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PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

The Acorn Health PROMs: A Case Study

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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Why is it we often wait to get help for something until the pain becomes so intense we can’t do what we want to do?

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?

PROMs health chiropractic pregnancy baby childbirth paediatricsAnother 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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s initial responses

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!)

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s outcome at 1 month

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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Patient X’s outcome at discharge

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 PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthyso 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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Acorn Health Outcome Satisfaction Results

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.

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PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

Injury for runners workshop

We hosted our injury for runners workshop todayknee acorn health
at The Run Company in Chichester.
We covered kinesiology taping techniques for common injuries for runners, and how the sport tape gives you the confidence to perform at your best.

The uses and benefits of kinesiology tape are overwhelming! At Acorn Health, we have utilised it for issues such as sports injury, post-operative rehabilitation, severe bruising and to help ease postural strains when pregnant.

Whether you’re training for your first marathon, getting ready for your next game, reaching a personal fitness goal, or just trying to get through the day, you already know that nothing slows you down faster than pain and injury.

Sport England has reported the number of people running on a regular basis has risen by more than a third since 2005. In over 10 years, running has become a favourite sport for many people but what should you do when pain and problems strike?  The most common running injuries are the focus of our workshops – join us on 19th August in Emsworth for the next injuries for runners workshop or visit our Facebook page for similar events. Just for fun – find out what type of runner you are by clicking here.Acorn Health leaflets irun

Please visit our resources page for guides on training for running events and more.

If you are unsure how chiropractic can help you please contact us on 01243 379693 or email acorn@acornhealth.org.uk.

Find out how we utilise kinesiology tape for pregnancy.

Prevention is better than cure

As the old proverb said, ‘prevention is better than cure’.  So what’s the simplest thing can we do every day to prevent musculoskeletal pain?

With every patient we find the root cause or underlying issue of the problem and treat it accordingly to patient preference and clinical evidence and research. The most common problem I see from children to adults…

The most effective way of getting you out of pain quickly is self management. We provide a personal back pain toolkits and show you how to do stretches to ease pain and prevent pain or injury in the future.

Prevent back pain with these three simple steps.

One.

Include stretching into your daily routine, or go to a regular yoga class. Think of preventing back pain like preventing tooth decay – it’s as easy as brushing your teeth.  We love using foam rollers in clinic- a great addition to your stretching routine.

Two.

Use ice immediately to reduce swelling and inflammation on a new injury. Use heat on a recurring injury to reduce pain. You can use paracetamol to help prevent swelling and pain as well.
Three.

Research shows a 20 minute walk everyday will reduce the risk of back pain by 10-50%. Similarly if you are sitting down all day, get up to move about or stretch every 20-30 minutes (this also has the helpful side-effect of improving your concentration).

If you would like more hints and tips about prevention of back pain or musculoskeletal injury please read our blog page that details particular injuries and more helpful tips.

Kinesiology Tape for sports injuries.

Focus on Tennis Elbow.

Guest Blog: Calcium and Osteoporosis.

Contact us for more information or to book an appointment.

E: acorn@acornhealth.org.uk T: 01243 379693

Running without pain sports fitness exercise health injury chiropractic

Marathon 101

The South Downs Marathon is this weekend. Thousands will be running, competing, having fun and raising money for charity all at the same time.

Whether you are an athlete, pro-runner or amateur there are some simple rules to stick by to prevent injury and pain after running all that way.  The South Downs Marathon is notoriously tough, so here’s our tips to help you overcome from the challenge!

1. Water – If it’s hot outside, you’ll need to drink more than usual, which is a challenge when you’re trying to run as well.  Please focus on hydration both pre- and post-race (being well hydrated will mean you recover more quickly too!) Don’t overlook the electrolytes you’ve lost through sweating. Rather than buy expensive, sugary energy drinks, simply add a few mmol of sodium (salt) or suitable electrolyte powde to your water. Tastes gross but does the trick!

2.  Don’t forget to eat. It might be the last thing on your mind after you’ve just run a hefty race but it’s important to rep
lenish your body with lost nutrients and electrolytes after expending so much e
nergy!

