So today, I woke up earlier than usual and have reached a rare moment of having achieved all of my urgent and important tasks on my list I needed to do today by 11:30 AM. This level almost never happens and it got me thinking- what was the difference in motivation levels today?
The truth is, there isn’t one thing, but instead a gradual accumulation of small changes that I’ve made to my lifestyle recently which I thought I’d share four top tips with you, that have helped me master Mondays!
First things first- I swear by my Lumie Bodyclock, and it is my best friend during the winter months. Waking up feeling groggy is horrible- as someone who used to have about 15 alarms on my iPhone to get me up (not even joking) a natural daylight lamp like the Lumie Bodyclock makes mornings slightly more bearable. It helps prevent what’s called sleep inertia– the inability to feel alert and perform when we first wake up. Studies have shown that these lamps help raise cortisol (an important hormone which helps with metabolism, memory and blood sugar), improve our reaction times and make us feel more refreshed. Not only that, but it’s lovely to wake up to daylight in these darker winter months. Step One: Wake up refreshed.
Question for you- did you make your bed this morning? I did- and here’s why you should too. Watch this video (6.01 minutes) for some inspiration that will get you going today. Step two: Make your bed.
I significantly cut down on caffeine recently, and now tend to start my mornings with a few glasses of water with lemon in it- I prepare this the night before and leave it in the fridge so it’s nice and cold to wake me up. Your metabolic rate is boosted by about 30% by drinking two glasses of water and the added lemon gives you around 40% of your daily vitamin C- great for the immune system. It also contains vitamin B6 which supports a healthy nervous system, and flavanoids which support the immune system and have anti-inflammatory benefits. Step Three: Boost your brain.
Then, I ate the frog. Not literally (I actually had a rather nice omelette for breakfast). Eat that frog comes from a saying by Mark Twain- and it refers to doing the thing you dread the most first. So for me, this was catching up on some bookkeeping (*urgh*) BUT it means that I’ve now completed that task and have the rest of the day to fill with things that I enjoy- like taking care of my patients. Reading some new research articles. Enjoying the sunshine at lunch (instead of being stuck at my desk). Step Four: Eat that frog.
So there you have it- four simple steps to help you get going on a Monday, or in fact any day of the week!
We’re not talking about the BBC PROMS, or in fact anything to do with music. We’re talking about Patient Reported Outcome Measures (PROMs), and they’re far more exciting than the BBC version (in our humble opinion).
Patient Reported Outcome Measures are the tools with which healthcare practitioners and clinicians can better understand the impact illnesses or conditions and treatment are having on our patients’ daily lives. At Acorn Health, we utilise Care Response, a system which gathers the data for us and is supported by the Royal College of Chiropractors.
We don’t collect PROMs purely for our own benefit, it’s also for yours. We want to understand how your pain or problem is affecting your daily life- are you able to wash and dress yourself without pain? Is it stopping you from having a social life? Is it preventing you from working? Not only that, but we want to know how you feel about your pain. Are you worried it’s never going to get any better? Perhaps you’re scared about whether being physically active is going to make it better or worse and had to duck out of that golf game you had lined up. These are all very common concerns (so don’t worry if you’re having them- we all do!) and by understanding what your concerns are and how your pain is affecting you, we can provide a more accurate and more appropriate course of treatment for you. The responses to these questions will also indicate to us whether you are at a low, medium, or high risk of the problem becoming chronic (lasting for a long time) and this can mean that we need to provide you with very specific advice and information in order to prevent this happening- and yes, it can be done!
PROMs are starting to sound really good, aren’t they?
Another fantastic thing about PROMs is that they can tell us whether the treatment plan we have together decided upon is having the effect we want or not. Often, when pain decreases it can be difficult to remember just how bad it was (Remember that saying about giving birth? If we remembered how bad childbirth was we’d never have more than one child!) That being said, PROMs give us a way to determine your response to treatment based on your original responses to the questionnaire.
The story of patient X: Utilising PROMs in clinical practice
So how do we put PROMs to use in clinical practice, and how do they help inform our decision making and improve the care we provide our patients? We’ve got a case study here to explain it.
