Four Things Good Physical Therapists Understand About People With Chronic Conditions
4 minute read
In the decade since being diagnosed with multiple sclerosis, I've seen a number of physical therapists.
And in that time I've realized that the best PTs have understood that working with patients with chronic conditions involve a different mindset from the traditional physical therapy patient.
Given that the typical course of physical therapy treatment is limited in sessions, one of the most beneficial things that PTs can do is give patients with chronic problems information, support, and guidance beyond the exercises themselves that patients can continue to use on their own. In other words at some point, because of the frequent mismatch between the amount of treatment needed and the amount covered, patients with chronic conditions are likely to have to become their own PT. To the extent that they can understand the thinking behind a course of physical therapy, it can help them be more successful on their own.
I realize that patients vary in how active they want to be in managing their condition. But for me, living with an unpredictable chronic problem is both tedious and frustrating, and I am eager to do anything that I possibly can that may help me to live a full, quality life.
I know others with MS who feel similarly. As such, rehabilitation goals may be different for people with chronic conditions, and success may have a different definition. Especially for people with degenerative diseases, even if we can't get back to normal, we still value maintaining function and any improvement, even if small. Many of us are not looking to run marathons or climb mountains; we are looking for better balance and mobility as we navigate our homes, stores, and other ordinary spaces.
The following is my insight for today's students and future clinicians for working with patients whose problems will likely outlast the course of treatment. While my points may apply to any patient, those with chronic conditions may particularly benefit from feeling like a true partner in the rehabilitation process.
It helps to know why I'm doing a particular exercise, and what it is supposed to accomplish.
When my shoulder froze a few years back, I didn't want to know the details of shoulder rehabilitation. I believed my shoulder would eventually get better and just wanted to get it working again. But I've had MS long enough to realize that maintaining functionality over time requires active involvement and thought on my part.
If I know how and why a particular exercise strengthens a given muscle or supports balance, it helps me stay focused. As I've discovered, it's easy to do an exercise wrong. Knowing why I'm doing it reminds me do it correctly.
It helps to see exactly how I need to change what I'm currently doing.
Partly because MS can affect proprioception and partly because I never paid attention to the mechanics of movement before my diagnosis, sometimes I'm not clear on how correct movements are supposed to feel or look. I don't realize what I'm doing incorrectly.
For example, I found that I can get by without using core muscles. It took me a long time to sense what an engaged core feels like and to understand how it assists me in moving more efficiently.
What may seem obvious to a PT is not always obvious to me. So for key movements, showing me what I am doing wrong, and perhaps filming me for a few seconds with my phone, will make things much clearer to me. Along those lines, the more you can show me how movements should look using skeleton or muscles models, the more I'll grasp what you are saying.
It helps if you can point out what look like bad habits.
In my case, bad habits of movement and posture predated my MS diagnosis. Although these habits feel difficult to change, mentally it is easier to think that I am working on a habit rather than only addressing neurological damage.
People with MS often get into a pattern of thinking that everything is an MS-related problem; sometimes we need reminding that it's not.
Pointing out any improvement, no matter how small, is a morale booster.
With a chronic condition, improvement is often incremental and undramatic. During a short course of physical therapy, change may be limited. However, I appreciate recognition of any progress, and it helps me build a sense of confidence and control. With the subtypes of progressive MS, little improvement is expected, so any change for the better, no matter how small it seems, is a big deal.
One frustrating aspect of conditions like progressive MS is the lack of a direct relationship between the amount of effort that goes into rehabilitation and the results. However, working with patients like me to develop a sense of understanding of what they are doing and to see the control they can have, can help keep them motivated long after the formal course of therapy ends.
Joan F. Peters, JD, MPH. Connect with Joan via email at firstname.lastname@example.org.
Podcast: Payment, Policy, and You: Ethics and Best Practices
Listening Time — 40:05
Value. Data. Ethics. Professionalism. Patient-centered.
These are all things today’s clinicians must account for in all settings, but what does it mean for you as current students and future clinicians?
In this episode, we talked with APTA payment and regulatory staff expert Kara Gainer, and physical therapists Bud Langham and Hannah Johnson on what students should know about the health care landscape, payment, and ethical practice, and included advice on things like documentation, ethical decision-making resources, and how to navigate tough conversations all while providing quality care to your patients.
Here’s our conversation with Kara, Bud, and Hannah.
To learn more and view APTA’s latest resources and information on payment and regulatory issues visit APTA.org/Payment.
APTA Podcasts like this one are available on Apple Podcasts, Google Play, and Spotify, or by visiting APTA.org/Podcasts.
