independence and encourage earlier discharge.
- Provide evidence based-specialist care: Specialist staff in hospitals for elderly (specialists on Geriatrics, Strokes, Falls, Mental Health). Specialist prophylaxis for stroke and specialists for treatment. Action to reduce falls. Integrated mental health services.
- Promote active healthy life: Promotion of healthy and active life via co-ordinated programme of action led by NHS in partnership with local councils.
6
Q
Assess the medical and social needs of an elderly person
A
Medical:
- Mobility aids.
- Medication.
- Psychiatric and memory assessment.
- Nutritional support.
Social:
- Socialisation.
- Transportation.
- Personal care support.
7
Q
Be aware of the community support groups available to patients with neurological conditions
A
- Spinal injuries association
- Stroke association
- The neurological alliance
- Parkinson’s UK
- Muscular Dystrophy UK
- Multiple sclerosis Trust
- Multiple sclerosis society
- Motor neurone disease association
- Independent neurorehabilitation providers alliance
- The Huntington’s Disease Association
- The brain injury association
- Guillain-Barre & Associated Inflammatory Neuropathies
- Dementia UK
- The encephalitis society
- Fighting strokes
- The brain tumour charity
8
Q
Outline the social and medicolegal implications of a diagnosis of epilepsy
A
Social implications:
- Depression (often co-morbid).
- Reduction in social participation (if photosensitive epilepsy) → e.g. may not attend cinema, concerts, bars etc.
- Stigma.
- Pregnancy and breastfeeding risks (teratogenic medications).
- Driving (DVLA) - must be seziures free for 12 months following diagnosis.
- Employment restrictions.
9
Q
Outline the prevention of spread of meningococcal disease including notification, chemoprophylaxis and immunisation
A
Most now due to Men B (because Men C vaccine is eradicating Men C). Men B vaccine was introduced in 2013, which should also reduce Men B rates.
Prevention:
1. Increased awareness of the symptoms of disease.
2. Good hygiene measures = handwashing, good sanitation, avoid overcrowding.
3. Isolate infected individual to limit spread.
4. Avoid sharing towels.
5. Identify close contacts in 7 days before onset (people in same household, sharing rooms, eating together or any intimate contact). Abx chemoprophylaxis to close contacts → Ciprofloxacin OR Vaccinate (any strain that has vaccine & person hasn’t had vaccine (ACYW). Chemoprophylaxis aims to prevent disease or infection. Highest risk to contact in first 7 days.
6. Childhood vaccinations.
7. Notifiable disease.
10
Q
Recognise stroke and clinically assess its aetiology including risk factors
A
RFs:
- Lifestyle: smoking, alcohol misuse and drug abuse, physical inactivity, poor diet.
- Established CV disease: HTN, permanent/paroxysmal AF, Infective endocarditis, Valvular disease, Carotid artery disease, Congestive heart failure, Peripheral vascular disease, Congenital/Structural heart disease.
- Age: risk of having a stroke doubles every decade after 55.
- Gender: men > women (increased risk in women who take COCP, have migraines with aura, in the immediate postpartum period and pre-eclampsia).
- Hyperlipidaemia.
- Diabetes.
- Sickle cell disease.
- Antiphospholipid syndrome.
- CKD.
- Obstructive sleep apnoea.
Suspect stroke if:
- Presents w/ sudden onset, focal neurological deficit which is ongoing or has persisted for longer than 24 hours and cannot be explained by any other conditions such as hypoglycaemia.
- Clinical features include: confusion/altered consciousness/coma, headache (sudden, severe, unusual, Weakness, sensory probiems (paraesthesia or numbness), speech problems (dysarthria, dysphasia), visual problems (homonymous hemianopia, diplopia), dizziness/vertigo/loss of balance, N&V, specific cranial nerve defects, gait problems.
11
Q
Outline the primary and secondary prevention of stroke, both individual and population strategies
A
Primary prevention:
- Identify and treat HTN, diabetes, hyperlipidaemia, cardiac disease.
- Smoking cessation.
