Table 1 Outline of the main components of each of the five consultations with the physiotherapist
| Â | Initial consultation (45 mins)- WEEK 1 | Consultation 2 (30 mins)- WEEK 2 | Consultation 3 (30 mins)- WEEK 4 | Consultation 4 (30 mins)- WEEK 7 | Consultation 5 (30 mins)- WEEK 10 |
|---|---|---|---|---|---|
Assessment | 15 mins | 5 mins | 5 mins | 5 mins | 5 mins |
Introduction and setting expectations | Checking in … . | Checking in … . | Checking in … . | Checking in … . | |
Review pre-consultation survey- choose questions for future reassessment. | - changes in knee pain | - changes in knee pain | - changes in knee pain | - changes in knee pain | |
- how they have managed with strengthening exercises | -Â how they have managed with overall program | -Â how they have managed with overall program | -Â how they have managed with overall program | ||
Subjective information as relevant. | - adverse events? | - adverse events? | - adverse events? | - adverse events? | |
Functional observation: walking, squatting, sit to stand, single leg standing balance, anything else as relevant. | - comments/questions arising from discussions last time. | - comments/questions arising from discussions last time. | - comments/questions arising from discussions last time. | - comments/question s arising from discussions last time. | |
Reassess questions from pre-consultation survey. | Reassess questions from pre-consultation survey. | ||||
Re-assess sit to stand and any other functional tasks as required. | |||||
Re-assess sit to stand and any other functional tasks as required. | |||||
Check progress with goals. | |||||
Education | 10 mins | Â | Â | Â | Â |
Understanding OA. | |||||
Benefits of exercise/physical activity. | |||||
Strengthening exercises | 15 mins | 10 mins | 10–15 min | 10–15 min | 15 mins |
Choose a program of 3 exercises from booklet (1 quadriceps; 1 hip/gluteal; 1 hamstrings/gluteal) | Review progress. | Review progress. | Review progress. | Review progress. | |
Check adherence in Log Book. | Check adherence in Log Book. | Check adherence in Log Book. | Check adherence in Log Book. | ||
- Congratulate adherence. | - Congratulate adherence. | - Congratulate adherence. | - Congratulate adherence. | ||
Prescribe variation (if necessary) and dosage. | - Discuss reasons for non-adherence & troubleshoot. | - Discuss reasons for non-adherence & troubleshoot. | - Discuss reasons for non-adherence & troubleshoot. | - Discuss reasons for non-adherence & troubleshoot. | |
Watch patient perform one set of each exercise & ensure they are working at hard to very hard level. | |||||
Review current exercises & modify/progress as required & add 2–3 more to program (max 6 in total; 2 quadriceps; 1 hip/gluteal; 1 hamstrings/gluteal; 1 calf; 1 optional extra). | Review current exercises & modify/progress as required. | Review current exercises & modify/progress as required. | Review current exercises & modify/progress as required. | ||
Discuss exercising with pain/flare-ups. | Watch patient perform one set of any new exercises & ensure they are working hard to very hard. | Watch patient perform one set of any new exercises & ensure they are working hard to very hard. | Watch patient perform one set of any new exercises & ensure they are working hard to very hard. | ||
Instruct use of Log Book. | |||||
Check patient knows how to change/progress their program over the next 6 months. | |||||
Watch patient perform one set of each new exercise & ensure they are working hard to very hard). | |||||
Advise patient to continue exercise program for next 6 months. | |||||
Education | Â | 5 mins | Â | Â | Â |
Physical activity. Activity pacing. | |||||
Physical activity | 5 mins | 10 mins | 5–10 min | 5–10 min | 5 mins |
Check patient has activity tracker set up and can use it. | Review daily step count recorded in Log Book. | Review daily step count recorded in Log Book. | Review daily step count recorded in Log Book. | Review daily step count recorded in Log Book. | |
Instruct patient to wear activity tracker every day for next week and record daily steps as a baseline for developing a daily step goal at the next visit. | Set daily step goal (may be maintain or increase from baseline). | Review progress with physical activity plan. | Review progress with physical activity plan. | Review progress with physical activity plan. | |
- Congratulate adherence. | |||||
Agree on physical activity plan to achieve steps and/or increase/maintain intensity of activity. | - Congratulate adherence. | - Congratulate adherence. | - Discuss reasons for non-adherence & troubleshoot. | ||
- Discuss reasons for non-adherence & troubleshoot. | - Discuss reasons for non-adherence & troubleshoot. | ||||
Set an ongoing physical activity plan that patient can manage in daily life (may/may not include step goals & use of activity tracker based on patient choice). | |||||
Instruct use of Log Book. | Ask patient to identify potential barriers & plan strategies for overcoming them. | Set daily step goal for coming weeks (may be to maintain or increase from previous weeks). Agree on physical activity plan to achieve step goal and/or increase/maintain intensity of activity. | Set daily step goal for coming weeks (may be to maintain or increase from previous weeks). Agree on physical activity plan to achieve step goal and/or increase/maintain intensity of activity. | ||
Check patient knows how to change/progress their program as required. | |||||
Advise patient to continue physical activity for next 6 months. | |||||
Education | Â | Â | 5 mins | 5 mins | 5 mins |
Understanding & managing your pain. | Weight loss for OA (relevant for all patients, even those of healthy body weight) | Dealing with lapses & set-backs. | |||
Encourage ongoing use of Log Book and activity tracker where possible. | |||||
Participant ‘homework’ | Pre-reading: | Pre-reading: | Pre-reading: | Pre-reading: | Encourage reading of: |
Physical activity. | Barriers to exercise and physical activity. | Weight loss for OA- if appropriate for the individual. | Modifying your exercise program. | Success stories. | |
Activity pacing. | Understanding & managing pain. | Dealing with lapses & set-backs. |