Paediatric pain researcher and resources developer, Joshua W. Pate, shares with Noigroup a passion for making learning more accessible for all – kids included! Enjoy part two of his insight here, delivered with a genuine enthusiasm that makes collaborating with Josh an absolute delight. (And when we say ‘collaboration’… watch this space!)
Part 2 of 2: A little follow-up on targeted education, to overcome the phrase ‘But I’ve already tried these exercises…’
I will assume you have read Part 1 of this series. Here’s a big question: Do you think that it makes more sense to create a potential learning ‘moment’ before or after prescribing Norah with her graded exercise program? Does the ‘when’ matter? To answer this, I’m going to call upon Norah from Part 1.
If you bottle-up Norah’s COPI responses for yourself and dive into your exercise prescription without mentioning anything about pain science, you might hear a phrase along these lines: ‘But I’ve already tried these exercises…’. That could be true (partially).
You: Yes… But the way you can now approach them will be VERY different!
Here, you are priming her expectations, and with active listening the brief educational discussion then shouldn’t even take 2 minutes, and hopefully she is now a little curious…
As you start walking/squatting etc., you could then cover the simple idea that she has a big protective buffer (bubble suit?) so it is safe to move and nudge into a little bit of pain. If that goes well, sometimes that is all that is needed.
Norah may say, ‘Oh, my old physio told me to avoid any movement that causes pain’. And if she does start to open up a little about her pathoanatomical beliefs, you could ask her something like: ‘Why do you think exercise would help with your pain?’ (This relates to item 13 of the COPI).
Can you see how the COPI can become a collaboration-building, therapeutic-alliance-enhancing tool? We can get straight to the heart of the matter, rather than dumping two hours of information on every person we see. What do you think about this suggestion?
I have answered my initial question (‘educate before or after exercise?’) with an example of ‘during’. Hopefully, you can now read back through this blog playing out various scenarios, such as what you might do if Norah really wanted to sit and talk first, or maybe if a conversation was the last thing she wanted.
In summary, I think the two key points here are:
- Genuinely try to understand where a patient is at.
- It is less about teaching the patient and more about the patient learning. You can hear Professor Lorimer Moseley telling me about this on One Thing.
I am always happy to hear from you if you would like to share your feedback, suggestions, or ponderings. I’m currently running a sham-controlled study on our soon-to-be-released children’s book series (each book focusses on one learning outcome for kids), so watch this space as there is plenty more to come!
–Joshua W. Pate
Lecturer in Physiotherapy at the University of Technology Sydney (UTS)