Welcome back to SpineIQ’s Back Blog! Last week, we discussed what patients want to know about self-management, including how to establish rapport with patients and provide them with the opportunity to fully engage in their own care. This week, we will discuss practical tips that clinicians can incorporate into their practice that can help build successful self-management plans. One of the most important things that clinicians can do for patients is teach them skills to self-manage their current and future conditions.1 Self-management plans involve patients engaging in activities that promote healthy behaviors or can be used to manage signs and symptoms of pain. 2(p)
Goals of self-management programs:
Clinicians are uniquely positioned to impact the life of their patients beyond just the time spent in the clinic.1 One way of doing this is by engaging in a partnership with patients – working with them to create a personalized plan that helps them learn the skills needed to be an effective self-manager.3 Below are several attributes that a patient who is capable of self-management:
- Gains knowledge of the condition/pain
- Adheres to the plan developed in conjunction with their clinician
- Provides feedback and opinions that leads to decisions in conjunction with their clinicians
- Knows how to monitor and manage their symptoms
- Knows that different things (emotional, psychological, social) can influence their symptoms and manages their impact on their life
- Performs activities and behaviors that have positive health impact
- Feels confident in their ability to access more services or care when necessary
As a clinician, you can have an impact on equipping patients with these skills and promoting an increase in self-efficacy.4
Tips to form self-management programs:
All good self-management programs must start with an invitation to the patient to be a partner in their care. As we discussed in last week’s blog, patients want their clinician to use lay language to inform them about their condition and what they can do about it.5 Once this information has been provided, a clinician can use the “teach back” test by asking the patient to describe how they are going to explain to their child/spouse/friend about what they learned during their clinic visit.6 This presents an opportunity to really understand what the patient heard you say, emphasize important points and address any areas of confusion.
After listening to the patient, it is important to reassure them about the benign nature of their back pain emphasize their positive prognosis. This is also the time to build an action plan towards self-management in conjunction with the patient. A conversation between patient and clinician should lead to developing goals that are really matter to the patient. These goals must be measurable, action based, realistic, and time-framed.4 The incentive for the patient to continue adhering to their self-management program will come as their self-confidence increases as a result of reaching their goals. However, for this to work, these goals have to be essential to the patient and directly relevant to the phase of care that they are in. Some general, practical tips dependent on phase of care are provided below:
| Phase | Tip |
| Acute | This is when the clinician should help the patient explore movements that reduce pain. Finding these movements is important so that the patients can do them at home to manage their symptoms. Additionally, clinicians should find what things (movements or psychosocial) exacerbate the patients’ pain and provide tips on how to avoid them for a short period of time, allowing the body an opportunity to heal. |
| Subacute | This is when the clinician should look to move beyond pain reduction and more towards activities that help patients regain function of the tasks important to them. During this phase, exercise to increase strength, mobility, and/or endurance help the patient get back to their desired tasks can be beneficial. The patient should be engaged in discussing what those exercises are, what equipment they have access to, and the amount of time that they can dedicate to doing exercises. Reminder: everything should be done in conjunction with the patients desires and preferences for true shared decision making |
| Long term | This phase is the time to check that the patient feels equipped to continue their self-care on their own. It is important that the patient knows they always have an open line of communication with you and that they have access to the resources your office is able to provide as they continue self-managing the current or future pain symptoms. |
Summary:
Self-management is a key pivotal factor in the overall comprehensive plan and approach to successful spine care. As the treating doctor you will have the ability to determine which phase of care is required depending on what phase the patient enters your office. Regardless of the phase of care it is important that clinicians invite patients to engage in all the decisions of their care and promote the skills required to achieve attainable, realistic goals that are important for patients.
Stay tuned for next week when we discuss more tips to promote self-management in your clinic!
References:
- Hutting N, Johnston V, Staal JB, Heerkens YF. Promoting the Use of Self-management Strategies for People With Persistent Musculoskeletal Disorders: The Role of Physical Therapists. J Orthop Sports Phys Ther. 2019;49(4):212-215. doi:10.2519/jospt.2019.0605
- Haas M, Groupp E, Muench J, et al. Chronic disease self-management program for low back pain in the elderly. J Manipulative Physiol Ther. 2005;28(4):228-237. doi:10.1016/j.jmpt.2005.03.010
- Du S, Hu L, Dong J, et al. Self-management program for chronic low back pain: A systematic review and meta-analysis. Patient Educ Couns. 2017;100(1):37-49. doi:10.1016/j.pec.2016.07.029
- Johnston V, Jull G, Sheppard DM, Ellis N. Applying principles of self-management to facilitate workers to return to or remain at work with a chronic musculoskeletal condition. Man Ther. 2013;18(4):274-280. doi:10.1016/j.math.2013.04.001
- Lim YZ, Chou L, Au RT, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother. 2019;65(3):124-135. doi:10.1016/j.jphys.2019.05.010
- Yen PH, Leasure AR. Use and Effectiveness of the Teach-Back Method in Patient Education and Health Outcomes. Fed Pract. 2019;36(6):284-289.