#PhysioTalk Transcript

Healthcare social media transcript of the #PhysioTalk hashtag.
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Joe Middleton @_JoeMiddleton
RT @physiotalk:
Pamela Kipps Hansford @PamKHphysio
@physiotalk @physiotalk #physiotalk Please repeat setting up tweetdeck instructions didn't manage last time but did manage 3rd sept
Leah @Leahphysio577
@physiotalk Hello! Leah from Manchester #physiotalk
Fran Hallam @FranHallam_PT
@physiotalk Hi! Fran from Nottinghamshire #physiotalk
Joe Middleton @_JoeMiddleton
@physiotalk Hi, I'm Joe. I am a physio in the South West of England. #physiotalk
francis rogan-physio @francisrogan
@physiotalk Hello, Francis tweeting from South Africa #physiotalk
Velocity Physio @_velocityphysio
@physiotalk Brighton! 🙌 #physiotalk
Central Health @central_health
#physiotalk Click now to read our #OlderPeoplesDay blog! https://t.co/yNjKQMbThM
IPTOP @IPTOPphysio
The #physiotalk chat on #falls has started - join in! #geriPT
Joe Middleton @_JoeMiddleton
Everyone's. Nurses will include in their admission paper work. Doctors will ask, but usually only if that is a feature of the presentation (Geriatricians are an exception to this). However, nobody asks as frequently or as in depth as physiotherapists (imho!). #physiotalk
Janet Thomas @JanetThomas47
I think this is an interesting question. In my setting (Day Hospital) we all ask (not all at the same time!) , but with differing reasons and questions. Hopefully not too repetitive though! #physiotalk
Joe Middleton @_JoeMiddleton
RT @IanTyrrell5:
Janet Thomas @JanetThomas47
@_JoeMiddleton Cant disagree in my opinion as well! Although the rest of the MDT in my workplace are very thorough :) #physiotalk
Velocity Physio @_velocityphysio
@physiotalk Drs & consultants during clerking and post taking patient. Then the physiotherapists with their CGA of the patient #physiotalk
Joe Middleton @_JoeMiddleton
@IanTyrrell5 @physiotalk A doctor asks because they want to know why you fell. A nurse asks because they want to keep you safe in hospital. We ask because we want to know why you fell, how we can minimise the risk, how we can get you home, and how we can keep you living the life you want #physiotalk
Joe Middleton @_JoeMiddleton
@physiotalk @IanTyrrell5 Physiotherapists can approach falls from multiple perspectives, encompassing the bio, the pyscho, and the social. #physiotalk
Fran Hallam @FranHallam_PT
@_JoeMiddleton @IanTyrrell5 @physiotalk Agree, one of our strengths as physios is to see the whole holistic picture and put all the pieces of the jigsaw together #physiotalk
Joe Middleton @_JoeMiddleton
RT @Louise_Brennan_:
Pamela Kipps Hansford @PamKHphysio
@physiotalk #physiotalk Pam Hansford from CT SA, a 75 yr-old neurophysio now also recovering quadriplegic (biggest challenge: mild L hemi-athetosis) who wonders why therapists still want to focus on the problem first (falls)?Lets make #healthyaging & #Wellbeing our goaldirected startingpoint
Joe Middleton @_JoeMiddleton
RT @FranHallam_PT: @_JoeMiddleton @IanTyrrell5 @physiotalk Agree, one of our strengths as physios is to see the whole holistic picture and put all the pieces of the jigsaw together #physiotalk
Jessica Metcalfe @JLMPhysio
RT @_JoeMiddleton: @IanTyrrell5 @physiotalk A doctor asks because they want to know why you fell. A nurse asks because they want to keep you safe in hospital. We ask because we want to know why you fell, how we can minimise the risk, how we can get you home, and how we can keep you living the life you want #physiotalk
Joe Middleton @_JoeMiddleton
Great point. As with most assessments, it is what is done with the findings that matters. #physiotalk
Joe Middleton @_JoeMiddleton
I assume we're not allowed to replace 'fall' with a mime? #physiotalk
Ọpẹyẹmi @opewalker
@physiotalk Usually the physiotherapist #physiotalk
