Arthritis & Low Back Pain
Patient Self Care
Resources / Handouts
Train the Trainer Session 1
April 4 – 5, 2013
TABLE OF CONTENTS
Goal Setting – Supporting Patient Self Management 3
Summary by Organization: Education Programs and Resources for Patients 6
Information Resources for Patients 9
Health Passport Overview 10
Handouts for Arthritis Patients 11
Handouts and Exercises for Low Back Pain Patients 26
Goal Setting – Supporting Patient Self Management
Patient Action Plan
Date: ______
My goal: ______
______
1. First step to help me achieve my goal: Something I WANT to do this week:
______
______
Describe your goal - so that someone else can understand and see it:
How often: ______
When (time of day): ______
Where: ______
2. Confidence rating: (0 - 10) ______
How confident (sure) are you that you can do the whole plan on a 0-10 scale? If confidence is less than 7, see problem solving suggestions
3. Follow-Up: Who are you going to talk to about how the plan went?
4. When are you going to check in?
Patient Signature: ______
Problem Solving Suggestions
If your confidence is low, or you encounter barriers completing your plan, try problem solving:
1. Identify the problem. Be specific! What’s getting in the way of being sure you can complete your plan before your start or carrying it out once you start.
2. List all possible solutions. Brainstorm ideas, from the ridiculous to the sublime.
3. Pick one. Sometimes a combination of a couple of ideas works.
4. Try it for 2 weeks. Give it a good test!
5. If it doesn’t work, try another.
6. If that doesn’t work, find a resource for ideas. Maybe a friend or a professional can help.
7. If that doesn’t work, accept that the problem may not be solvable now. Set it aside for now and work on something else.
Reference for Action Plan and Problem-solving:
Centre for Comprehensive Motivational Interventions, www.centreCMI.ca
Kate Lorig et al Living a Healthy Life with Chronic Conditions 2 ed., Bull Publishing, San Francisco, 2001.
Summary by Organization:
Education Programs and Resources for Patients
Education Program / Resource / Description /The Arthritis Society
Website
www.arthritis.ca / Downloadable PDF handouts, information about programs
The Arthritis Answers Line
1. Lower Mainland: 604 875 5051
2. Other: 1 800 3211433 / A telephone service available in English, French, Cantonese, Mandarin and Punjabi.
Arthritis Self-Management Program (ASMP) / Improve understanding of arthritis, pain management and self-management strategies. Program is taught by1-2 trained volunteers who either have arthritis or are health care professionals. 6 sessions (2 hours, once/week), $25.00 per person.
Chronic Pain Management Workshop / Improve understanding of treatment and management of pain in arthritis. Workshop is led by ASMP leaders. Classes range from 10 - 14 people
Lifestyle Makeover Challenge / 4 week programs that encourage exercise and healthy eating to delay the onset and reduce pain of osteoarthritis
Take Charge! Early Intervention for Osteoarthritis / 4 week program to help patients with arthritis deal with the physical and emotional aspects of the disease
Joint Works and Water Works group exercise programs / 45 min – 1 hr group exercise programs for people with arthritis, offered in various BC communities
HealthLink BC
www.healthlinkbc.ca
8 1 1 on your telephone to speak to a nurse, pharmacist or dietician / Large online database offering general information on Osteoarthritis, Rheumatoid Arthritis and Low Back Pain among hundreds of other health issues.
Translation services available in over 130 languages by request.
Hospital Programs / Services
Some hospitals offer independent programs and services for patients with arthritis or MSK issues. Contact your local hospital to enquire about available programs.
Mary Pack Arthritis Program
www.arthritis.ca/local%20programs/bcyukon/publications%20and%20resources/MPAP/default.asp?s=1 / Locations:
3. Vancouver - 895 W 10th Avenue, Vancouver, BC, V5Z 1L7
4. Victoria - 2680 Richmond Avenue, Victoria, BC, V8R 4S9
5. Penticton - 550 Carmi Avenue, Penticton, BC, V2A 3G6
6. Cranbrook - 13 – 24th Avenue North, Cranbrook, BC, V1C 3H9
Patient Education Program (all sites) / Free classes on a range of topics to help patients manage their arthritis.
Outpatient Rehabilitation Services (all sites) / Treatment services for children and adults with all forms of arthritis. Referral is needed by family physician for physical and occupational therapy. Referrals for nursing, and vocational counseling can be from any health care professional. Referrals for social work can be self-referred.
Specialized Programs / Services
(services vary by location) / Specialized programs and services that require rheumatologist referral.
