Assessment and Treatment Skills for Telerehabilitation for Physiotherapists
These are unprecedented times. The world has been put on hold by a pandemic and "business as usual", is no longer the status quo. Stress and anxiety are at an all-time high, and pain responses and sleep disturbances are sure to rise accordingly.
"We are at an unprecedented time in the history of healthcare and, the history of humanity - isolated, with an increasing need to stay connected." - COVID-19 and the Healthcare Capacity Crisis.
What can you do right now to adapt your practice to continue to serve your patients and build your business?
We are in a new normal and digital healthcare is not going away. As a clinician, you no longer have access to the tools that you would use when you see your patient in the clinic. Overnight, we have been asked to change and shift the way we think and treat.
Carolyn and Brittany Vandyken have designed an online course, Telerehabilitation 101: Assessment and Treatment skills for Online Success, to give you a jump-start on evidence-based strategies to assess pain-related distress in order to address pain from a whole person, biopsychosocial perspective.
Carolyn and Brittany Vandyken Can Help You:
- Learn how to assess central sensitization, catastrophization, depression, anxiety, and stress
- Adopt some basic strategies that you can use as a physiotherapist to address these concerns
- Develop your skills using a psychologically informed approach that translates well into virtual patient care.
- Brush up on your pain education skills as well so you can confidently connect their psychosocial distress and their pain experience.
Watch the Introduction to the Course Below:
In This Online You Will Learn:
- How to listen to your patient's story to really develop a strong therapeutic alliance during telerehabilitation.
- How to assess central sensitization to determine if it requires a psychologically informed approach. These are the patients you are most likely to positively affect using telerehabilitation.
- How to assess distress markers such as catastrophization, depression, anxiety, and stress to create a psychologically informed approach.
- Develop instant skills in addressing these distress markers using tools with a physiotherapist's scope of practice, including global movement and exercises easily taught over telehealth.
- Draw on an established exercise skillset that addresses these distress markers using an evidence-informed framework that is easily taught on pelvic health
- Build your skills in pain biology education quickly and practically to deliver this much needed, broader perspective to treat persistent pain.
Throughout this course, an evidence-based discussion is centered around the broader services that physiotherapists can provide through telerehabilitation and virtual care.
What Is Pain?
It starts with an understanding about what pain actually represents. When your patients are given the definition of pain and you unpack the meaning for them, they are given the opportunity for their first “Ah-ha” moment. According to the International Association Study of Pain (IASP), pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." For patients, the recognition that emotions are always involved in producing pain rings true for them. Many patients can relate to a stressful period of life affecting or even starting their pain journey.
Defining pain as a sensory and emotional experience requires that physiotherapists look at persistent pain through both a “bio” lens as well as a “psychosocial” lens. However, we are not skilled in the psychosocial contributors of pain outside of identifying yellow flags. Now is the time to build your skillset. Patients want to understand the broad nature of their pain as well as the opportunities that they have to change their pain system through easily targeted lifestyle strategies including diet, sleep, exercise, relaxation exercises and a strong belief system that they can retrain their pain system and get better.
Don’t Forget the “BIO” Piece of the Puzzle
Have you spent much time really understanding the mechanical nature of pain. For those physiotherapists that did their training in Mechanical Diagnosis and Therapy (MDT) or commonly known as a McKenzie approach, you will have a huge advantage in moving towards telerehabilitation.
Why should you use an MDT approach?
- This is a strong, evidence-based approach that teaches therapists how to categorize patients into derangements when appropriate, looking for reproducible, changeable and sustainable changes to the pain pattern
- 66% of people with LBP have a directional preference which can be identified easily whether their pain is acute, subacute or chronic
- An MDT approach builds self-efficacy and empowers patients to control their pain; this builds a strong therapeutic alliance and will produce friends and family referrals in abundance
- When patients can be the masters of their own destiny by changing their pain quickly and sustainably with an MDT approach, positive expectations and hope are the side benefits which are also highly connected with strong outcomes
- This approach can easily be adapted for telerehabilitation.