Joe Middleton @_JoeMiddleton
RT @physiotalk:
francis rogan-physio @francisrogan
@IanTyrrell5 @physiotalk Agree devil is in the detail. From physio point of view I ask about activity, do strength test. However I think physician who sees patient should be looking at medication etc. it needs to be a team approach #physiotalk
Janet Thomas @JanetThomas47
@AliceKilbyPT @_JoeMiddleton @IanTyrrell5 @physiotalk It is worrying though how often when we met after our MDT assessment how often we have all been told different things. Why? Is it linked to how we ask? #physiotalk
Joe Middleton @_JoeMiddleton
Ask re: balance (whether patient has ever loses balance or whether they feel balance is poor). Ask whether able to get up from the floor? #physiotalk
Leah @Leahphysio577
@physiotalk Ask about mobility in the house/outdoors? Then move towards how they perceive their balance as this usually sparks the conversation about previous falls #physiotalk
Janet Thomas @JanetThomas47
@_JoeMiddleton I'm often told at the start of an assessment that they feel their balance is poor and they struggle with STS or stairs People know their own bodies! #physiotalk
Joe Middleton @_JoeMiddleton
@IanTyrrell5 @caldwell_pt Blasphemy!!! #physiotalk https://t.co/Q8imJISMqs
IPTOP @IPTOPphysio
@IanTyrrell5 @caldwell_pt @_JoeMiddleton NOOOOOOOOOOOO #physiotalk
Joe Middleton @_JoeMiddleton
RT @JanetThomas47: @_JoeMiddleton I'm often told at the start of an assessment that they feel their balance is poor and they struggle with STS or stairs People know their own bodies! #physiotalk
Joe Middleton @_JoeMiddleton
RT @IanTyrrell5:
IPTOP @IPTOPphysio
@PhysioArmstrong @mariand84 @physiotalk It probably should be Lots of evidence behind frailty screening in MSK outpatients #physiotalk
francis rogan-physio @francisrogan
@Louise_Brennan_ @IanTyrrell5 @physiotalk Agree. And the from there to feedback to the patient too. I think patients are lost in the follow up ( working in a private setting) #physiotalk
Joe Middleton @_JoeMiddleton
This is so, so vital. e.g. the patient said 'oh, I don't know... I must have tripped' vs. the patient said she 'tripped' #physiotalk
IPTOP @IPTOPphysio
@IanTyrrell5 @physiotalk And does the type of injury help you assess - falls forwards onto face, ability to get saving arm out etc etc #physiotalk
Leah @Leahphysio577
@physiotalk We don't just ask, we observe too. As many of the things that can contribute to a fall can stem from age, past medical history, mobility, medication, eye sight... #physiotalk
KB @KBNeuroinfo
RT @caldwell_pt:
Leah @Leahphysio577
RT @caldwell_pt:
IPTOP @IPTOPphysio
@hmlyoungphysio @physiotalk To assess …. Or to screen for risk? (Spoiler - do they work?) #physiotalk
Janet Thomas @JanetThomas47
@AliceKilbyPT @physiotalk It wouldn't be the first time I've defined a fall (in laymans terms) first! #physiotalk
Alex Fisher @alex_fisher1969
@IanTyrrell5 @_JoeMiddleton Oops #physiotalk
Joe Middleton @_JoeMiddleton
- Number in past 12/12 - Frequency - Nature & Pattern (inc. location & time) - Prev. injury - Preceding symptoms - Ability to summon help/get off the floor - Fear of falling - Self-reported balance problems - Mobility - Function - PMH & DH of note - Recall of events #physiotalk
Joe Middleton @_JoeMiddleton
As a starter for 10. #physiotalk
Leah @Leahphysio577
RT @_JoeMiddleton: - Number in past 12/12 - Frequency - Nature & Pattern (inc. location & time) - Prev. injury - Preceding symptoms - Ability to summon help/get off the floor - Fear of falling - Self-reported balance problems - Mobility - Function - PMH & DH of note - Recall of events #physiotalk
KB @KBNeuroinfo
RT @_JoeMiddleton: - Number in past 12/12 - Frequency - Nature & Pattern (inc. location & time) - Prev. injury - Preceding symptoms - Ability to summon help/get off the floor - Fear of falling - Self-reported balance problems - Mobility - Function - PMH & DH of note - Recall of events #physiotalk
