Exam 2
Which of the following is NOT a significant predictor that a person will return to work: Social functioning Age Mental Health Expectations of Recovery
Age
Describe conversion disorder:
Also known as functional neurological disorder Manifests as neurological symptoms in the absence of neurological disorders; there is a psychological stressor. Marked by the presence of deficits in voluntary motor or sensory function, including paralysis, blindness, movement disorders, etc. uConversion disorder begins with some stressor, trauma, or psychological distress. Usually the physical symptoms of the syndrome affect the senses or movement. uCommon symptoms include blindness, partial or total paralysis, inability to speak, deafness, numbness, difficulty swallowing, incontinence, balance problems, seizures, tremors, and difficulty walking. u These symptoms are attributed to conversion disorder when a medical explanation for the afflictions cannot be found.
How does billing change with patients on worker's comp?
"No more than four physical medicine procedures, modalities or time units will be reimbursed in one visit by each type of medical provider. No more than two of the four CPT code charges can be modality codes" CPT Code: 99750 Limit of $600 reimbursed Work rehabilitation programs fall under the same code 2 Codes per treatment session: max amount $267 Modifier 59 Ability to perform physical performance tests/measures plus and FCE in the same day A lot of the time you are treating someone else and just checking in on them through out or working with an aide
What are some patient education interventions for fear avoidance?
"The Back Book" - SEE PDF Fear avoidance beliefs and negative beliefs were reduced when pamphlets were used to educate patients in work and clinical settings In the Case study, the patient was given the Back BooK and additional interaction between PT and patient to reinforce/enhance the delivery and purpose of the pamphlet The Back Book was provided as part of the patient's HEP
What is the board's pledge to employees from the Worker's compensation of GA?
"The main focus of (name of company/employer) is to assist job-related injured workers in receiving immediate and quality medical care, to administer worker's compensation claims from the initial injury until the closing of the claim, and to safely return lost-time employees to productive employment. We believe that a healthy, safety, conscious and productive company is the result of a healthy, safety conscious and cooperative employees."
WHAT IS THE PUNISHMENT FOR TRUE MALINGERING AS A WORKER'S COMPENSATION PATIENT?
"You shall be guilty of a misdemeanor and upon conviction shall be punished by a fine of not more than $10,000 or imprisonment up to 12 months, or both for making false or misleading statements when claiming benefits. Also, any false statements or false evidence given under oath during the course of any administrative or appellate division hearing is perjury"
What is MMI?
maximal medical improvement Your condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Once you reach MMI, a doctor can assess how much, if any, permanent disability resulted from your work injury. The doctor obtains this information from a PT/FCE so judgement can be objective
What must patient reach before the impairment rating can be done?
must reach MMI before the impairment rating can be done Too early to do an impairment rating if: -Further restoration of function is probable -Flare up or new injury eg: car accident after injury -If it is a chronic or progressive disease it has reached MMI when condition is not likely to improve
List some examples of documentation examples to objectively document malingering or suspicious behavior?
- Ability to sit in the waiting room - Ability to perform essential tasks that appear different than testing of similar activities. - Patient wants to continue PT after max benefit to obtain more medical bills
What is the diagnostic criteria for functional neurological symptoms disorders (conversion disorder)?
- The patient has at least one symptom of altered voluntary motor or sensory function. - Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. - The symptom or deficit is not better explained by another medical or mental disorder. - The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
What is the treatment for conversion disorder?
- include hypnosis, psychotherapy, physical therapy, stress management, and transcranial magnetic stimulation. - Explanation. This must be clear and coherent as attributing physical symptoms to a psychological cause is not accepted by many educated people in western cultures. It must emphasize the genuineness of the condition, that it is common, potentially reversible and does not mean that the sufferer is psychotic. Physiotherapy where appropriate - OT to maintain autonomy in ADL - Treatment of depression and anxiety if present - There is little evidence on treatment
What are the components of exercise?