- Exercise encouragement.
- Healthy lifestyle promotion.
Secondary prevention:
- Anti-hypertensives and statins.
- Anti- platelets: aspirin 300mg for 2 weeks then long-term clopidogrel.
- AF: DOAC or warfarin.
12
Q
Discuss the options available for complex discharge planning
A
MDT approach:
- Social worker —> helps allocate where they go.
- Notification of Assessment to request social worker allocation.
- Notification of Discharge submitted = medically fit and social services is only delay.
Important features:
- Pre-admission functional status, often OT assessment.
- Where admitted from.
- Current function —> strengths, transfers/mobility, ADLs.
- Compare this with baseline = identify potential for improvement/how they’ve been improving.
Destination:
- Home +/- support —> if function adequate = mobilise.
- Inpatient rehab —> if good pre-admission potential but not achieved yet.
- Residential or nursing home —> can be to achieve potential = medically but not socially fit, or can be for further assessment, or may be permanent.
- Palliative fast track = within last 6 weeks of life —> funding applied for that allows prompter fast-track, to allow for chosen place of death.
13
Q
Describe and recognise risk factors for falls
A
- Drugs.
- Ageing = age-related changed e.g. sarcopenia, decreased vestibular function, decreased visual acuity.
- Medical = neurological, CV, GU → incontinence, urgency. MSK = myopathy, arthritis, reduced cognitive function.
- Environment = poor footwear, pets, poor lighting, slippery floor, rugs.
14
Q
Discuss the effects of polypharmacy in the elderly considering drug classes such as anticholinergics, antihypertensives and opioids
A
- Anticholinergics: urinary retention, constipation, delirium, confusion, dry eyes, dry mouth, blurred vision, tachycardia, dilated pupils.
- Antihypertensives: hypotension, syncope, dizziness.
- Opioids: nausea, drowsiness, constipation.
15
Q
Appreciate the limitations to successful rehabilitation
A
- Capacity
- Injury
- Willingness to improve
16
Q
Recognise substance misuse in the elderly
A
- Older men are considered the greatest risk of substance misuse including alcohol and illicit drugs.
- Older women are most at risk of problematic use of sedative/hypnotic and anxiolytic medication.
- Signs and symptoms may be attributed to or masked by other problems e.g. cognitive impairment.
- Addicted to prescription medications e.g. opioids.
- Not taking prescription medications.
Physical symptoms that should trigger screening:
- Sleep complaints.
- Cognitive impairment, memory or concentration disturbance.
- Seizures, malnutrition, muscle wasting.
- Liver function abnormalities.
- Unexplained medication interactions.
- Persistent irritability without obvious cause.
- Unexplained chronic pain or other somatic symptoms.
- Incontinence, urinary retention.
- Poor hygiene and self neglect.
- Unusual restlessness or agitation.
- Complaints of blurred vision or dry mouth.
- Unexplained nausea and vomiting.
- Changes in eating habits.
- Slurred speech.
- Tremor, poor motor coordination, shuffling gait.
- Frequent falls and unexplained bruising.
17
Q
Outline the pharmacological treatment of dementia and discuss the role of health economics in NICE technology appraisals to determine access to these, and other, new treatments
A
- Acetylcholinesterase (AChE) inhibitors e.g. Donepezil, Galantamine, Rivastigmine.
- Memantine (NMDA antagonist).
- Antipsychotics e.g. Haloperidol, Risperidone.
- Reduce polypharmacy if appropriate.
Must be considered cost effective to be implemented into national guidance.
18
Q
Recognise the importance of the multidisciplinary approach in the assessment and management of inflammatory arthritis
A
- Primary care: usually first access to healthcare, refer to specialist, arrange investigations (blood tests, X-rays), measure functional ability with Health Assessment Questionnaire (HAQ).
- Secondary care (inc. Rheumatologists, specialist nurses) - provide treatment and education.
- Other: Physiotherapy, Occupational therapy, Hand exercise programmes, Podiatry, Psychological interventions, Diet and complementary therapies.