KB @KBNeuroinfo
RT @caldwell_pt:
Joe Middleton @_JoeMiddleton
- Continence - Vision - Hearing - Bowel habit - Footwear - Environment (e.g. lighting, flooring etc.) #physiotalk
Janet Thomas @JanetThomas47
@_JoeMiddleton Are all your falls the same... Any common factors? Strength (not just functional strength although that's vital!) Gait speed as well as gait (if you know what I mean!) #physiotalk
Joe Middleton @_JoeMiddleton
#physiotalk
Joe Middleton @_JoeMiddleton
@JanetThomas47 Do you ask about gait speed or just assess it? #physiotalk
Janet Thomas @JanetThomas47
@_JoeMiddleton Timed walk but also ask about community mobility, can they get to toilet in time etc Also distance - whats the furthest you've walked in the past week / month #physiotalk
francis rogan-physio @francisrogan
@hmlyoungphysio @physiotalk In screening we have used TUG, and now introducing hand grip strength. This helps us to decide if patient discharged with walker/ crutches. It also has helped us manage expectations of patients, and to help them plan. We use in combination with RAPT score to plan d/c #physiotalk
Axelle Mokry @axelle_mokry
RT @physiotalk:
Joe Middleton @_JoeMiddleton
All patients in hospital, aged 65 or older, are to be considered at risk of falling #physiotalk
Janet Thomas @JanetThomas47
@HealthPhysio @caldwell_pt @physiotalk I fell last weekend.... Now I know I have grey hair but.... #physiotalk #overwhelmingextrinsicfactors #segway
francis rogan-physio @francisrogan
@mariand84 @physiotalk Ideally yes. But often depends on the funder and patients means (in private setting) #physiotalk
Joe Middleton @_JoeMiddleton
@IanTyrrell5 @JanetThomas47 Frequently get that look of bewilderment and annoyance on a relative's face. 'He was worse than this this morning. Honest!!!' #physiotalk
Fran Hallam @FranHallam_PT
@physiotalk Before asking anything I start assessing as soon as I arrive at the person's house, looking at the access, how long they take to answer the door, use of mobility aid, footwear, signs of injury….#physiotalk
Joe Middleton @_JoeMiddleton
RT @avington_suzann:
Leah @Leahphysio577
@physiotalk Chair based exercise to start to build confidence and them move to strength, balance and propripception exercise #physiotalk
Pamela Kipps Hansford @PamKHphysio
@physiotalk #physiotalk need to ask about medication - @Atul_Gawande Atul Gawande in his fascinating book Being Mortal points out that people taking more than 4 prescription medications are at risk of falling! Only 4? Also: #Deprescribing & @TheIHI are promoting understanding of this aspect
Joe Middleton @_JoeMiddleton
Must take the opportunity to plug the @MDTea_podcast episode on 'Fear of falling' https://t.co/FFW3QPa5VL #physiotalk https://t.co/Mzzj8BibJT
Janet Thomas @JanetThomas47
@Leahphysio577 @physiotalk Would you always start with chair based? I'm wondering why? #physiotalk
Joe Middleton @_JoeMiddleton
Must take the opportunity to plug the @MDTea_podcast episode on 'Acute management of falls' https://t.co/i7FZ78Pcz6 #physiotalk
IPTOP @IPTOPphysio
@caldwell_pt I totally recommend the @MDTea_podcast A great listen on all types of subjects #physiotalk
francis rogan-physio @francisrogan
@physiotalk Depends on setting, but I often ask them if I can test there balance and time their stride standing balance. I use this as opener for them to say “oh my balance is good/bad” and the I can ask “why?” #physiotalk
Alex Fisher @alex_fisher1969
@physiotalk #physiotalk embedding 'exercise' into meaningful activity. Again alot if the folk I work with are cog impaired & have neuro apathy. They may not have insight into 'needing' exercise
Joe Middleton @_JoeMiddleton