-Aerobic endurance Physical work sustained for a long period of time designed to increase efficiency of O2 transport -Anaerobic endurance High intensity work designed to increase muscular strength Weight lifting -Flexibility, coordination, and relaxation Stretching, yoga, ballet
WHO/WHAT IS COVERED BY THE STATE'S WORKER'S COMPENSATION PROGRAM?
-Any employee of a company that has more than 3 full time workers -If the correct job is being performed but in haste, the employee is still covered. -If the incident occurs because of another employee's wrongdoing, the injured employee is still covered. -Occupational related diseases -Repetitive motion injuries (doesn't have to be traumatic)
What can you do after becoming disabled in the state of GA?
-Go separate ways from employer after settlement has been reached -Return to work with company to same position if possible, return to a different position -Return to workforce with a different company or area if qualified.
What is NOT covered by the STATE'S WORKER'S COMPENSATION PROGRAM?
-If the injury occurs during employee misconduct (fight, horseplay, drug or alcohol abuse on the job, etc.) all rights of worker's compensation are revoked. -Spouses are not covered like they may be if there is health insurance provided through a company. -Heart attack or stroke
What is the overall prognosis on conversion disorder? Do symptoms ever go away?
-Prognosis for conversion disorder varies widely, with some cases resolving in weeks, and others enduring for years or decades. - There is also evidence that there is no cure for Conversion Disorder, and that although patients may go into remission, they can relapse at any point. - Many patients who are 'cured' continue to have some degree of symptoms indefinitely
What are the three steps of FAMEPP?
1- Screening for patients with elevated fear avoidance beliefs 2- educating patients with elevated fear avoidance beliefs in specific manner 3- prescribing exercise that directly addresses the patients dear avoidance behavior
What is the process of FCE?
1. Informed consent 2. Therapist interviews worker -Demographics -ADLs -Current symptoms, medications and treatment history -Medical records 3. Brief physical exam -HR and BP 4. Physical testing begins Referral: Once evaluation is completed; written report is sent to the referral source containing 1. The physical demand level achieved by the worker 2. answers to referral questions -Can the worker perform past work? 3. the workers sincerity of effort
What percent of workers involved in personal injury, worker's compensation, or disability systems are found to be malingering?
25-30 percent
Describe symptoms magnification:
A conscious or unconscious self-destructive, socially-reinforced, behavioral response pattern consisting of reports or displays of symptoms which function to control the life circumstances of the sufferer
What are work restrictions?
A doctor's description of the work you can and cannot do. Work restrictions help protect you from further injury.
What is permanent partial disability award?
A final award of permanent partial disability made by a workers' compensation judge or the Workers' Compensation Appeals Board.
What is permanent disability payments?
A mandatory bi-weekly payment based on the undisputed portion of permanent disability received before and/or after an award is issued.
Describe impairment rating:
A physician estimates the severity of the medical condition and degree that it decreases a person's ability to perform common ADL's, excluding work A percentage estimate of how much normal use of your injured body parts you've lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). · Self-care and personal hygiene · Communication · Physical activity · Sensory function · Non-specialized hand activities · Travel · Sexual Function · Sleep The AMA Guides use the impairment rating report as the GOLD STANDARD for documenting permanent impairment to support insurance and legal proceedings
What is should you consider when confronting malingering? (ABCS)
ABCS: If clarification is sought from an evaluee regarding inconsistencies in self-reports or other evidence of feigning, remember your ABCS: -Avoid accusations of lying -Beware of countertransference -Clarification, not "confrontation" -Security measures -If you are irritated with the patient and you refer that energy to the patient - our place is to leave our emotions out of it and objectively document
Define Permanent disability: How is it rated?
Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. A percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by your job, and your diminished future earning capacity. It determines the number of weeks you are entitled to permanent disability benefits.
How can you use the FABQ if your patient's pain is not work related?
As stated and used in the study, the physical activity scale of the FABQ can be used if the patient's injury is not work related Suggested that scores >15/24 are high (avoider) MCID of 4 points is hypothesized for physical activity scale of FABQ
What is the most important factor to determine if acute pain will proceed to chronic disability?