Outpatient Day Programs
Drug Monitoring Program (Vancouver and Penticton)
Rapid Access for Diagnosis of Early Rheumatoid Arthritis (Vancouver)
Children and Young Adults Program (Vancouver, Victoria and Penticton)
Fibromyalgia Self- Management Program (Victoria and Penticton)
Outreach Services / Consultations, treatment and education services to underserved rural communities provided by rheumatologists, occupational therapists, and multidisciplinary teams
Travelling Rheumatology Consultation Service - Pender Harbour, Powell River, Comox, Campbell River, Port Alberni, Alert Bay, Cranbrook, Valemount, Nelson, Castlegar, Trail, Williams Lake, Burns Lake, Dawson Creek, Fort St. John, Fraser Lake, Hazelton, Kitimat, Massett, New Aiyansh, Prince George, Prince Rupert, Smithers, Terrace, and Queen Charlotte City.
Travelling Occupational Therapy Service - Bella Bella, Bella Coola, Klemtu, 100 Mile House, Lillooet, Merritt, Williams Lake, Hazelton, Prince George, Quesnel, Smithers, Terrace
OASIS – OsteoArthritis Service Integration System
Website:
7. http://oasis.vch.ca/ / Information and videos for people with OA who want to learn about self-management strategies and joint replacement surgery. Translated documents in Punjabi, Farsi, Traditional Chinese and Simplified Chinese
Multidisciplinary Assessment / An assessment with a nurse, PT, and/or OT to create an Action Plan for self-management of OA with referral to community resources. Available in Vancouver, Richmond and West Vancouver
Primary Education Sessions / Free education sessions for patients with OA to encourage self-management. Topics include disease information, goal setting, joint protection, exercise, pain management, nutrition and weight control.
Listing of Community Services:
http://oasis-services.vch.ca/search.aspx / Searchable database to link patients to hundreds of programs, organizations and resources throughout BC
Patient Voices Network
Website:
8. www.patientvoices.ca / The Patient Voices Network is led by ImpactBC in collaboration with Patients as Partners, Ministry of Health.
Peer Coaching Program / Telephone based model where people can phone in to get support and motivation towards healthy lifestyle changes. Free but requires registration.
University of Victoria – Centre on Aging
Website:
http://web.uvic.ca/~pmcgowan/research/cdsmp/index.htm / The Centre on Aging at the University of Victoria is a multidisciplinary research centre established in 1992. Their mandate is to promote and conduct basic and applied research throughout the lifespan.
Chronic Disease Self–Management Program / Free general education program for adults experiencing chronic health conditions (e.g., hypertension, arthritis, heart disease, stroke, diabetes, etc.)
Chronic Pain Self- Management Program / Free education program developed specifically for persons experiencing chronic musculoskeletal pain.
Information Resources for Patients
Program / Resource / Description /Arthritis is Cured
www.arthritisiscured.org / Arthritis Quick Reference tool - handout for physicians that includes (1) arthritis indicators for RA and OA, (2) Red Flag Indicators/Symptoms, (3) Course of Action for Physicians. Also accessible to the public.
Arthritis Research Centre (ARC)
www.arthritisresearch.ca / Provides educational videos, decision tools (ANSWER, etc.), research plain language summaries, a comprehensive list of terms and acronyms to help patients/consumers disseminate research results, and a support group (Consumer Advisory Board) that publishes a quarterly newsletter.
Arthritis Resource Guide for BC
http://www.argbc.ca/ / Links to resources based on patient’s input of geographical location.
PDFs not easily accessible by arthritis patients as these documents are only located under the “practitioner” tab.
Back Care Canada
www.backcarecanada.ca/ / Information addressing topics for people suffering from back and leg pain in an easy-to-read and focused format
Canadian Arthritis Patient Alliance
www.arthritispatient.ca / Support community to promote advocacy of arthritis to improve the quality of life and care of people with arthritis
Cochrane Musculoskeletal Group
http://musculoskeletal.cochrane.org/ / Dedicated to evidence-based research in the form of plain language summaries. These summaries recap the main ideas and results of systematic reviews in everyday language. Also available, decision aids.
Guidelines and Protocols Advisory Committee (GPAC) – Patient Guidelines
http://www.bcguidelines.ca/gpac/patient_guides.html / Patient information guides: Downloadable PDF files on a variety of topics including RA and OA
Joint Health (formerly Arthritis Consumer Experts)
www.jointhealth.org / Offers subscriptions to monthly newsletters, breaking news subscriptions, podcasts, online video workshops, and surveys regarding arthritis.
Health Passport Overview
What is the Health Passport?
The Health Passport is a comprehensive tool that has been designed to support individuals in the management of their health care conditions. It can be used for any state of health from healthy living choices for those who are generally healthy to people that are living with one or more chronic illnesses such as arthritis.
How is the Health Passport useful to patients?
The Health Passport has a number of tools to support patient self-care including goal setting, tracking the progress of a condition, preparing for medical visits and helping to find information or education resources. Individuals will use the passport differently; some may fill it out in its entirety or just use the sections that are most meaningful to them.
