Hey guys! My apologies, I owe you multiple blogs…
On my current rural practical, I spend half of every day in musculoskeletal outpatients. Last week I had a patient called Lucy* who had been referred for neck pain. Upon getting Lucy from the waiting room it was instantly clear to me that she was very anxious++.
On the short walk from the waiting room to the treatment cubicle Lucy made several comments, including “it’s like going to the dentist”, and she appeared overwhelmed by the size of the physiotherapy department. During subjective questioning it became clear that she had some psychosocial issues (she was being treated for depression), and she became very apologetic if she could not recall the answer to certain questions. When it came to assessing PAIVM’s during the objective assessment, Lucy became claustrophobic from lying in prone with her face in the hole. As a result she had increased tension throughout her cervical and shoulder girdle musculature and this made it very difficult to gain any information from PAIVM’s.
It was at this point I began to recall the communications units we did with Penny, waaayyyy back in second year. We discussed a similar scenario in which a patient presented to physiotherapy extremely anxious, either due to a preconceived notion of what physiotherapy was about, or because of a bad experience with physiotherapy previously. Penny made several points when discussing this scenario 1) that we should spend more time building rapport with such patients, 2) that we should go out of our way to make sure the patient is comfortable, and 3) that we should be more gentle in our assessment and treatment than we might otherwise be to ensure the patients return. Unfortunately I hadn’t really followed any of these principles! However after the flashback I changed my approach. I positioned the patient sitting in a chair, leaning forward and resting her head and arms on pillows placed on top of the plinth. This ensured that she was more comfortable. As treatment, I simply went for a hot pack for 10 minutes over the neck followed by a gentle massage of tight structures. The patient found this quite pleasant and her anxiousness decreased as a result.
In the future if I come across a patient that is particularly anxious I will follow the principles that were discussed in our communications units. This will help to ensure that I gain the patients trust and leave them with a better impression of physiotherapy than they may have had previously. Also, it is important to note that it is never too late to change things if we find that they are not working mid-assessment/treatment.
1 comment:
Hey Ryan, I had a very similar patient who was also very anxious and was also being treated for depression and who also had neck pain due to tight cervical musculature.....I too initially found it difficult to assess and treat my patient as she was very anxious. My initial sessions also consisted of relaxing strategies such as heat, advice on soft music and relaxing positions.
On following sessions, the patient was a lot more relaxed and had received great symptom relief from the relaxation techniques.
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