Avoidance behavior/ response; elevated fear avoidance beliefs
What are the most commonly used FCEs?
Blankenship, Ergos Work Simulator and Ergo-Kit variations Isernhagen Work System Hanoun Medical Physical Work Performance Evaluation (Ergoscience), WEST-EPIC Key Ergos ARCON Assess Ability *There is no standard used by PTs*
What Psychosocial measures can be used to assess psychosocial variables in patients?
Depressive symptoms measured using- Center for Epidemiological Studies Depression Scale (CES-D) FABQ Anxiety- Beck Anxiety Index (BAI)
According to Chen, all of the following are common aims of a FCE except: Developing a treatment program Measuring physical abilities of patients before/after a rehab program Evaluate whether or not an injured worker can return to work Determine whether or not to litigate an OSHA violation
Determine whether or not to litigate an OSHA violation
What is important for PTs to remember when working with worker's compensation patients?
Don't let our stereotypes of the patient affect how we treat them
What were the results of return to work status for the "Education group" vs "Traditional group"?
Education group: 10 (62%) returned to work within 28 days all 16 (100%) returned to regular work duties within 45 days Comparison group: 9 (50%) returned to work within 30 days 12 (67%) gad returned to regular work duties within 45 days 3 (17%) had not returned to regular work duties by 90 days or more Conclusion: Subjects in the comparison group took longer than subjects in the education group to return to regular work duties. "The education and counseling that were provided to the subjects in the education group seemed to reduce their fear of activity, enable them to tolerate trunk strengthening and flexibility exercises and, most importantly, facilitate their return to work"
What FABQ score determined a likelihood that patient won't return to work?
FABQ physical activity scale >15 has been proposed as indicator of high fear avoidance FABQ work scales >34 associated with increased risk of not returning to work Work scales <29 associated with decrease risk of not returning to work
What should be incorporated into the FCE's to use them best?
FCE's do a good job of contributing to the medical model But we must incorporate missing links societal, personal and external factors in determining disability(ICF) As a clinician we should advocate for a multidisciplinary approach to address all of our patient to help them function at their highest capacity
Disability encompasses only changes in an individual's health status. True or False
False
What is the FABQ?
Fear Avoidance Beliefs Questionnaire "Focuses specifically on how a patient's fear-avoidance beliefs about physical activity and work may affect and contribute to his/her low back pain...and resulting disability"
What is the FAMEPP? What does it include?
Fear Avoidance Model of Exaggerated Pain Perception (FAMEPP) This was developed to explain why some experience resolved sxs and return to PLOF whereas others continue to have sxs and disability "In this model, fear of pain and fear avoidance beliefs are hypothesized to be the most important factors in determining whether a person will experience chronic disability after an episode of acute LBP." A spectrum from confrontation to avoidance is used to describe a patient's reaction to a painful experience Confronters= LBP and lower levels of Fear avoidance beliefs; this is an adapted response and associated with gradual return to patients desired level of function Avoiders= those with higher fear avoidance beliefs; maladaptive response and associated with chronic disability; also includes psychological and physical consequences such as exaggerated pain perception or disuse syndrome this model assumes that the patient's LBP is not from a serious pathological source Fear of Pain and Resultant Avoidance Behavior: most important factor in determining if a person will experience chronic disability after an acute LBP episode:
What is the single most reliable measure to determine if a successful return-to-work is possible? Why?
Functional Capacity Evaluation (FCE) - as it is inherently a thorough and accurate evaluation process that documents an individual's residual physical abilities, level of effort expended during testing, reliability of reports of pain and limitation, and it is an overall gauge of feasibility for employment. FCE is a multi-hour or multi-day assessment of an individual's physical capabilities
What is a FCE? Why would it be used?
