Educational QVHS and Strive

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Educational QVHS and Strive
Occupational Rehabilitation

• THE NEW RSI

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Educational QVHS and Strive
Occupational Rehabilitation

• Zen Koan
• "The wise man points to the moon.
• The idiot looks at the finger."

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Dr David EatonOccupational PhysicianQueensland
Vocational Health Service
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Sharon DarmodyPrincipal ConsultantOccupational
Therapist Strive Occupational Rehabilitation
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FIBROMYALGIA

• The one disease, one diagnosis, one drug
  approach does not apply with this group of
  illnesses.

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To find a solution we have to figure out the
problem?

• Symptoms can include musculoskeletal pain,
  fatigue, headaches or bowel complaints
• Social and family problems
• Financial problems
• Stress related to being part of compensation
  system

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Where do we start?

• Establish
• Needs
• Wants
• Worries
• Seek first to understand, then to be understood.
  Stephen Covey

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The other persons interpretation?

• There is no way my patient can go back to work -
  they have chronic pain and they cant possibly
  do that job - I am going to keep certifying them
  off work.
• I am not well and should be left alone until I
  feel better.
• It is the employers fault I got sick anyway so
  I will come back in my own time.

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So what is the answer?

• Question time!
• So often we think we know the answer before
  waiting for the other persons interpretation

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What questions?

• Are you saying that?
• What else was happening?
• And then what happened?
• What problems does that cause?
• Can you tell me more about that?
• What else would you find helpful?
• What is at the back of your mind?

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What do we do now?

• Medical treatment
• Graduated exercise with a focus on functional
  movement patterns and posture
• Cognitive behavioural therapy
• Address work related factors.

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Keys to making this successful

• Early intervention
• Prompt appropriate and consultative RTW planning
• Involvement of a supervisor
• Case conferencing

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How was your day at the office dear?
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Do not give up!

• This is taking too long
• It is not working
• I am too busy
• Things are getting worse
• ASK MORE QUESTIONS!

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Outcomes

• Achieve early return to work
• Minimise the social/ financial impact for the
  worker
• Reduce the cost of incapacity to the Insurer
• Reduce overall cost to employer and the community

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AliceWould you please tell me which way I ought
to go from here?

• Cheshire Cat That depends on which way you want
  to go. Lewis Carroll

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• Thank You

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Exercise Intervention

• Julie Brown
• Exercise Physiologist

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Exercise Intervention

• Research Results Littlejohn, 1996
• Localised problems physical therapy to loosen
  tight areas, such as pressure points on back,
  lower and upper and arms.
• Long term exercise yoga, tai chi, feldenkrais.
  
• Hydrotherapy for very unfit.

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Exercise Intervention

• Littlejohn (1996) reported that for a case study
  A psychologically based program including
  education of condition, relaxation and coping
  strategies, and mild regular aerobic exercise,
  led to considerable alleviation of pain and other
  symptoms.

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Exercise Intervention

• Look for increase functional capacity
• Increase movement ability
• Decrease pain and stiffness

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Exercise Intervention

• Chronic Fatigue Syndrome Research by Wallman et
  al, 2004
• 12 week programme of aerobic exercise
• Improvement in aerobic ability
• Increased strength
• Decreased scores for depression, mental fatigue
  and physical fatigue.

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Exercise Intervention

• Programme started at between 5 and 15 minutes of
  walking, cycling or swimming.
• Intensity based on mean heart rate achieved at
  initial testing, or their heart rate at maximum
  workload during the last full minute of the
  exercise test.

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Exercise Intervention

• Walk every second day unless relapse occurred
• Graded as required.
• Positive results seen

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Exercise Intervention

• Intensity How hard you exercise and how fast
  you move

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Exercise Intervention

• Three things to look at
• Intensity
• Duration
• Frequency

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Exercise Intervention

• Frequency every day, or twice a week?

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Exercise Intervention

• Duration length of time spent exercising.
• Research started between 5 and 15 minutes.
• If too hard, alter intensity, then duration, then
  frequency.

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Exercise Intervention

• Aids
• Heart rate monitor
• Diary on amount exercises, response to exercise,
  etc.
• Diary on all tasks performed in the home.

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• Questions?