- MDT provides the opportunity for periodic assessments of the effect of disease on their lives (e.g. pain, fatigue, everyday activities, mobility, ability to take part in social/leisure activities, quality of life, sexual relationships). Allows rapid access to specialist care for flares and ongoing drug monitoring.
- Adults the inflammatory arthritis should have access to a named member of the MDT e.g. specialist nurse who is responsible for co-ordinating their care.
19
Q
Appreciate the impact of untreated inflammatory arthritis on function and quality of life
A
- Functional impairment (walking, exercise, sleep quality, ADLs, work, participation in sport and leisure).
- Negative impact on sexual relationships.
- Poor self-image - deformity.
- Psychological effects of chronic pain and illness.
- Fatigue impacts ability to attend social events.
20
Q
Outline the physical and psychosocial factors (including yellow flags) that can influence the persistence of disabling back pain
A
Impact of back pain:
- Significant time off work → social isolation, personal/community economic impact, psychological impact (not valuable). 2nd most common cause of lost working days and has significant rising disability associated with it.
- Major drain on benefits.
- Major loss of ADLs & ability to take part in usual activities.
- May feel stigmatised, as if others thinks they’re feigning illness. May lead to psychological sequelae.
- May become dependent on family → care stress & role reversal, relationship stress/
resentment. - May also impact on ability to care.
- Side effects from medication/cost of alternative therapies.
- Reduced libido.
Psychosocial factors that are associated with development of persistent disabling back pain (yellow flags):
- Negative belief is due to serious underlying pathology.
- Negative attitude that back pain is HARMFUL/ SEVERELY DISABLING. Perceived risk of persistent pain.
- Maladaptive coping strategies —> fear avoidance behaviour and reduced activity levels.
- An expectation that passive, rather than active, treatment will be beneficial.
- Seeking treatments that seem excessive/inappropriate.
- Overbearing/unsupportive family.
- Tendency for depression/anxiety, low morale and social withdrawal.
- Social or financial problems.
- Negative feelings toward work (low support/dissatisfaction).
- Ongoing litigation.
- Stressful life events causing physical or emotional trauma.
- Previous substance misuse.
- Sleep disturbance.
- Fatigue.
- Catastrophising.
Impact:
- Disuse of muscles/tendons/ligaments/joints leading to shortened structures so that nociceptors are triggered more readily.
- Amplification of afferent input by peripheral + central sensitisation.
- Fear of pain/anxiety/depression.
Management of back pain:
- MDT: PT, OT, social services, GP (NSAIDs).
- Focus on return to work and highlighting what patient can do instead of what they can’t do.
21
Q
Outline the role of and evidence for physiotherapy, osteopathy, and chiropractic therapy in the management of back pain
A
Physiotherapy:
- Aerobic exercises, muscle strengthening, spinal stabilisation.
- Evidence for reducing pain.
Osteopaths:
- Touch, physical manipulation and stretching to increase mobility and blood flow, relieving spasms.
- Evidence for spinal manipulation in back pain.
Chiropractic:
- Manual adjustments of spine and joints, soft tissue manipulation to relieve MSK mechanical disorders and nervous system.
- Evidence for spinal manipulation in back pain.
- Not cost-effective.
Acupuncture:
- Needles to reduce blood flow to pain matrix in brain.
- NICE doesn’t recommended for back pain management.
- Not cost effective.
22
Q
Assess the physical, social, psychological and spiritual dimensions of pain in patients (and their relatives) with life-limiting illness, such as cancer
A
23
Q
Describe the initial investigations to identify the cause of pain (palliative care)
A
- Bloods: FBC, ESR, CRP, U&E’s, ALP, PSA, LFT’s, TFTs
- Urine dip
- ECG
- Serum/urine electrophoresis - consider multiple myeloma
- Imaging: XR, US, CT, MRI
24
Q
Understand the main features of current debate about euthanasia; be aware of situations when a request for euthanasia may arise
A
- Euthanasia: deliberately ending a person’s life to relieve suffering (e.g. administering a toxic drug).