Functional Capacity Evaluation - A series of tests measuring physical strength, ''range of motion'', stamina, and tolerance to functional activities, including lifting and carrying. These tests can be used to evaluate work tolerance, and the necessity for work restrictions. Related terms include o Used for a variety of reasons. To develop a treatment program, to measure the physical abilities of a patient before and after a rehabilitation program, to modify a rehabilitation treatment, to evaluate whether an injured worker can work, and to determine when he/she can return to work.
How does the state of Georgia measure impairment?
Georgia measures impairment by objective criteria outlined in the AMA Guides and the impairment rating is expressed as a percentage of the involved area
Describe the difference between impairment and disability.
Impairment is defined by the AMA Guides as an alteration of an individual's health status that has been assessed by medical means. Disability is the term used to describe the relationship between impairment and an individual's inability to complete a task or duty. Impairment is a significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder, or disease. Eg: Decreased hip ROM, or decreased grip strength (like a problem list) Disability is activity limitations and/or participation restrictions in an individual with a health condition, disorder, or disease. Result of the impairment. E.g. Can't play soccer, can't complete daily physical training in the military. The relationship between impairment and the impact those impairments have on individual's life, namely the level at which they can or can not complete a task or duty -Total permanent disability- The person can no longer work secondary to sustained injuries -Permanent disability rating- reflects the individual's loss of potential earning capacity secondary to their disability Based on % 0% = no disability that impacts earning capacity , 100% = Total permanent disability
Which of the following FCEs was found to have consistent inter-rater reliability and predictive validity? Blankenship AssessAbility Iserhagen Work System Hanoun Medical
Iserhagen Work System
How does performing an FCE correlate with closure of a claim?
It is common for a completed FCE to result in the closure of a claim, though the actual performance on the FCE may not be predictive of return to work. In essence, by having a functional capacity evaluation, a patient is likely to be put in a position of deciding whether he or she is will to return to work. The closure of a claim often results in proximate suspension of disability benefits.
What principles from the Back Book are important for patients to acknowledge?
Key principles described in The Back Book for people to acknowledge: 1- LBP doesn't suggest the presence of serious disease 2- spine is strong, pain doesn't mean that the spine is damaged 3- lasting pain relief depends on what people do and not on medical txs 4- activity essential for restoring normal function and fitness 5- positive attitudes and coping skills are helpful
What are issues that threaten FCE validity?
Lack of standardization in terminology, test length, evaluator qualifications, report format, and determination of material handling and problems..
What psychological factors contribute to predicting which people experience chronic disability for LBP?
Maladaptive responses to movement related pain, beliefs about physical capabilities, fear avoidance beliefs contribute to which people have a greater likelihood of experiencing chronic disability in the future following an episode of LBP.
What variables should be measured during an initial evaluation that are predictive of prolonged work restriction?
Measure of impairment Measure of pain Measures of disability Psychosocial measures
What are some of the evaluation components of FCE?
Musculoskeletal -Range of Motion -Strength -Cardiovascular Functional Capabilities -Workplace tolerance -Work simulation -Everyday life activities Worker Performance -Sincerity of effort Sitting Reaching Pulling Pushing Balance Squatting Crawling Lifting Climbing Walking
List the categories of work tolerance levels:
Not Present (never): Activity or condition does not exist. Occasionally: Activity or condition exists up to 1/3 of the time. Frequently: Activity or condition exists up to 1/3 - 2/3 of the time.
What happens within the sensorimotor system for muscles in individuals with chronic pain versus healthy individuals?
Patients with musculoskeletal pain, in comparison to healthy individuals, have functional changes (reorganization) of the neuronal properties in the sensorimotor system representing the muscles most affected by pain.
What is permanent partial disability benefits?
Payments you receive when your work injury partially limits the kinds of work you can do or your ability to earn a living.
What is permanent disability benefits?
Payments you receive when your work injury permanently limits the kinds of work you can do or your ability to earn a living.
What is the difference in physical activity vs. exercise?