Must take the opportunity to plug the @MDTea_podcast episode on 'Falls prevention' https://t.co/aUYUJkzT0p #physiotalk https://t.co/vC0kxrvNax
IPTOP @IPTOPphysio
Here's a few that I saw during #FPAD2018 promotions #physiotalk https://t.co/0LVMjmY9Gp
Leah @Leahphysio577
@JanetThomas47 @physiotalk Not always. Depending on the individual patient. I tailor each program individually as everyone is different and some more confident than others #physiotalk
Fran Hallam @FranHallam_PT
@HealthPhysio @physiotalk Sustainment is a really good point and often difficult to achieve #physiotalk
Janet Thomas @JanetThomas47
@HealthPhysio @physiotalk Agree! Challenge, tailoring and progressions are vital #physiotalk
Janet Thomas @JanetThomas47
@Louise_Brennan_ @physiotalk @clock_yourself Promotional tweet alert! We have @MegLowryPT from @clock_yourself speaking at #AGILE18 on 10th Nov #physiotalk
Joe Middleton @_JoeMiddleton
@physiotalk Working in the very acute setting (ED/AMU), I don't get to do much in the way of exercise with my patients. However, I believe resistance exercises and tai chi are both pretty good. Otherwise, what ever the patient will continue to do, and challenges them! #physiotalk
Janet Thomas @JanetThomas47
At a risk of being too promotional - recommend the training from @LaterLifeTrain (Yes, I do tutor on their courses :) ) #physiotalk
Alex Fisher @alex_fisher1969
@physiotalk #physiotalk Consideration should also take into account carer burden. Their time in managing compliance with what we px and advise
Joe Middleton @_JoeMiddleton
https://t.co/NZg2rfxqyb @LaterLifeTrain #physiotalk
Joe Middleton @_JoeMiddleton
@IanTyrrell5 @JanetThomas47 I find that validating patients fear is a big step. Telling them that it is okay to be scared of falling, but together we canm bit-by-bit, get on top of this. #physiotalk
IPTOP @IPTOPphysio
@_JoeMiddleton @physiotalk The best exercise is the one the person will do! On the other hand, we do need to motivate them to do the evidence based exercises - otherwise no good for falls! #physiotalk
Alex Fisher @alex_fisher1969
#physiotalk I am v much enjoying hanging out with u lovely lot
francis rogan-physio @francisrogan
@mariand84 @physiotalk One of my favorites for patients. Often introduce it early and do sit-stand test as there are norms. Patients quite like the challenge and to see an improvement #physiotalk
Pamela Kipps Hansford @PamKHphysio
@physiotalk #physiotalk start with a,b,c, (not #Strengthening!) #Alignment to gain #Balance to work on #Control and create #DynamicStabilisation through #Education & #EnergisingThroughExercise in meaningful #FUNctionalActivity in #DailyLife
Alex Fisher @alex_fisher1969
@IanTyrrell5 @physiotalk #physiotalk get friendly with yr local CNRTs. If u're discharging folk their way, they may order off the peg
Joe Middleton @_JoeMiddleton
I'm still waiting to see my first patient that has summoned assistance via Alexa #physiotalk
Pamela Kipps Hansford @PamKHphysio
@physiotalk #physiotalk Also #Dancing for People with PD would be appropriate for all people whose balance is challenged
Fran Hallam @FranHallam_PT
@caldwell_pt @PhysioArmstrong @HealthPhysio @physiotalk Get to know the person, what motivates them, their interests, their lifestyle. And if this fits with an evidence-based activity for improving muscle, bone strength and balance even better! https://t.co/yDcYxj38YQ #physiotalk
francis rogan-physio @francisrogan
@physiotalk Have been using Otago exercises. Easy, standardized and patient can do with a family member. Need to think of ways to decrease costs etc #physiotalk - using family members helps get extra sessions in.
Alex Fisher @alex_fisher1969
@physiotalk #physiotalk Emerging tech is great. Sadly it's the funding which is the bug bear in the era of austerity & folk being turned down for PIP. I get slightly aerated when I think of the cost savings. End of rant!
