I am currently on a musculoskeletal outpatient placement in which I am treating a lady diagnosed with traumatic trochanteric bursitis after a fall onto her side of her hip. During the initial session the patient explained that she felt she had pulled some ligaments or broken her hip. She has ideas regarding the basic anatomy of the hip in general saying she felt the “ball and socket isn’t rotating properly”. After doing the physical examination I was confident she hadn’t broken her hip nor pulled any ligaments.
I explained to the patient some of the reasons she was having the pain in the hip and thigh and our plan for treatment. I reassured her she hadn’t broken her hip and that I had tested for ligament problems and found them all good. On the second time seeing this patient she had noticeable improvement in pain, ROM and function. However she still felt she had a broken hip (even though she had nil pain, able to walk/run, all ADL’s). Once again I reassured her hip wasn’t broken and explained to her the healing that takes place and the muscles running over her G.T., bursa etc etc. She felt better and understood. At the very end of the session I showed and explained a picture of the hip, muscles and bones. She sighed of relief.
With this patient I focused a lot of the treatment session on education and getting the patient to understand the problem. But while understanding the problem the patient did not entirely exclude their own conception. This suggests the patient had not entirely understood what I had explained on the initial treatment. The patient finally understood when a picture was used that separated the area of interest (G.T) to the ball and socket joint (in which she thought she had broken/damaged ligaments).
From this patient I have acknowledged the importance of readdressing education regarding the cause of a problem. It also illustrated the benefit of using diagrams/visual aids to help in explaining mechanics and anatomy. In future I will try to use diagrams or visual aids in an initial treatment session. I have learnt the importance of ensuring patients understand the problem, but also reassuring and explaining any misconceptions.
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3 comments:
This situation highlights the importance of asking a patient their beliefs and understanding of their disorder. In this case, it appears the patient offered this information (her belief was that she had broken her hip). When a patient doesn't automatically offer this information, it is important the therapist asks the patient about their beliefs and understanding of their problem during the subjective interview. That way, the therapist can address any "mis conceptions" or "mal-adaptive beliefs" and ensure the patient and therapists beliefs are aligned. This assists in developing patient rapport and allows the therapist to address any beliefs that may adversely affect progress or outcome.
I agree with the importance of diagrams/visual aids. I think it would've been pretty hard to get through anatomy without diagrams. They give the patient a more clear picture of the reason for the pathology.
I agree that patient's require a really good explanation about the pathology behind the problem and especially how your treatment/exercises are going to help fix the problem. I know I often get a bit caught up with what I'm doing and forget to explain things thoroughly to the patient with diagrams and models.
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