B160 Physiotherapy

It is important to note that Demetria is just 25 years old thus she is still categorized as young. It is not possible therefore, to state that the multiple joint pains were as a result of her age. There is specific cause(s) of the multiple joint pains other than her age. It is also not likely that multiple joint pains are as a result of her medical history (thalassaemia) unless if it was “transfusion thalassaemia” – a condition that arises after blood transfusion resulting to iron overload. Most importantly, is to establish physiotherapy management of the multiple joint pains that are growing to worse in Demetria’s life.

Possible physiotherapy management

One of the physiotherapy management would be hydrotherapy. According to O'Leary et al. (2018), this is a form of therapy that utilizes water to control pain. There are specialized exercises that will be done while inside the water with a range of temperature: 33-36c. Ayanniyi, Egwu and Adeniyi (2017) emphasize that physiotherapist control and guide the patients with those specific exercises including strengthening exercises, aerobics and stretching.

The other physiotherapy management appropriate for Demetris is manual therapy. It is the kind of approach that calls for physiotherapists’ effective use hands-on techniques to help in pain and stiffness relief. Karel et al. (2017) note that this technique has shown great benefits in treating multiple joint pains related conditions. Regueiro et al. (2017) note that the other approaches like thermotherapy and acupuncture also showed great benefits in joint pain relief.

Ayanniyi et al. (2017) posit that joint pains can sometimes be life threatening. Hip joints for example, bears the body weight; this joint translate to the overall mobility. A physiotherapy is aimed at improving patient morbidity in such cases. Demetria has been demonstrated as having increased weight during the lockdown period particularly because of reduced movements. There is a high likelihood that the joint pains are as a result of increased weight which continually stress on the joints. Therefore, O'Leary et al. (2018) mention that some of the techniques that will be used by physiotherapist include weight management training, manual therapy stretching and strengthening and hip joint protection strategies. It will also be important for the physiotherapist to educate the patient regarding certain joint protection methods. It is usually advisable that patients experiencing joint pains avoid carrying heavy weights and also doing intense physical activities that might overload the joint (Karel et al., 2017). Most of them are also provided with aids where they are advised to use appropriate footwear. It is also the responsibility of the physiotherapists regarding maintaining an appropriate posture (Karel et al., 2017).

Most important, it is necessary for a physiotherapist to carry out a physical assessment test before initiating any treatment or recommendation. The assessment will be based on gait, respiratory function, muscle strength test. To be precise in the assessments, it is advisable that the therapist use the impact measurement scale I and II and questionnaires for health assessment.

Psycho-social issues impacting on the patient

One of the psychosocial problem negative attitude by Demetria. Multiple joint pain that are being experienced by the patient are likely to make her uncomfortable almost all the time. As a result, attitude towards other people might change especially because she is never feeling comfortable (Regueiro et al., 2017). She might stop being free to people and even to her husband, her attitude towards him might change.

The other psychosocial problem is the mood state. There is also a high likelihood that the mood state of the patient will change. For example, if Demetria was supposed to stay happy and jovial, she cannot because of the multiple joint pains. These pain results into a series of mood changes such that it is not possible to tell when she is happy and when she is not. With such a state, it is difficult to interact or relate with an individual simply because the state of health is wanting and too dire to warrant them joy.

The other psychosocial problem is inability to work. When someone is not able to work because of pain, their usual daily routine is affected. Considering that Demetria is a professional in law, there are several daily activities that she will not be able to undertake because of the multiple joint pains. It will perhaps require her not to stand for so long or even not engage in certain activities that will call for straining.

Anxiety is also another psychosocial problem that Demetria is likely to undergo or experience. Jewett et al. (2017) state that people with chronic pain are potential of developing anxiety symptoms three times more than an individual without pain. The daily demands that are brought by chronic pain continually exacerbates anxiety among individuals experiencing such pain episodes. Eberly et al. (2018) also emphasize that a cycle of worry and pain can really wear an individual down particularly by making their lives unbearable. It is for this reason that the physiotherapist must attempt to deal and resolves about the psychosocial issues revolving around pain in Demetria's life as he/she performs physiological management practices on the patient.

How they might be addressed by Physiotherapy

The physiotherapist will counter these psychosocial problems by effectively putting into use the skills he/ she possess regarding the problems. Man et al. (2019) mention that even when patients do not experience mental health problems, healthcare professionals working in various fields including physiotherapists, have enough skills to provide psychological support, education and provide reassurance to constantly reduce distress while at the same time promoting change in behavior.