A bit of background- this Patient (let’s call them Patient X… sounds all mysterious and technical doesn’t it!) Anyway, Patient X had sustained a lower back injury in a road traffic accident more than a decade ago and had suffered with recurring episodes of lower back pain which, as seen by the chart below, were having a significant impact on their ADL’s (activities of daily living- things like washing, doing housework and sleeping) as well as their social life (going out to see friends, going to the gym, playing sports), the pain was a 6/10 and it was also making them anxious, depressed, having quite a severe impact on their working day and they had very little ability to cope with, control or reduce the pain themselves. All in all, not a very pleasant situation to find yourself in, but these results are fairly common in the patients we see in clinic. So much so, in fact, that Philippa takes a special clinical interest in chronic pain management– but that’s a story for another time.
The questions on the initial form are part of a validated assessment tool called the Bournemouth Questionnaire, and the answers are scaled on a 0 – 10 linear scale, 0 being “the pain has no interference” and 10 being variations of responses such as “completely unable to carry on” or “extremely anxious/extremely depressed.” As you can see, this patient was also at medium risk of chronicity due to some concerns they had about their back pain and what it meant for them, as they were worrying about it a lot of the time and felt that it was never going to improve.
We normally complete an outcome questionnaire after 2 weeks but in this particular case it was after 4, and Patient X completed this questionnaire which asked how their pain has changed, and also assesses the impact this pain is having on their lives at that time. This is where we get a bit geeky and excited- bear with us while we explain why.
Yes, as you can see below, Patient X’s pain level had increased at the time they completed the outcome questionnaire because (by their own report) the “Sciatic nerve in left leg has been irritated since last weekend” after spending a weekend doing a lot of heavy work in the garden…. they knew it wasn’t the best idea (!) However, despite the fact that they’d been doing quite hard physical work and had a slight flare-up as a result, they still reported they were “much improved” as a result of treatment, and their Bournemouth Questionnaire (the one that tells us how the pain is impacting on your day-to-day life) had reduced from 52/100 to 34/100 (which is computed as a 34.62% improvement!)
How is it possible that the pain could actually have increased, but Patient X felt better? Well, as we do with all our patients, we had a lengthy chat with Patient X about their pain, and how it was impacting them, and how they could manage it more effectively, as well as what we could do to help. Studies have shown that in some specific cases, a pain management course is actually more helpful than physical treatment, so we always include pain management as part of our treatment programmes. The more control you have over your pain, the less pain you feel. So through understanding pain and knowing what’s going on, what the cause was (in this case a mechanical issue with how a joint in the lower back was moving) what it isn’t (lower back pain is very rarely serious) and what to do about it (treatment and active self-management), Patient X felt less pain as they were less threatened by it, understood what was going on, were less concerned by the pain and able to move more normally without fear of pain.
After speaking to Patient X to establish what they felt had changed, the overall message was “I know what’s happening now, and I know what to do about it.” Woohoo! This is why it’s absolutely critical that we convey the right messages to you and help you to understand your pain. As practitioners, we also know that pain in itself is a really unreliable indicator of the severity of the underlying issue. To use our favourite analogy- think how painful a papercut can be despite the fact it’s a fairly minor injury. Pain in itself is just a symptom and studies have shown it does not relate to the severity of the underlying problem- in fact, some studies show that pain related fear is more disabling than the pain itself!
To understand more about pain and what causes pain, this should be your next bit of reading: Understanding Pain.
Let’s get back to Patient X, who today completed their final outcome assessment.
As you can see, the pain has dropped now to a 3/10. Those sections where Patient X reported were a 9/10 (ability to complete ADL’s and impact on social life) have dropped to a 3/10 and 2/10 respectively, impact on work was initially 7/10 and is now 0/10, anxiety and depression are both down from 7/10 to 1/10, and ability to cope with, control and reduce the pain was initially a 7/10 and is now a mere 2/10!