Leah @Leahphysio577
@physiotalk We've got access to the OTAGO program that we can refer via the local leisure centre which has been really popular and recommended by lots of patients #physiotalk
Pamela Kipps Hansford @PamKHphysio
@physiotalk correction #physiotalk Also #DancingForPeopleWithPD would be appropriate for all #peoplewhosebalanceischallenged
Alex Fisher @alex_fisher1969
@caldwell_pt @physiotalk #physiotalk Can u tell I'm an OT? Honestly can't do my job without u all
Janet Thomas @JanetThomas47
@IanTyrrell5 @_JoeMiddleton Don't forget the new Apple watch as well! #physiotalk
Joe Middleton @_JoeMiddleton
I think @IanTyrrell5 summed it up at the start. The devil is in the detail. Go full on #Sherlock or #Poirot #physiotalk
Leah Devlin @Leahdevlin1989
RT @physiotalk:
Alex Fisher @alex_fisher1969
@physiotalk #physiotalk thank you
Janet Thomas @JanetThomas47
@PhysioArmstrong @francisrogan @physiotalk Lots of strength exercises - just make sure you use an appropriate leg weight #physiotalk
francis rogan-physio @francisrogan
@physiotalk Prevention is better. Test patients, encourage strengthening and physical activity in every patient. #physiotalk
Joe Middleton @_JoeMiddleton
@JanetThomas47 @IanTyrrell5 Probably still face the issue of these amazing people not wanting to 'cause a fuss' or not wanting to 'bother anyone'. Having said that, I assume there is some sort of accelerometer in an apple watch? So it could detect the fall itself? #physiotalk
gemma weatherby @gemmaweatherby
Very interesting tweetchat tonight about falls! #physiotalk
Janet Thomas @JanetThomas47
@HealthPhysio @physiotalk Some interesting apps discussed at the last @LaterLifeTrain conference for exercises and adherence. Just can't quite remember what they were called... #looksforconferencetweets #LLTconf #physiotalk
Joe Middleton @_JoeMiddleton
Great chat @physiotalk. Thanks for hosting @caldwell_pt #physiotalk
francis rogan-physio @francisrogan
@PhysioArmstrong @physiotalk In the very weak Patient it is a great start. I have started using hand grip strength in every older patient. Some are surprisingly week, and then others surprisingly strong. #physiotalk In the very week, Otago is good.
gemma weatherby @gemmaweatherby
RT @_JoeMiddleton: Must take the opportunity to plug the @MDTea_podcast episode on 'Fear of falling' https://t.co/FFW3QPa5VL #physiotalk https://t.co/Mzzj8BibJT
Pamela Kipps Hansford @PamKHphysio
@HealthPhysio @physiotalk #physiotalk Lets start by asking them #WhatareyourStrengths? Working in water can be amazing for those who enjoy swimming
Meg Lowry @MegLowryPT
@physiotalk Otago if resourced. Otherwise HEP w 3-4 tailored exercises 1) LL strength exercise (sit-stand, single leg calf raise, stairs, lunge or floor transfer) 2) static balance narrow BOS 3) multidirectional stepping eg @clock_yourself 4) one w head & body turns when safe #physiotalk
Janet Thomas @JanetThomas47
@IanTyrrell5 @_JoeMiddleton I think you could describe my approach as gentle sarcasm in general. But depends on individual #physiotalk
Joe Middleton @_JoeMiddleton
@HealthPhysio @physiotalk I remember a big @thecsp campaign about falling not be an inevitable part of ageing. My thought was; but it is an inevitable part of bipedal ambulation? #physiotalk
Janet Thomas @JanetThomas47
@_JoeMiddleton @IanTyrrell5 That's what I understand. But you can switch it off..... #physiotalk
Janet Thomas @JanetThomas47
@_JoeMiddleton @HealthPhysio @physiotalk @thecsp I don't think you can count my Segway fall as bipedal ambulation! But it was probably inevitable... #physiotalk
Joe Middleton @_JoeMiddleton
I'm ready. #physiotalk
Meg Lowry @MegLowryPT
@physiotalk @clock_yourself A safe HEP is different to what can be done w standby assistance from physio. During Rx I go with goal oriented training + Outdoor mobility, reaching, asymmetrical farmers carries, step downs, kneeling & standing balance on BOSU, dual task games, timed challenges. #physiotalk
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