Assessing Central Sensitization, Depression, Anxiety and Stress: The PSYCHOSOCIAL piece of the Puzzle
Is it time to expand your practice and move beyond identifying yellow flags as a reason for a lack of patient improvement? Do you sometimes think that your patients are “crazy” when they have yellow flags and it is their fault for not getting better? If ⅔ of low back pain patients have mechanical pain and an identifiable directional preference, the remaining majority are struggling with a very common problem in persistent pain, a sensitive nervous system. This can be measured using the Central Sensitization Inventory and is a useful tool to identify those who need to work in a broader framework, namely a biopsychosocial framework. Once identified, a sensitive nervous system can be profiled using different questionnaires including the DASS 21 (Depression, Anxiety and Stress), PCS (Catatrophization), PSEQ-2 (Low Self-Efficacy), PANAS (Low positive affect), IEQ (Injustice), Self-Compassion (Shame) and Sensory-Motor Representation Changes. We call this profiling SAD CLLIFSS for short.
The significant value in profiling a sensitive nervous system allows you to address the components of sensitization that are present for each individual within a framework of pain neuroscience education. Have you ever educated a patient about the pain system, and then thought, “Now what?”. Many of us default to treating the tissues even in persistent pain because, like an MDT approach, this is an overlooked area in our education system!
In this course, you will learn how to measure the most common areas of distress to get you started on your biopsychosocial journey. This includes Catastrophization, Depression, Anxiety and Stress. Best yet, you will be given practical, physiotherapy-driven, scope-enhancing strategies to change these phenotypes and the sensitivity of your patient’s nervous system. These strategies also build a huge fan-base with your patients because you are giving them measurable, changeable strategies that build their self-efficacy and change their pain. Now, that is true empowerment. All using virtual, video visits. Those results are worth striving for. Learn to do things differently! We will show you how!
Carolyn is the co-owner of Reframe Rehab, a teaching company engaged in breaking down the barriers internationally between pelvic health, orthopaedics and pain science. Carolyn has practiced in orthopaedics and pelvic health for the past 34 years. She is a McKenzie Credentialled physiotherapist (1999), certified in acupuncture (2002), and obtained a certificate in Cognitive Behavioural Therapy (CBT) in 2017.
Carolyn received the YWCA Women of Distinction award (2004) and the distinguished Education Award from the OPA (2015). Carolyn was recently awarded the Medal of Distinction from the Canadian Physiotherapy Association in 2021 for her work in pelvic health and pain science.
Carolyn has been heavily involved in post-graduate pelvic health education, research in lumbopelvic pain, speaking at numerous international conferences and writing books and chapters for the past twenty years in pelvic health, orthopaedics and pain science.
Brittany Vandyken is a Registered Physiotherapist and co-owner of Physio Works Muskoka. She graduated with an Honours Bachelor of Science degree from Brock University in 2014 while playing as an Academic All-Canadian on Brock’s varsity basketball team.
Following this, she obtained her Masters of Science in Physiotherapy from McMaster University in 2017 winning several awards and scholarships including Faculty of Health Science Outstanding Achievement Award, the Ontario Graduate Scholarship and the CPA Award for graduating top of her class. She has received additional post-graduate training in central sensitization, soft tissue release, pelvic floor rehabilitation, breast health and oncology rehabilitation. Brittany has a passion for clinical research on lumbopelvic pain and pelvic floor dysfunction, recently publishing a novel research study in the journal Muskuloskeletal Science and Practice, Physical Therapy; a second study is currently under review by the Brazilian Journal of Physiotherapy.
Brittany is grateful to be able to stand on the shoulders of giants in her profession such as Carolyn Vandyken, Darryl Yardley and Sinead Dufour, and is passionate about helping new grads to quickly establish competency and confidence by utilizing current concepts in central sensitization, pain education, and pelvic health.