- Assisted suicide: deliberately assisting/encouraging another to commit suicide (giving the person the means to kill themselves, e.g. pescribing them a pill to take, but not directly administering it).
Types:
- Active - does the act of ending life.
- Passive - withholds life-prolonging treatment - pt can consent to this as make advanced directives to refuse this.
- Voluntary - when person dying consents.
- Non-voluntary - when person dying can’t consent so another makes the decision for them, often based on statement of wishes.
- Involuntary - against the person’s wishes (murder).
Arguments for:
- Allows patient autonomy to control own body and how they die.
- Is already done in some sense - DNACPR is passive and sedation to shorten life by ending suffering in palliative care.
- Acts in patients best interests.
Arguments against:
- Religious - only god has right to end human life.
- Could change atitudes regarding human ife - very ill may feel they have to accept death, may hinder research into cures.
- could lead to euthanasia when death wasn’t imminent.
- Violates non-maleficence- could lead to lack of respect for terminally ill/feel like doctor is encouraging killing them.
- Detracts from instead of improving end of life care - good quality EOL care should remove suffering and thus solve the problem.
Physician assisted suicide = suicide by a patient facilitated by means (as a drug prescription) or by information (as an indication of a lethal dosage) provided by a physician who is awore of the patient’s intent.
How doctors should respond to euthanasia requests:
- Be prepared to listen and discuss reasons why.
- Limit any advice/information to: explain that it’s a criminal offence and advise about palliative care options.
- Be respectful and compassionate.
- Explore understanding of current condition and care plan.
- Assess if they have unmet care needs, such as symptom management and social support.
25
Explain the principles of palliative care, as outlined in the World Health Organisation definition, to a patient and their carers
WHO defines palliative care as: an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
- Entails early identification and impeccable assessment, enhances QoL, promotes dignity and comfort, may have positive influence on course of illness.
- Provides accompaniment for the pt and family throughout the course of illness.
- Should be integrated with and complement prevention, early diagnosis and treatment of serious or life-limiting health problems.
- Does not intentionally hasten death but provides whatever treatment is necessary to achieve an adequate level of comfort for the pt in the context of the patients values.
- Should be applied by healthcare workers at all levels of the healthcare systems including primary care providers, generalists and specialists in many disciplines.
- Encourages active involvement by communities and community members.
- Provides an alternative to disease-modifying and life-sustaining treatment of questionable value near the end of life and assists with decision-making about optimum use of life-sustaining treatment.
26
Describe the role of department of health policies such as the End of Life Strategy in the provision of palliative care
The End Of Life Strategy: comprehensive framework published by the Department of Health and Social Care promoting high quality care across the country for all adults approaching the end of life.
What it means for pts:
- The opportunity to discuss personal needs and preferences and for these to be recorded in a care plan so that all services are aware of a pt's priorities.
- Coordinated care and support - ensuring that pt needs are met, irrespective of who is delivering the service.
- Rapid specialist advice and clinical assessment wherever the pt is.
- High quality care and support during the last days of a patient's life.
Services which treat the pt with dignity and respect both before and after death.
- Appropriate advice and support for carers at every stage.
27
Understand the use of end of life tools and Gold Standards Framework in the provision of palliative care
End of life tools: used to identify adults who are likely to be approaching end of their life:
- The Gold Standards Framework.
- The Amber Care Bundle.
- Supportive and Palliative Care Indicators Tool (SPICT).
Triggers suggesting a patient is nearing the end of life:
- The surprise question: Would you be surprised if this pt were to die in the next few months, weeks, days?
- General indicators of decline - deterioration, increasing need or choice for no further active care.
- Specific clinical indicators related to certain conditions.
- Deterioration and irregular breathing.
7 key tasks of the gold standards framework:
- Communication
- Coordination of care
- Control of symptoms and ongoing assessment
- Continuing support
- Continued learning
- Carer and family support
- Care in the final days
28
Outline the role of the National Service Frameworks (NSFs)
Policies set by NHS to define care standards for major diseases (Cancer, CHD, COPD, DM etc.) or for specific patient groups (elderly, palliative care).