Call for volunteers for 2020 House of Delegates
We are seeking student volunteers to serve as ushers at the 2020 APTA House of Delegates in Phoenix, Arizona, June 1-3, 2020.
As an usher, you will have the opportunity to see how the physical therapy profession governs itself and sets professional policies. You’ll get a first-hand look at APTA’s House of Delegates, a policymaking body of the association, and have the opportunity to learn from dedicated and experienced physical therapists as they set the professional standards for the coming year. This is a rewarding experience that many students have taken advantage of and this year, you can too!
If you are a student enrolled in a physical therapy or physical therapist assistant program and are interested in serving as an usher, please review the responsibilities and eligibility requirements before submitting an application online. The deadline to apply is Monday, March 30, 2020. If you have any questions please email email@example.com.
Putting Advocacy To Work at Federal Advocacy Forum
4 minute read
I have to be honest, I did not really know what APTA’s Federal Advocacy Forum was when I registered to attend in 2019. All I knew was that it was the place to be if you wanted to be involved in professional advocacy, which was really great because my passion for advocacy was growing stronger every day.
Admittedly, I was both very interested and very nervous.
I didn’t know if I was prepared enough to talk to senators and representatives about the legislative issues currently happening regarding our profession.
I tried my best to stay up to date with those efforts and to think of ways that I could make them stand out when talking to politicians. That brought another problematic thought to my head though.
At the time, I was a second-year physical therapy student and I had not yet been on any full-time clinical affiliations. I wasn’t sure if I had enough experience to speak to any of the pressing issues we’d be discussing.
Even with all of that uncertainty I wanted to go and experience #PTAdvocacy in action and learn where I fit in to all of it.
Upon arrival at FAF, I immediately felt a different atmosphere than other professional conferences. Everyone was there for a reason and had a task to accomplish. That feeling was inspiring! I felt that I was part of a group with a true purpose.
I had been learning in my classes about the many fights that the physical therapy profession had won impacting our scope of practice, patient access, payment, and more. The most notable of those being the repeal of the Medicare therapy cap, which was a long-fought initiative that paid off in 2018. But what I was really learning was that there were still many initiatives that needed a lot of work and advocates behind, and I knew that I wanted to be one of them. I was ready to start advocating for my profession and showing everyone the breadth of what we can do.
The first thing that I learned was that it didn’t matter how much I knew about policy and legislation. As long as you came with a passion for your patients and the future of our profession, you would make a definite impact.
The speakers did a great job of preparing everyone for their meetings with legislators. They went over everything from the best way to communicate during our upcoming meeting with legislators to the best entrance to use to get into the building quickly.
One of the issues of focus at FAF 2019 was the ways to lessen the burden of student debt. We talked a lot about the newly proposed bill to add physical therapists to the National Health Services Corps. As a student, it was great to hear that our professional organization was taking this problem seriously. It almost felt that this was meant to be who better to talk about student debt than me, a student, who was being impacted by it in real time. I knew at that moment that I had something significant to add to this experience.
After a couple of days of learning as much information as we could about professional advocacy, policy priorities for APTA and the profession, and prepping for our meetings with legislators it was time to meet with our senators and representatives.
Since I am from a small state (shout out to Rhode Island!), I had the unique opportunity to be a part of a small group meeting with all of our state legislators. We made sure to talk about the NHSC bill and the many positive changes it could make for our country and our state. We also made sure to highlight the #ChoosePT campaign and the impact that physical therapy has had on the opioid crisis as well as the improvements this bill could have on student debt. Rhode Island sadly has a very serious problem with opioid overdose deaths, and listing PTs in NHSC would add our profession to our local community health centers and bring more resources to those who may not be able to access them otherwise. Our meetings were very successful, not only for communicating our information, but also for fostering relationships with our state legislators that will hopefully continue in the future. It was an unbelievable experience to be in those meetings, talking to our legislators, and putting #PTAdvocacy to work!
So, should you attend the upcoming Federal Advocacy Forum? Yes. Should you be worried that you do not have enough experience with legislation or advocacy? No. Do you need to have years of professional experience to be to make an impact? Definitely not. All you need is a willingness to learn about our current legislative efforts and a passion for improving the future of our profession.
Join us March 29-31, 2020, in Washington, DC, for APTA’s Federal Advocacy Forum. Registration is open now through March 16.
Erin Sayles, SPT, is a student at the University of Rhode Island and serves as the chair of the APTA Student Assembly Advocacy Project Committee. You can connect with Erin on Twitter at @ErinSaylesSPT.