Whilst plenty of naysayers might say “Sure, but they’re not pain free and their Bournemouth Questionnaire isn’t zero.” If you had an illness or disease that lasted several years, would you take a few pills and expect it to be cured? No. Realistically, you’d hope that it would be better, as it is for this patient. Recovery takes time and is something that cannot be rushed. If you recall, Patient X’s problem had started over a decade ago, so we’re delighted that two months later the pain has improved this significantly. Not only that, but Patient X reports feeling “much improved” as well so we know they’re happy with how they’ve progressed- which gives us all sorts of warm fuzzy feelings. Hooray for job satisfaction!
So what happens now? At this stage, we’ll see a lot less of Patient X as they are formally discharged from care. The pain is now so minimal and intermittent that after discussing it with them, they’re happy to manage it themselves at home with stretches, exercises and lifestyle modifications (such as taking regular breaks from sitting whilst at work). We’ll check up on them in a few months to review their exercises, identify if there are any issues that have crept back on and this also gives us an opportunity to discuss their progress with them and if they have any further concerns. Of course, we’re always at the end of a phone or email, Facebook, Google+ or Twitter if they (or you) want to get in touch in the meantime!
We never guarantee 100% cure as nothing in medicine can. No pill, no operation, no treatment. There are no guarantees. What we do say at Acorn Health is that we will always give you the very best treatment and care, in accordance with the latest research guidelines and current evidence base. We can also say (thanks to another fancy PROMs questionnaire) that we have 100% satisfaction rates from every patient we’ve seen since we opened back in 2014, and that makes us very happy indeed.
So there’s a little overview and case study into how PROMs are put into use in clinical practice, and why we utilise them! If you’d like to know more, or would like to get in touch to book your own appointment, you can contact us using the form below.
They say money never sleeps, but in reality, it’s healthcare that never sleeps. Constant innovation, new technologies, new treatments, medications, therapies and more, healthcare is changing and developing fast enough to make your head spin.
With a New Year just hours away, we thought we’d take the opportunity to review the latest and greatest developments in healthcare throughout 2015, as well as popular healthcare articles that made headlines and our own most popular content.
One of the most widely-shared articles on the internet in 2015, this article from The Atlantic posed some interesting questions about how doctors interpret (or in fact, underestimate) women’s pain. In America, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing. A harrowing and extreme example perhaps, but it highlights the ultimate need for all healthcare professionals to listen, understand and consider each person as an individual before making a clinical decision. There is no place for assumptions or generalisations in healthcare.
3. When the media gets it wrong
In a classic example of misinterpretation, a report from the American Journal of Cardiology caused quite a stir when it suggested that “strenuous jogging is as bad as no exercise at all.” The claims were quickly clarified by the NHS, as what the media failed to make clear here was the size of the demographic involved in the study- once the 1500 participants had been split into groups based on duration, frequency, and pace, some individual groups – particularly the most active groups – were (by research standards) too small to draw any real clinical significance from, with just 36 runners classified as “strenuous joggers.” As a result, the analyses conducted were less able to detect what, if any differences were present between the two groups. A classic example of needing to know the full picture when drawing a healthcare conclusion like this. (N.B. The biggest concern with exercise is not “overdoing” it. It’s not doing enough! If you’re thinking of taking up a new hobby in 2016, let’s keep you injury free.)
4. Kinesiology tape
Our most popular post of 2015 was “Kinesiotape during Pregnancy”, which to date has had a whopping 22,800 social shares. Kinesiotape is paradoxically gentle, yet strong, and depending on the way it is applied, it creates an effect on skin that improves circulation, relieves pain and supports muscles and joints which can be a huge help for mums to alleviate some of the postural aches and pains associated with a growing bump!
5. Back pain and paracetamol
An article published in the British Medical Journal back in March of 2015 confirmed what many of us have known for some time- that paracetamol is ineffective for back pain. With prescription of paracetamol being the most common approach to treatment used by general practitioners for spinal pain and osteoarthritis of the hip or knee, this has highlighted the need for a review and potential reconsideration of current recommendations that support the use of paracetamol for these groups. The current guidelines from the National Institute of Health and Clinical Excellence support the use of manual therapy for low back pain, alongside a structured exercise programme. Good news for Acorn Health patients who will know this is a fundamental part of our treatment programmes.