Roles:
- Set formal quality requirements, based on best evidence for/against treatments/services.
- Offer strategies/support to help organisations attain these.
29
Describe the NSFs for dementia
- Care from specialist dementia staff.
- Memory assessment.
- Written information about their condition, treatment and support.
- Personalised care plan.
- Opportunities to discuss advance decisions, LPA and preferred care.
- Assessment and management of non-cognitive symptoms.
- Access to special dementia liaison services when accessing inpatient care.
- Assessment of palliative care in later dementia stages.
- Carers receive emotional, psychological and social support.
- Carers have access to respite services.
30
Describe the NSFs for stroke
Patients with suspected stroke …
- Are screened with a validated tool.
- Receive brain imaging within 1hr of hospital arrival.
- Admitted to acute stroke unit and assessed for thrombolysis.
- Swallowing assessment within 4hrs.
- Assessed by specialist rehabilitation team within 24hrs.
- Receive ongoing rehabilitation (if needed) in a specialist stroke rehabilitation unit.
- 45 mins of each active therapy.
- Assess and treated for incontinence.
- Screened within 6 weeks for mood disturbance and cognitive impairment.
- Followed up by specialist stroke rehabilitation services after discharge.
- Carers given information about care plan.
31
Recognise the risk factors, investigation and management of osteoporosis
RFs:
- Steroid use of >5mg/d of prednisolone.
- Hyperthyroidism, hyperparathyroidism, hypercalciuria.
- Alcohol and tobacco use.
- Thin (BMI <18.5).
- Testosterone (low).
- Early menopause.
- Renal or liver failure.
- Erosive/inflammatory bone disease e.g. multiple myeloma.
- Dietary (low calcium, malabsorption conditions, DM).
Investigations:
- DEXA scan.
- Bloods: calcium, phosphate, ALP.
Management:
- Lifestyle: smoking cessation, reduce alcohol intake, weight-bearing exercises, balance exercises, calcium and vit D rich diet, home-based fall prevention programme.
- Bisphosphonates (1st line = Alendronic acid, 2nd line = etidronate/risedronate, 3rd line =. Zoledronic acid (IV)).
- Calcium and vitamin D.
- HRT - prevention of osteoporosis in post-menopausal women.
- Raloxifene (SERM - acts similarly to HRT).
- Teriparatide (Recombinant PTH - useful in those who suffer further fractures despite treatment with other agents - potential increased risk of renal malignancy).
- Calcitonin - may reduce pain after vertebral fracture.
- Testosterone - may help in hypogonadal men by promoting trabecular connectivity.
- Denosumab - monoclonal antibody to the RANK ligand given SC 2x yearly.
32
Outline the consequences of a stroke diagnosis
Ethical issues:
1. Autonomy and restraint e.g. with NG tubes.
2. Capacity decisions with dysphasia.
3. Maintaining patient dignity.
4. End of life decisions.
5. Safeguarding and best interests.
Significant effects from stroke - loss of:
1. Normal function = walking, writing, hobbies.
2. Control = seizures, cognition = can precipitate anxiety.
3. Social contacts = harder to socialise.
4. Job = loss of role, satisfaction, relationships.
5. Role = no longer supporting family, recipient of care rather than giver.
6. Autonomy = dependent on carer (often husband/ wife) for various activities.
7. Direct damage to brain = could cause depression/ other psychiatric disorders.
33
Outline the driving restrictions for neurological conditions
Stroke:
- 1 month ban if no residual neurological deficits.
- 3 month ban for multiple TIAs.
Chronic neurological disorders (MS, PD):
- Complete DVLA PK1 form.
Epilepsy:
- 1 provoked/isolated seizure → 6 month ban.
- Epilepsy (>1 seizure) & 12 months seizure free → can reapply for license → if no seizures for 5 years then a til 70 license' is restored.
