MSK - Self management (FS-09)

Hutting N¹, Johnston V², Richardson J³, Walsh N^4
1HAN University of Applied Sciences,Faculty of Health and Social Studies, Research Group Occupation & Health, Nijmegen, Netherlands, ²The University of Queensland, School of Health & Rehabilitation Sciences, St Lucia, Australia, ³McMaster University, Institute of Applied Health Sciences, School of Rehabilitation, Hamilton, Canada, ⁴University of the West of England, Faculty of Health & Applied Sciences, Bristol, United Kingdom

Learning objectives

1. Participants will be aware of the current state of the literature around interventions where physical therapists have been involved in the self-management of chronic conditions.
2. Participants will gain knowledge about behavioural change techniques, general self-management principles and strategies and the effectiveness of self-management programs for patients with chronic (musculoskeletal) disorders.
3. Participants are able to apply principles of self-management in their daily clinical practice and to support patients in their self-management behaviour.

Description

Self-management is defined as education and support provided by health professionals and/or lay leaders to increase patients' ability and self-confidence in managing their health and well-being.

In self-management, patients are stimulated to be engaged in activities that protect and promote health, monitoring and managing the symptoms and signs of illness; managing the impact of illness on functioning, emotions and interpersonal relationships, and adhering to treatment regimes. It enables patients to make informed choices, to adopt new perspectives and generic skills that can be applied to new problems as they arise, and to practice new health behaviours. Patients who are able to make the lifestyle modifications and behavioural changes often report improved quality of life and clinical outcomes. However, patients need guidance and support to initiate and maintain these changes.

Several self-management programs are available for patients with musculoskeletal disorders, including interventions for osteoarthritis, rheumatoid arthritis, osteoporosis, upper limb pain, fibromyalgia, knee pain, temporomandibular disorders, (chronic) low back pain, and various 'mixed' conditions. However, there is inconsistent evidence regarding the effect of self-management programs for patients with chronic musculoskeletal pain (Carnes et al. 2012). Some reviews suggest that self-management education alone is unlikely to improve clinical outcomes. Instead, it needs to be part of multifaceted interventions that also target clinicians, the environment, and wider health system issues.

Self-management interventions can provide equal or better results compared to individual physical therapy (Toomey et al. 2015). Integrating self-management principles into routine care delivered by physical therapists may improve positive health behaviours and enable the patient to better manage the impact of their condition on their life (Hutting 2015). However, there is evidence that clinicians do not always promote self-management in their patients (Cooper et al. 2009). Thus, additional training and knowledge is required to enhance the therapists' skills in the use of self-management principles in their treatment. Professional training for clinicians has a significant positive impact on their engagement in clinical self-management support and patient centeredness, as well as on their overall confidence to support self-management (Mudge et al. 2015). Therefore, training in self-management skills, which enables them to support patients, seems worthwhile for physical therapists (Hutting 2015).

Based on the expertise of the contributors and available evidence, this focussed symposium will discuss the role of self-management in physical therapy practice (both group sessions and individual therapy). Behavioural change theories and techniques (Keogh et al. 2015), effectiveness of self-management programs for several populations (Richardson et al. 2014; Hutting et al. 2015; Sheppard et al. 2015) development and evaluation of self-management programs (Johnston et al. 2014; Dufour et al. 2015; Hutting et al. 2016), and theoretical methods and practical strategies for self-management will be discussed (Johnston et al. 2013; Hutting et al. 2015). Moreover, implications for physical therapists will be presented and discussed with/by the audience.

Implications / Conclusions

Physical therapists can play an important role in the delivery of self-management interventions for patients with chronic (musculoskeletal) disorders. Moreover, therapists can use self-management principles in their clinical practice and develop online self-management training to extend the benefit of their services. This focused symposium will provide the first step in training physical therapists in self-management skills to support patients with musculoskeletal disorders. These skills can also be used in other populations with other chronic conditions. Self-management principles for patients with musculoskeletal disorders are essentially the same regardless of culture or geography, the knowledge and skills provided in this focussed symposium can easily be applied in other populations and settings of physical therapy practice.

Keywords

1. Self-management
2. Physical therapy
3. Chronic (musculoskeletal) disorders

Funding acknowledgements

ZonMw, the Netherlands Organisation for Health Research and Development (Project number: 208030004).

Relevance to physical therapy globally

Self-management is considered an important component in the provision of high-quality care for patients with chronic conditions. Integrating self-management principles into routine care delivered by physical therapists may improve positive health behaviours and enable the patient to better manage the impact of their condition on their life. Training and enhancing the skills of therapists to facilitate self-management in their patients is likely to improve the quality of life and reduce reliance on health care services.

Target audience

This topic will appeal to practitioners, researchers, educators, students and policy makers.

Programme subject to change