6. Our big news
2015 was a fantastic year for us as Philippa was accepted into the Royal College of Chiropractor’s specialist Pregnancy and Paediatric Faculty. These specialist faculties recognise chiropractors who have undertaken formal postgraduate studies and have specialist knowledge and expertise in their particular fields and Philippa was delighted to be welcome into the Paediatric Faculty in addition to her already acheiving Licenciate status with the specialist Pain Faculty. Not only that, but 2015 also saw Acorn Health pick up
it’s second national award with the Royal College of Chiropractors, the Clinical Managment Quality Mark, which is awarded to those clinics that demonstrate excellence in terms of operating within a structured and managed clinical environment. The clinics must demonstrate excellence in a range of areas including clinical audit, incident reporting and patient satisfaction.
We were also delighted this year to have been accepted as a Dementia Friendly Business with the Hampshire Dementia Action Alliance, part of the Dementia Friends group.
2015 brought sugar to the small screen in the form of the controversial Jamie’s Sugar Rush. One of our favourite pieces of the year was this article from the Huffington Post, showing what sugar does to your brain. In addition to being a key contributor to rising obesity levels, sugar is also known to impair memory, contribute to depression and anxiety and is linked to cognitive decline and dementia. 2015 was definitely the year that the UK began to combat the hidden sugars in our food, and began to make healthier dietary choices.
9. First Paracetamol, now Nurofen
The UK-based manufacturers of Nurofen, Reckitt-Benckiser were forced to defend their product after Australian courts ordered certain products off the shelves after finding each product, despite being marketed as able to treat specific pains, such as migraine, were identical to one another and contained the same active ingredient, ibuprofen lysine 342mg. Prices for these products also averaged around £3.49 for a box of 16 capsules. Why is it that snazzy packaging and good marketing so often tempts us in? We’ve said it once, we’ll say it again. Save your money and buy generic. (They’ll cost you about 30p instead!)
10. Paraplegic man walks again
An accident 5 years ago left a 26 year old American man paralysed from the waist down, unable to use his legs. This year, scientists successfully rerouted nerve signals from the man’s brain to electrodes on his knees, enabling him to become the first person with paraplegia caused by a spinal injury to walk without relying on robotic limbs that are controlled manually. Yes, our jaws dropped at this one too. Around 50,000 people in the UK live with paralysis, and whilst this treatment surely won’t be appropriate or possible for each of them, it was a truly groundbreaking achievement in science, and a step on the path to giving this young man back his independence.
Gosh- you see what we mean about how much takes place in a year? We know there’s been hundreds of new developments, too many to even mention, but we wanted to highlight a few of our favourites from 2015.
We have an exciting year lined up for us, with a new clinic opening at ActivHealth, Langstone Technology Park, Havant. We also have big plans for the introduction of new and improved online resources, new courses and workshops to be held and a few surprises we have in store for you (but aren’t quite ready to share yet!)
May we wish you all a very happy and healthy New Year!
We’ve received some really exciting news today- Philippa has been accepted into the Royal College of Chiropractor’s specialist Pregnancy and Paediatrics Faculty!
Philippa is also a Licenciate to the Royal College’s specialist Pain Faculty– these faculties recognise chiropractors who have undertaken formal postgraduate studies and have specialist knowledge and expertise in their particular fields. Being accepted to these specialist faculties allows Philippa the opportunity to further her skills and learning, take an active role in latest research and develop the evidence base relevant to each field. Exciting times for us at Acorn Health!
The Role of the RCC’s Specialist Faculties
Recognise experience and qualifications relevant to each subject area
Foster open inquiry and debate among practitioners and the wider healthcare community
Encourage further, relevant continuing professional development and study
Define and uphold the competencies of Specialist Faculty members as they pertain to each subject area
Review, disseminate and develop the evidence-base in each subject area
Support specialist faculty members in developing and extending skills and knowledge in relevant subject areas