Patient Education

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Patient Education
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Patient Education

• Planned
• Learning experience
• Uses a combination of methods
• Teaching
• Counseling
• Behavior modification
• Influences patients knowledge and health behavior

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What PTs Teach

• Rationale for treatment (95)
• Home programs (94.5)
• Strengthening (94.5)
• Range of motion, stretching (92.4)
• Postural awareness (86)
• Basic safety precautions (84)
• Prevention, risk factors (82.5)
• Body mechanics (81)
• Chase L, Elkins JA, Readinger JL, et al.
  Perceptions of physical therapists toward patient
  education. Phys Ther 199373(11)787-796.
• .

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How PTs Teach

• Verbal discussion (99)
• Demonstration (97.5)
• Patient-specific instruction sheets with sketches
  (79.9)
• Patients working with only one therapist (74.4)
• Moving the body passively through the desired
  motion (53)
• Chase L, Elkins JA, Readinger JL, et al.
  Perceptions of physical therapists toward patient
  education. Phys Ther 199373(11)787-796.

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Barriers to Delivering Patient Education

• Patient attitudes about illness or disability
• Patients passive role and attitude toward
  therapy
• Patient attitudes or expectations regarding
  physical therapy outcomes
• Patients cognitive status
• Patients emotional status
• Shortage of staff
• Lack of trust in therapist
• Chase L, Elkins JA, Readinger JL, et al.
  Perceptions of physical therapists toward patient
  education. Phys Ther 199373(11)787-796.

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Discussion

• PTs agree that patient education is important.
• PTs rarely report using technological equipment
  or prepared materials for teaching in the
  clinical setting.
• Consideration of the impact of psycho-emotional
  issues on patient learning is very important.
• Chase L, Elkins JA, Readinger JL, et al.
  Perceptions of physical therapists toward patient
  education. Phys Ther 199373(11)787-796.

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Barrier to Patient Education

• Problem Patient attitudes about illness or
  disability
• Solution Evaluate patients beliefs

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The Patients Beliefs

• How would you describe the problem that brought
  you to physical therapy?
• What do you think caused the problem?
• Why do you think this happened to you?

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Barrier

• Problem Patients passive role and attitude
  toward therapy
• Solution Assess motivation

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Assessing Motivation

• What is the most important activity you wish to
  recover?
• What symptoms do you wish to minimize first?
• How confident are you in your ability to perform
  the exercises?
• Do you think these exercises will help you
  recover or return to your important activities?

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Barrier

• Problem Patient attitudes or expectations
  regarding physical therapy outcomes
• Solution Assess patients treatment beliefs

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The Patients Treatment Beliefs

• What treatments, home remedies, or activities
  seem to help, and what are you not willing to
  try?
• What are the worst things you would anticipate
  about treatment?
• Have you ever tried exercise?
• If you were to do the treatment, what
  difficulties would you have doing it?

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Barrier

• Problem Patients cognitive status
• Solutions
• Assess how much the patient understands
• Assess patients literacy level
• Assess family support

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Does the Patient Understand?

• Can you tell me what you are supposed to do?
• Can you demonstrate the exercise(s)?
• What should you do if the exercises are not
  working or causing a negative change in symptoms?

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Assessing Family Support

• Is there are primary person at home to assist the
  patient with activities?
• What is that persons schedule and who will be
  available when he or she is not at home?

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REALM

• The Rapid Estimate of Adult Literacy in Medicine
  (REALM)
• Screening instrument that assesses an adult
  patients ability to read common medical words
  and lay terms for body parts and illnesses
• Assists in estimating a patients literacy level
  so that appropriate level of patient education
  materials or oral instructions may be used
• Takes 2 to 3 minutes

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Activity

• Administer the REALM to the person sitting next
  to you.
• Determine his/her literacy level.

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Adapting to Low Literacy Levels
3rd Grade and Below Needs repeated oral instructions illustrations, or audio or video tapes
4th to 6th Grade Low literacy materials
7th to 8th Grade Low literacy materials
High School Will be able to read most patient education materials
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Barrier

• Problem Patients emotional status
• Solution
• Assess if patient clinically depressed
• Refer to appropriate practitioner
• (More in Understanding Loss class.)

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Barrier

• Problem Lack of trust in therapist
• Solution
• Use a Patient-Centered approach
• Exhibit connecting non-verbal and verbal
  behaviors

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Two Different Approaches

• Provider-Centered
• Professional as expert

• Patient-Centered
• Professional as teacher

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Patient-CenteredConnecting Behaviors

• Verbal
• Greeting the patient in a friendly manner
• Making positive comments
• Inquiring about the patient
• Reflecting on the patients feelings
• Clarifying the patients needs

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Connecting Behaviors (contd)

• Nonverbal
• Facing the patient
• Making eye contact
• Leaning toward the patient
• Displaying an open posture
• Using nonverbal cues to acknowledge active
  listening (e.g. nodding)

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Disconnecting Behaviors

• Acting busy
• Reading notes
• Doing tasks
• Using medical jargon
• Cutting off the patients story
• Responding only to disease information
• Failing to give feedback
• Showing little empathy
• Not asking about the patients concerns

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Patient Adherence and Cooperation
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Is the Patient Adhering to the Treatment Regimen?

• Can you perform the exercise(s)?
• What changes have you noticed and what do you
  believe caused the change?
• Were there any negative consequences of doing the
  exercise(s)?
• How many times did you forget to do the regimen
  and what problems did you have?
• What has happened with progress toward your
  valued activity goal?
• How long before you expect to notice some
  improvement in your condition?

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Factors Related to Treatment Non-Adherence

• Personal variables (forgetfulness, lack of
  understanding, health beliefs, lack of resources,
  etc.)
• Disease variables (e.g. characteristics of the
  disorder)
• Treatment variables (characteristics of treatment
  or setting, inconvenience, etc.)
• Patient/practitioner relationship variables (poor
  communication or rapport, attitudinal or
  behavioral conflicts, failure of PT to elicit
  feedback from patient)

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Following A Treatment Plan Requires That The
Patient

• Chooses to do so
• Knows when to enact the plan
• Has the psychomotor skills to perform the plan
• Remains motivated until problem is resolved

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Improving Patient Adherence

• Can the patient tell you why he or she is not
  doing the exercise?
• Does the patient believe that adherence to the
  regimen will help the problem?
• Does the patient understand the exercise program?

• Listen and problem solve.
• Explore the patients belief system.
• Teach the patient why the exercises are important.

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Dealing with Personal Variables

• The patient forgets to do the exercises.
• The patient doesnt understand the program.
• The patient does not believe the therapy will
  help.

• Design memory strategies.
• Explain it again in a different manner and teach
  the patient why it is important.
• Explore the patients belief system and work to
  find common ground.

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Cases

• Join a group
• Read the assigned case
• Refer to the Interview Questions handout and try
  to figure out possible reasons for the patients
  lack of adherence or compliance
• Complete the Diagnostic Checklist for Analyzing
  Compliance