Whoa boy!
If you believe that TrAb re-education is impossible how do you explain the
reduction in LBP recurrence rates that I have cited in other postings today?
Again to quote the Hodges et al book "A high level of skill is required to
effectively rehabilitate the motor control changes present in low back pain
patinets. In addition, skill is required to effectively communicate 'spinal
segmental training' to a patient and a considerable amount of practice is
required for the therapists to achieve the necessary level of competence...
Therapists need to take tome to develop their problem solving and assessment
skills... Success in treatment is always closely aligned to the diagnostic
and therapeutic skills of the practitioner" (pg103)
I think the point of this passage is that the Queensland team found that
thugh they had very positive clincal outcomes many people in the UK
especially were reporting dissatisfaction with outcomes. On visiting the UK
they realised that most practitioners had 'learned' this complicated
programme from reading about it or attending a non-practical lecture on the
research - they realised that people needed training in what is a very
complex method of suitable selection of patients, proper assessment,
motivation and education of patient, the ability to spot 'substitution
strategies' (ie cheating) in patients and the ability to progress exercises
approriately. It isn't just about selecting the right patients but about
being a skilled, thoughful practitioner who has been properly educated.
My feeling is that if a group of people are reporting consistently
convincing clinical outcomes using this sort of complex skills re-education
and you are finding outcomes are dissapointing the conclusions can either be
that (A) the research is flawed (B) your clinical training need addressing
in this area. Now, no matter how I re-phrase this it sounds patronising,
which it isn't meant to be. I realised several years ago that I was getting
poor results and since then have been on several practical sessions with the
research group (including one where they showed us our own TrAb contrations
on real-time U/S - very funny). My outcomes are much improved.
I often use the analogy of teaching someone to play golf - (Tr Ab is skills
training) and how difficult it would be to teach someone else to hit a ball
a long distance in a straight line with the end of a long stick - unless you
yourself were skilled in it.
If you read about golf in a book or watched it on TV and then went out and
tried to play it would be incredibly difficult - we all need training in
this area (I need more traning still).
But to answer your question "What do patients like this look and/or act
like?" more directly, they look like this: Patients with first-onset or
recurrent non-specific mechanical low back pain (or with evident
morphological changes) who are able to understand the principles behind the
exercises and are motivated enough to complete the exercises. IE if you thin
you would have difficulty educating or motivating these patients - don't go
there!
John Spencer
----- Original Message -----
From: "Barrett Dorko" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, August 16, 2002 1:07 AM
Subject: Re: A question of posture
> John writes: "As TvA training is about teaching a skill you have to select
> patients that are capable of
> learning it."
>
> What do patients like this look and/or act like? Just trying to save
myself
> some time wasted trying to teach something that can't be learned.
>
> Barrett L. Dorko, P.T.
> <http://barrettdorko.com>
>
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