Physical activity Any bodily movement generated by skeletal muscles resulting in energy expenditure Exercise A biochemical, social, and physical activity that can be manifested in a variety of forms, with the purpose of training or developing the body to promote physical health
What medical expenses are covered by worker's comp?
Physician's Visits Surgical Procedures Imaging Therapeutic Interventions Pharmacological Interventions
Describe malingering:
Purposeful production of falsely or grossly exaggerated physical or psychological complaints with the goal of receiving a reward
Describe the process of claiming worker's compensation after an incident:
Report Find a Physician Follow your treatment plan Close Claim OR Settle
What variables had the most value in predicting prolonged work restrictions?
Risk of prolonged work restrictions increase from 29% to 58% when a score >34 on FABQ work scale Those with score of <29 are at decreased risk of prolonged work restrictions FABQ work subscale has greatest predictive validity → Screening tool
List the categories of strength and physical demand levels:
Sedentary: 1-10 lbs occasionally, < 1 lbs frequently or constantly Light: 11-20 lbs occasionally, < 10 lbs frequently, negligible lbs constantly Medium: 21-50 lbs occasionally, < 10-25 lbs frequently, <10 lbs constantly Heavy: 51-100 lbs occasionally, 25-50 lbs frequently, 10-20 lbs constantly Very Heavy: >/= 100 lbs occasionally, > 50 lbs frequently, >20 lbs constantly
How is worker's sincerity of effort determined?
Sincerity of Effort = Validity or Reliability Defined as: "a patient's conscious motivation to perform optimally during an evaluation. How do you measure it? -Heart rate intensity Max HR = 220 - Age -Repeated measure assessed by coefficients of variation Measures reliability NOT validity -Documentation of pain behavior through visual observation No evidence for reliability and validity
What are some symptoms which may lead you to believe malingering is present?
Suspicion of voluntary control over symptoms as demonstrated by: -Bizarre or absurd symptomatology -Unusual symptomatic response to treatment -Atypical symptomatic fluctuation consistent with external incentives -Complaints grossly in excess of clinical findings -Substantial noncompliance with assessment or treatment
Other than the FABQ, what is another helpful outcome measure to use with patients with fear avoidance?
Tampa Scale of Kinesiophobia (TSK)
What are the different types of income benefits one can receive with workers comp?
Temporary Total Disability Benefits Temporary Partial Disability Benefits Permanent Partial Disability Benefits Death Benefits
What is secondary gain?
The benefits (external gains) a person realizes from symptoms or relief behaviors they have. This can include increased attention from others, avoidance of expected responsibilities, financial gain, and the ability to manipulate others in the environment.
What is locus of control?
The extent to which individuals believe how much control they have over their lives. internal vs. external
What has been found to be most predictive regarding who will still be off work at 4 weeks? (Based on Godges article)
The individual's beliefs about his or her ability to return to work was found to be the most predictive.
Was diagnostic imaging ordered for individuals with acute LBP?
The physicians who referred the subjects did not order diagnostic imaging examinations for subjects with acute, work-related LBP UNLESS the subjects had symptoms suggesting a serious medical pathology.
Which FCE has been found to have consistent inter-rate reliability and predictive validity?
They found that the Isernhagen Work System had consistent inter-rater reliability and predicative validity.
What is the purpose of FCE? What is the goal of it?
To objectively determine the individual's functional limitations and physical capacities to work. Safely return to work
True or False: The FABQ can be used for fear of pain and resultant behaviors unrelated to work.
True
Describe FCE reliability, validity, and generalizability:
Validity: Ability of the test to accurately measure the tasks required for RTW Determine if the individual is giving a valid effort Generalizability: Specific FCE-only for a very specific type of job General FCE- idea is that it is more generic, but is generalizable to different types of jobs in a particular job category. Reliability: Reliability of the actual test Reliability of the PT performing the test Accurate assessments, avoids bias etc
What is a way to determine nonorganic signs of pain?