It will be the responsibility of the physiotherapist to change the patient's mindset by giving psychological support which is aimed at helping her manage her mood state and attitude. Negative attitude and change in mood states can play a huge role in a psychosocial well-being of an individual. Driver et al. (2019) note that a patient's ability to heal or to become whole is dependent on the kind of attitude they have every single day. A positive healthy attitude will enhance chances for positive health outcome as opposed to negative healthy attitude. It is therefore, the responsibility of the physiotherapist to ensure that the patient has developed a positive attitude even when negative attitude had dominated her entire life. Although it is not easy, it is one of the best practices that the physiotherapist can work on as the first management practice for the patient. It is imperative that the therapist must change the attitude of the patient towards her state of pain as he/she introduces her to the new management practices regarding her situation.

How they might be addressed by MDT

Based on the assumptions that MDTs help in improving the Care Quality through incorporation of the perspectives into the service users' planning of care, MDTs has become a standard of practice in almost all services associated to mental health. Effective and efficient MDTs practice is one of the agreed approaches for improving mental health services in addressing complex needs in severe mental complications (Taberna et al., 2020).

Therefore, MDTs will address the potential psychosocial problems experienced by the patient through interventions related to their respective areas of expertise. Absence of MDTs might have perhaps demand that Demetria be admitted in hospital for close checking and monitoring. This however is not the case with presence of the multidisciplinary team as they are always engaging with the patient. In other words, the team will ensure that everyone does their part as per their expertise.

Additionally, Giebel et al. (2019) posit that one of the strengths that is evident with MDTs is that it creates a new environment that facilitates various professions to utilize their skills, values, attitude, abilities within their practice scope. In other words, because of the MDTs, Demetria will have an ample time as there might be several underlying conditions related to joint pains that might not be solely dealt with by an individual expert in bones. There could be the possibility that the joint pains are related with the circulatory system. This will therefore mean that a Healthcare professional who is an expert in matters to do with circulatory system will work in conjunction with another expert in bones to relate the actual problem and find out proper mechanisms to handle the problem. These team will therefore work in conjunction to identify the psychological problem, device ways of handling the problem and also monitor the progress of the patient. There is a likelihood that some of these psychosocial problems are attached to individual body issues that must be addressed by the experts in those specific area of expertise.

Conclusion

Demetrias' condition could be attributed to her body weight and the perhaps the kind of work outs she is engaging in.  There are specific workout practices that might not be favorable for some people thus the need to give a careful observation. It will therefore require the holistic intervention of the multidisciplinary team including physiotherapists, psychologists and doctors to give appropriate recommendations and management strategies to achieve the desired positive outcome.

Bibliography

Ayanniyi, O., Egwu, R.F. and Adeniyi, A.F., 2017. Physiotherapy management of knee osteoarthritis in Nigeria—A survey of self-reported treatment preferences. Hong kong physiotherapy journal, 36, pp.1-9.

Driver, C., Oprescu, F. and Lovell, G.P., 2019. Exploring physiotherapists' considerations regarding the use of psychosocial strategies in practice. Physiotherapy Research International, 24(4), p.e1783.

Eberly, L., Richter, D., Comerci, G., Ocksrider, J., Mercer, D., Mlady, G., Wascher, D. and Schenck, R., 2018. Psychosocial and demographic factors influencing pain scores of patients with knee osteoarthritis. PloS one, 13(4), p.e0195075.

Giebel, C., Medley, G., Smith, S., Thornton, M., Furlong, M., Ennis, M. and Young, C., 2019. Communicating psychosocial well-being in motor neurone disease to staff: results from a World Café approach. Quality of Life Research, 28(9), pp.2579-2584.

Jewett, L.R., Kwakkenbos, L., Delisle, V.C., Levis, B. and Thombs, B.D., 2017. Psychosocial issues and care for patients with systemic sclerosis. In Scleroderma (pp. 615-621). Springer, Cham.

Karel, Y.H., Scholten-Peeters, G.G.M., Thoomes-de Graaf, M., Duijn, E., van Broekhoven, J.B., Koes, B.W. and Verhagen, A.P., 2017. Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic-and therapeutic management. Physiotherapy, 103(4), pp.369-378.

Man, I., Kumar, S., Jones, M. and Edwards, I., 2019. An exploration of psychosocial practice within private practice musculoskeletal physiotherapy: A cross-sectional survey. Musculoskeletal Science and Practice, 43, pp.58-63.

O'Leary, H., Smart, K.M., Moloney, N.A., Blake, C. and Doody, C.M., 2018. Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis. Pain, 159(9), pp.1877-1886.

Regueiro, M., Greer, J.B. and Szigethy, E., 2017. Etiology and treatment of pain and psychosocial issues in patients with inflammatory bowel diseases. Gastroenterology, 152(2), pp.430-439.

Taberna, M., Moncayo, F.G., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Torres, E.P. and Mesía, R., 2020. The multidisciplinary team (MDT) approach and quality of care. Frontiers in oncology, 10.

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