- If drive a heavy good vehicle → 10 year ban → NB there may be other occupational restrictions e.g. can't work in army.
Syncope:
- Simple faint = no restriction.
- Single episode, explained & treated = 4 week ban.
- Single episode, unexplained/untreated = 6 month ban.
- 2nd episode = 12 month ban.
Visual:
- Field defect = stop driving & require assessment for suitability.
- Monocular may drive if acuity/visual field normal.
34
Describe the causes of immobility in the elderly
- Physiological changes of ageing: fragility, sarcopenia, arthritis.
- Physical illness: HF, postural hypotension, COPD/asthma, PD, OA, leg ulcers, cataracts, poor diet.
- Psychological and social factors: isolation, bereavement, dementia, poor housing conditions.
35
Outline the physical and psychological consequences of falls
Physical:
- Fracture
- Soft tissue laceration
- Pressure sores
- Hypothermia
- Wound infection
- Rhabdomyolysis —> AKI.
Psychological
- Loss of confidence
- Fear of falling
- Depression
- Anxiety
Social:
- Isolation
- Immobility
- Increased dependence (loss of independence)
- Long term care needs
36
Clinically assess the probable cause of falls and outline the approaches to falls prevention
Multifactorial assessment:
1. >65 and 1+ fall in last 12 months & risk factors.
2. Multifactorial assessment → CV risk, osteoporosis risk, gait/ balance, home hazards, meds review, cognitive neuro examination, visual impairment, urinary incontinence.
Multifactorial intervention:
1. Strength and balance training.
2. OT home hazard review —> mobility aids, home adaptations and equipment.
3. Podiatry improving footwear.
4. Improve vision.
5. Medication review.
6. Treatment conditions including bone strengthening.
7. PT —> rehabilitation and strengthening exercises.
37
ReSPECT forms are a type of…
Advance care planning
38
What is the doctrine of double effect?
- If doing something morally good has a morally bad side-effect, it's ethically OK to do it providing the bad side-effect wasn't intended. This is true even if you foresaw that the bad effect would probably happen.
- Although euthanasia is illegal in the UK, doctors are allowed to administer potentially lethal doses of painkilling drugs to relieve suffering, provided they do not primarily intend to kill the patient. This is known as the doctrine of double effect.
- It is used to justify the case where a doctor gives drugs to a patient to relieve distressing symptoms even though he knows doing this may shorten the patient's life.
- This is because the doctor is not aiming directly at killing the patient - the bad result of the patient's death is a side-effect of the good result of reducing the patient's pain.
- Many doctors use this doctrine to justify the use of high doses of drugs such as morphine for the purpose of relieving suffering in terminally-ill patients even though they know the drugs are likely to cause the patient to die sooner.
39
What is Dignitas?
A Swiss nonprofit organisation providing physician-assisted suicide to members with terminal illness or severe physical or mental illness, supported by independent Swiss doctors.
40
What is the most common form of inflammatory arthritis?
Gout
41
What is the most common autoimmune inflammatory arthritis?
RA
42
Does severity of disease activity for arthritis correlate with QoL?
No - severe disease activity doesn’t mean they’ll have a poor QoL/physical/mental function. Older age at diagnosis impacts negatively on QoL, compared with earlier diagnosis.
43
Outline the MDT management of inflammatory arthritis
- Internal medicine
- Infectious diseases
- Physiotherapists
- Podiatrist
- Orthopaedics
- GP
- Nurses
- Surgical team
- Rheumatology
- Pharmacists
- OT
- Psychologists
Earlier treatment leads to better outcomes and less joint damage/disability.
44
What support needs do patients with inflammatory arthritis need?
- Disease impact and pharmacological treatment.
- Care continuity and relations with HCP.
- Importance of non-pharmacological therapy e.g. meditation, acupuncture, yoga.
- Support from family and friends.
- Support needs related to work.
- Contextual preferences for self-management support.
45
Outline the red flags for back pain
- Previous cancer
- IVDU/recent infection
- Pain persisting for > 3 months
- Steroid use