Waddell Sign: ●Tenderness: ○Superficial Tenderness ○Non-Anatomical Tenderness ●SImulation Tests: ○Axial Loading ○Acetabular Rotation ●Distracted Tests: ○SLR ●Regional Disturbances: ○Sensory ○Weakness ●Overreaction ●Positive sign= 3 or more of the five signs are present ●Indicates: Patient may have a belief that contributes to the way they perceive their pain. ●PT need to use Waddell Sign carefully: ○Some use this criteria inappropriately to say their patient is "faking" the pain
Which FCE task was most predictive for determining return to work?
What they think about their recovery The time off work may actually be a strong predictor of return to work.
What would make an evaluator deem a FCE unreliable?
When inconsistencies between maximum effort and less than maximum effort are detected, the evaluator may deem the FCE "unreliable" or "invalid", with different evaluators using different terms.
What is the difference between work conditioning and work hardening rehabilitation?
Work conditioning - Addresses physical and functional needs in the clinic; may be provided by one discipline (single discipline model) - Typically less complex (up to 4 hrs/day, 5 days/wk for 8 wks) -Goal: restore overall physical capacity and function to → work Work hardening - Addresses physical, functional, behavioral, vocational needs within a multidisciplinary model in the particularly work place - typically more complex (up to 8 hrs/day, 5 days/wk for 8 wks) -Goal: address specific issues of productivity, safety, physical tolerances, worker behaviors
Where does work fit into the flag system?
Work, used to be under yellow flags - but it is now set up under blue and black BLUE FLAGS Constructs -Negative expectations of RTW -Job Stress Work-related fear avoidance BLACK FLAGS Objective workplace conditions that can affect disability -Insurance -Availability of graded RTW -Attitude of employer in helping workers return
What are both positive and negative prognostic factors for return to work?
Worse: ○High FABQ scores ■PA Scale >15 ■Work Scale >34 ○Out of work longer than 3 months ○Attorney involved ○High physical work demands ○Depression/anxiety ○Coping strategies ○Negative self efficacy and self esteem Better: ○Lower FABQ scores ○Higher education/socioeconomic status ○Higher self efficacy and self esteem ○Optimistic expectations ○Lower severity of injury ○Return to work coordination ○Multidisciplinary interventions
Can PTs make recommendations for work restrictions?
Yes!
What is "modified work" defined as?
Your old job, with some changes that allow you do to it. If your doctor says you will not be able to return to your job at the time of injury, your employer is encouraged to offer you modified work instead of supplemental job displacement benefits or vocational rehabilitation benefits.
What is self-esteem?
a measure of how much you value, respect, and feel confident about yourself
What outcome measure would has the greatest predictive validity for those at risk with prolonged work restrictions? a. FABQ b. ODI c. EBPQ d. RMDQ
a. FABQ
What type of test should FCE be considered?
considered a behavioral test that is influenced by physical abilities, beliefs and perceptions
According to the FAMEPP, what is true regarding confrontation and avoidance to describe a patient's reaction to a painful experience? a. Confronters experience exaggerated pain perception b. Confrontation is an adaptive response associated with chronic disability c. Avoiders experience lower levels of fear avoidance d. Avoidance is a maladaptive response associated with chronic disability
d. Avoidance is a maladaptive response associated with chronic disability
Which of the following has not been linked to chronic disability from LBP? a. Depression b. Fear avoidance beliefs c. Locus of control d. Physical impairment
d. Physical impairment
A person has reached Maximal Medical Improvement and can be given an impairment rating when: a. Have activity limitations and/participation restrictions due to their health condition, disorder, or disease. b. The patient is close to stable, but further restoration of function is probable c. The patient's condition is unlikely to change in the next 3 months d. The patient's condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment.
d. The patient's condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment.
