-----Original Message-----
From: Matthew Groom <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Monday, 19 July 1999 7:20
Subject: Pre-assessment clinics

Due to the chronic waiting lists persistant at our department,
we are trying out a form of "triage" assessment, where patients are
brought in for a quick session as soon as they are placed on the
waiting list. This hopefully will enable us to achieve two aims:

1. Screen out the true acute patients from the chronics (we're a
bit sick of the referal card with "acute" written on it, but
the patient has had the problem for 20 years).

To where do you sift the acute exacerbation of an old injury which could be 20 years old? does this mean that acute patients don't need or will benefit from exercises?

2. Give the true chronics some general exercises and advice whilst
the are on the waiting list.

what is a "true chronic" is this time based only? Is the advice written down? Memories are notoriously poor at first visits. What is the purpose of "general" exercises? is it just to keep them happy until you can see them? "General" exercises are commonly ineffective and may be counterproductive. If they do this for months and nothing happens then you examine them and decide on specificity of exercise, can you convince them that it is worthwhile to persevere? Specific exercises require a thorough assessment, guidance and practice.

Reilly et al's randomised, controlled, prospective trial "Differences between a supervised and independent strength and conditioning program with chronic low back pain syndromes" (Journal of Occupational Medicne. 1989; vol 31 No 6 June) studied physiological parameters of 40 male and females in each group for 6 months. The supervised group had markedly greater strength  and endurance and an average of 50 points lower in intensity of self reported pain as well as significantly lower percentage body fat composition, lower resting heart rate and lower diastolic blood pressure. The experimental (supervised) group showed only an average of 0.25 relapses to the control group's 3.05.
  

HAve you thought of specific group exercise which may be a way of seeing/dealing with a few patients at a time to make inroads into your lists. This way you can be more specific and effective with your exercises if you cannot see them one to one.

Has anyone had any success/ failure with this idea?

We are just starting a pilot, so any suggessions would be
appreciated.


Matthew Groom
Physio
Hull Hospitals Trust
email: [log in to unmask]

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