The Heath Passport has the following sections:
Section / PurposeIntroduction / To provide information on the Health Passport including why and how to use it
To discuss some common health care terms such as prevention and self-management
About Me / To provide patients with a one page information sheet to record their personal and health care information, including allergies, medical conditions and medications
Working with My Health Care Team / To provide various self-management tools including a tracking diary, information on how to set goals, recording test results and finding education resources
My Community Contact Information / To provide contact information for a list of national and provincial health care resources
Miscellaneous / To provide some useful websites with information on symptoms, tests, medications and making medical decisions
Retired Health Records / To provide a section for patients to store older health records for safekeeping and future reference
Forms for Photocopying / To provide a section for patients to store forms that are used on a regular basis
How is the Health Passport useful to family physicians?
Although a patient-focused tool, the Health Passport can be useful to family physicians in two ways: (1) as an optional tool to help patients coordinate and direct their self-care efforts; and (2) to serve as a reference point for various self-care discussions and interventions such as goal setting, tracking symptoms and drug interactions, recording test results and finding community resources.
Handouts for Arthritis Patients
PATIENT HANDOUT – Specific Disease (RA) Information for Patients
What is Rheumatoid Arthritis? / Most common type of inflammatory arthritisaffects ~1% of the adult population and affects women more than men
can start at any age but most commonly occurs in the 30-50 age group
Inflamed joints are painful, swollen, hot and stiff
Inflammation is in the lining of the joints, and if it is not controlled, it will cause permanent damage to the bone and cartilage
Cause / Unknown
Caused by the body’s immune system attacking the joints—is an autoimmune disease
Smoking increases the risk of developing RA
Diagnosis / Symptoms:
may be sudden or gradual
pain or stiffness with swelling in joints, usually worse in the morning
commonly starts in the fingers, wrists and feet although other joints may be involved
most often tends to be symmetrical, involving joints on both sides of the body
Blood test is not completely diagnostic; may take months to confirm diagnosis
Treatment / Important to treat RA early and aggressively
DMARDs can slow or stop inflammation that causes joint damage, but cannot reverse damage
Referral to rheumatologist
Learn about RA, set goals
Most well-balanced RA treatment plans include medications, weight control, exercise, pain management, relaxation, healthy eating, smoking cessation
Access community services/programs
Access other healthcare providers as needed, e.g. physiotherapist, occupational therapist, dietitian, etc.
PATIENT HANDOUT – Specific Disease (OA) Information for Patients
What is Osteoarthritis? / Most common type of arthritisMost common in the hands, hips, knees and spine
Breakdown of the cartilage on the ends of bones
Symptoms can include pain, stiffness and mild swelling
Cause / Unknown
Factors that increase your chance of getting OA include
Examples of Team members:
Age (getting older)
Excess weight
Heredity
Injury and overuse
Other types of arthritis
Treatment / Learn about OA, set goals
Weight control, exercise, pain management, relaxation, healthy eating
Access community services/programs
Access other healthcare providers as needed, e.g. physiotherapist, occupational therapist, dietitian, etc.
PATIENT HANDOUT – A Comparison of Inflammatory Arthritis and Osteoarthritis
Features / Inflammatory Arthritis / OsteoarthritisWhat are examples of diseases? / Rheumatoid arthritis
Psoriatic arthritis
Ankylosing spondylitis
Systemic lupus erythematosus / Osteoarthritis
Who gets it? / Usually starts in middle age (30 – 60) and tends to get worse over time. However, it can start at any age. / More common as we age, tending to occur in joints that have been subject to “wear and tear” by excessive use
What is the cause? / The body’s immune system attacking the joints / Deterioration of cartilage
How quickly does it start? / Fairly quickly, affecting joints over a period of weeks to months / Usually slowly, with joints getting worse over a period of months to years
How many joints does it affect? / Usually lots of joints and tends to be symmetrical, involving joints on both sides of the body (i.e. both hands, both elbows etc.) / Usually a few joints and tends to be asymmetrical (not matching), with swelling and pain in single joints (i.e. on knee, one finger etc.)
What joints can be affected? / Small joints of the hands and feet
Wrists, elbows, shoulders, knees, hips
Any joint can be affected / Most commonly joints of the fingers, neck, lower back, knees and hips
Can occur in any joint
What are the usual symptoms? / Joint pain, swelling, tenderness and redness of the joints
Prolonged morning stiffness and less range of movement
Sometimes fever, weight loss, fatigue and/or anemia / Stiff, painful and enlarged joints
Gradual onset and worsening
What amount of morning stiffness is experienced? / Morning stiffness lasting more than 30 minutes / Morning stiffness lasting about 15-30 minutes
What medications are available? / Non-steroidal anti-inflammatory Drugs (NSAIDS)
Disease-modifying Anti-Rheumatic Drugs (DMARDS)
Steroids
Biologics
Steroid Injections / Analgesics
NSAIDS
Injections, steroids and viscosupplementation
(Source: the Arthritis Society - Arthritis Medications – A Consumer’s guide, January 2011)