What has been found to be linked to chronic disability for low back pain?
depression, anxiety, coping strategies, fear-avoidance beliefs, and health locus of control strong relationship between elevated fear avoidance beliefs and chronic disability due to LBP
Which of the following would be least appropriate to be used as a single intervention for a patient with high fear avoidance beliefs? a. Graded exercise b. Cognitive behavioral therapy c. Graded exposure d. Fear avoidance based patient education e. Anatomy and physiology education f. Refer for consultation with mental health professional
e. Anatomy and physiology education
What interventions have been found to prevent acute LBP to transition to chronic disability?
fear avoidance education and exercise intervention strategies cognitive-behavioral interventions educational pamphlets Education and counseling regarding pain management, physical activity, and exercise can reduce the number of days off work in people with fear avoidance beliefs and acute low back pain.
What is countertransference?
is defined as redirection of a psychotherapist's feelings toward a client - or, more generally, as a therapist's emotional entanglement with a client.
What is an impairment rating used to calculate?
permanent disability rating but is different from your permanent disability rating
What is self-efficacy?
the belief that one can master a situation and produce favorable outcomes
Describe yellow flags:
●Belief, Appraisals, and Judgements ●Emotional Responses ●Pain Behavior (including pain and coping strategies) ●Eamples: ○Avoidance of movements due to expectation of pain ○Unhelpful beliefs about pain and poor treatment outcomes
What are the components of the biopsychosocial approach?
●Combines factors in order to understand a person's diagnosis/condition ○Biological factors - physiological pathology ○Psychological factors - emotions, coping skills, self esteem, fear avoidance behaviors, etc. ○Social factors - cultural, socio-environmental, work issues, family
What are some ways in which PTs can increase self-efficacy and self-esteem?
●Communicate the belief that patient is able to make a change ●Use of goals that are specific, challenging, and achievable ●Offer patients a collaborative role in treatment - review goals with patients and revise them as needed ●Provide positive feedback and opportunity for patient to successfully practice skills ●Providing education and empowerment to the patient ●Recognize and make adjustments for individual learning styles ●Peer support groups
What is the difference between confronters and avoiders?
●Confronters ○Lower levels of fear avoidance beliefs ○Adaptive response ○Strong motivation to return to activity ○Gradual return to function ●Avoiders ○Higher levels of fear avoidance beliefs ○Maladaptive response ○Avoid activities anticipated to cause increased pain → may lead to reduced activity levels, increased fear avoidance behaviors, prolonged disability and adverse physical and psychological effects ○Associated with chronic disability *
What are should PT do for fear avoidance?
●Graded Exercises ●Education→ The Back Book ●PT should ○Educate on fear avoidance and pain management ○Provide take-home education materials about physiology, fear avoidance, and exercise ○Provide cognitive behavioral interventions ○Promote patient self efficacy ○Promote activity, no matter how small The PT in the case used graded exercise to progress the patient's exercise prescription This is believed to encourage the patient to be a confronter and decrease the elevated fear avoidance beliefs Graded exercise description- intensity, duration, frequency of exercise were based on patient's pain intensity and current activity level Graded exercise emphasizes activity tolerance.
How is the FABQ scored?
●Higher score= greater fear avoidance behaviors ○Max score = 96 ●Physical Activity subscale (4 items) ○Range 0-24 ○Items #2-5 ●Work subscale (7 items) ○Range 0-42 ○Items #6, 7, 9-12, and 15 **Predictive validity for prolonged work restrictions
How is the TSK scored?
●Questionnaire for Fear-Avoidance patients ●17- Item Scale with 2 Subscales ○Activity Avoidance ○Somatic Focus ●Scores range from 17-68 ○>38 indicates that a patient has Kinesiophobia
Describe black flags:
●System and Contextual Obstacles ●Examples: ○Work duties are intense and patient has little room for modifications ○Legislation restricting a return to work ○Insurance conflict over injury claim
What is pain catastrophizing and how is it measured?
●the tendency for a patient to magnify the experience of pain while feeling a sense of helplessness ●PCS= Pain Catastrophizing Scale ○13-Items that ask patients to reflect on past pain experiences ○Screening tool for risk of chronic pain or disability ●Increased scores on the PCS predicted the development of chronic pain
