STARES #3: EBP

Evidence Based Practice

SITUATION

My placement for this rotation is in the outpatient physiotherapy at Tom Price Hospital with the majority of patients falling under the musculoskeletal category with a small number of women’s health, paediatric and neurology patients. Tom Price is a small, rural mining town with the majority of the patients we see being mine workers and partners of those employed by the mine. Due to the demographics and occupational hazards there are many people with chronic low back pain and other persistent pain problems. Often these conditions are self limiting but in a small portion, usually with multiple yellow flags, pain becomes chronic and is very detrimental to the patient in regards to physical, social and work issues.

TASK
As a part of my placement in Tom Price my supervisor asked me to design a brochure on the central sensitisation of pain and an introduction to chronic pain management that can be given to chronic pain patients.

ACTION
Once told of this project I immediately got to work on finding appropriate resources to gather information from. I decided that I was going to use the book Explain Pain by David Butler and Lorimer Moseley as the foundation for this project as it nicely summarises essential information on pain in terms able to be understood by both patients and therapists. Obviously I was not going to be able to include all the information portrayed by the book in an A4 sized pamphlet so it was important me to have a good understanding of the book in order to decide which aspects were most relevant to my patient population and hence what I wanted to included in my brochure. I chose to start with a brief explanation of pain and reassurance that it is normal. I also briefly summarised the mechanisms of pain production in the initial phases of a pain experience and then discussed how pain can be maintain by other factors than purely tissue damage. I concluded the main body of information with an overview of key strategies for taking control of pain – education, knowledge, understanding and movement, with emphasis on active coping strategies. As well as the facts about the pain experience I also gave a couple of examples of patients who had extreme injuries such as amputation in war time, but felt little or no pain because of the context of the pain experience.

RESULT

The result of this task is an informative but not overwhelming resource that can be given to patients as an introduction into understanding about pain and how to best manage it. This task has also resulted in me having a greater understanding of central sensitisation of pain and ways to incorporate pain management into a treatment plan for chronic pain patients.


EVALUATION
I think that this brochure was a very good resource for a first attempt at designing a brochure for patient in a clinical setting. I felt that my prior understanding of the pain experience provided a solid base of knowledge for me to build on and develop into something able to be understood by someone with no prior knowledge or understanding of the pain experience. One area that I believe could have been improved was the number of resources I used to get information from for this project. As I was in a rural environment I was limited in my access to relevant texts however I could have searched for relevant information in the form of e-Books or e-Journals. Even if they could not explain the facts as well as Explain Pain does, I could have developed my own understanding even further and developed my own terminology and analogy’s to describe the pain experience. Instead I predominantly used the descriptions as worded by Lorimer Moseley and David Butler.


STRATEGIES
Strategies that I would employ if I was required to produce another brochure under similar circumstances I would use a wider variety of sources. I also feel that the brochure may be to ‘wordy’ to engage all patients. In hindsight the inclusion of more flowcharts or diagrams to explain key ideas would probably have been better. Specific strategies I have employed since producing this brochure were to examine a wide variety of the other brochures at the hospital to see what designs/layouts really appealed to me and which ones I felt best delivered the various messages. Other methods I used to improve this area were to get a wide scope of feedback on the brochure I produced from other health professionals, nursing students, my supervisor and a chronic pain patient. This was very beneficial and confirmed that some people did find there to be too much text and not enough information provided that would entice visual learners to take in the key messages.