  • Replenishing stores of glycogen (what gives you your energy!) in the muscles and liver
  • Protein helps aid muscle repair
  • Restores fluid and electrolytes lost in sweat
  • Supporting the immune system in removing the lactic acid that can build up after strenuous activit

3. Kinesiotape is not only helpful when you’re out running to help support your joints and muscles, but it may alsoKinesiotape Running Pain Pregnany Sport Nike Chiropractic Adidas Hampshire Emsworth Sussex Physiotherapy Osteopath aid recovery from injuries by improving blood and lymphatic flow around the injured areas.

If you are reeling from any form of exercise this weekend and are in need of some assistance please contact the clinic on 01243 379693 or email acorn@acornhealth.org.uk

 

 

*Cover photo taken from www.209events.com


HotYoga: This Girl Can!

I like to practice what I preach, and so when I saw the “This Girl Can” campaign from Sport England, I thought it was about time I tried something new!  I grew up playing team sports, and freely admit I am much more comfortable charging around a lacrosse field in sub-zero temperatures than I am in a yoga studio, particularly one that is heated to a tropical 40 degrees, yet that’s exactly what I did yesterday.   I had heard a number of my patients mention hot yoga in Chichester, so after a brief chat with Natalie the owner, we went along for our first session.

Bikram Yoga is a series of 26 yoga postures with breathing exercises, and the temperature of the room is designed to warm and ease your soft tissues (muscles, ligaments and tendons) to allow a deeper stretch, as well as adding a little bit of mental challenge to the exercises.  Anyone who thinks that yoga is a bit of deep breathing and a gentle stretch- think again!

Our clinic manager Rhiannon is already a bit of a yoga bunny, so she kindly accompanied me for moral support.  It may surprise you to know that chiropractors can suffer with back pain too (mine is related to one-too-many falls off a horse) so I was hesitant about contorting myself into the bizarre postures that I’ve seen yoga fans perform, envisaging a few days of the inevitable grumbling lower back pain and achey I’ve-done-a-workout shoulders afterwards.

90 minutes? 40 degrees? We must be mad!  However, fuelled with images from Sport England’s advert of women looking exhausted but triumphant, I decided that I wanted to be one of them and was determined to give Bikram a go.  Trying something new and totally different was a little nerve-wracking (“What on earth is a tree pose? Who is savasana and why do they keep asking her to lie down?”) but after a while, and with some gentle advice from the instructor, I managed to get the hang of the exercises.

There’s a moment when you’re exercising or trying to get fit, where that little voice in your head tells you “It would be so much easier if you stopped”, or better yet “You really can’t do this. You’re never going to look like that girl over there so why bother?”  Ignoring that little (or not-so-little) voice in your head is the real challenge.  For me, that little voice kicked in after about an hour, when I caught sight of my red, puffy face in the mirror and realised that no, my leg really doesn’t bend that way.  So I took a break. Yep, I stopped, sat down, reassessed, and watched everyone else sweating and stretching away.   This Girl Can is encouraging us all to “wiggle, jiggle, move and prove that judgment is a barrier that can be overcome.”  So when I sat down in a sweaty heap on my mat, a part of me expected to receive the inevitable raised eyebrows or smug “I’m-fitter-than-you” smirks.  But no, not ONCE did I feel embarrassed about it, or lazy, or feel like a failure.  I was amazed to receive a smile and a wink from the instructor, the girl next to me gave me a relieved s
mile and then plonked down on her mat for a minute, and the chap at the end of the room mouthed “You ok?” to me.  That was when the dawning realisation came to me that we were all there trying to acheive the same thing- relaxation, fitness, flexibility, and I’m sure a few other things too!  There was no shame in taking a break (yes, I got back to it a few minutes later) as we were all supporting each other to help get through what was a challenging activity!

Taking breaks when it becomes too much allows you to establish where your limits lie, and gives you an opportunity to identify problem areas that you might want to work on in the future.  We all have to start somewhere, so whether you are an exercise addict already, or just want to try and get back in to shape, try something new, bring a friend with you, make it social and fun, or do like we did and go to Bikram and make it sweaty!

We conquered HotYoga, and although I am a little achey today, I know I’ll be going back.  Because this girl can!


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Acorn Health Limited © 2014 - 2020

Website Created by WebHolism