CLINICAL DECISION MAKING IN PATIENTS WITH LOW BACK PAIN: TRANSLATING EVIDENCE INTO CLINICAL PRACTICE

Instructor
Lukman. O. Ganiyu, PT, DPT, MHSc, OCS, MTC
Certified Manual Physical Therapist
Board-certified in Orthopaedic Physical Therapy
Director, Spine & Orthopedic PT, LLC Beloit, WI
Fellow in Training, EIM Institute of Health Professions, Kentucky USA
lukman@spinept.net

COURSE DESCRIPTION
Low Back Pain (LBP) is the second leading reason for primary care office visits in the United States. Patients with LBP comprise approximately 50% of all patients receiving outpatient physical therapy services. LBP prevalence and impact have spawned proliferation of sophisticated diagnostic procedures and expensive surgical interventions. Recent studies on Medicare beneficiaries show a 629% increase in expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance imaging; and a 220% increase in spinal fusion surgery rates. The available studies suggest that these increases have not led to population-level improvements in patient outcomes or disability rates. Diagnosis remains essentially a challenge in patients with back pain. The diagnosis dilemma implies that treatments remain largely empirical with wide variation in practice pattern yielding poor clinical outcomes. This course will focus on differential diagnosis and evidence – informed classification system for matching the right treatment to the right patient at the right time. Evidence-based use of joint manipulation, directional exercises, lumbar neuromuscular re-education and traction will be reviewed. Impact of psychosocial issues on treatment outcomes will be discussed. The use of Cognitive behavioral intervention in select group of patients will be elaborated. We will also discuss strategies by which patients at risk of developing chronic LBP can be promptly identified and managed. The course will conclude with clinical reasoning session using case examples.

 Learning Objectives
After attending the workshop, participants will be able to:

1. Demonstrate better understanding of components of evidence based practice (EBP)
2. Apply EBP to clinical decision making in managing patients with LBP
3. Demonstrate the concept of medical screening to identify patients needing medical or other referrals
4. Discuss pathology-based diagnosis versus classification systems in management of patients with LBP
5. Administer treatment-based classification system to guide intervention and inform prognosis in patients with low back disorders
6. Identify the impact of psychosocial issues on patient outcome and place of cognitive-behavioral intervention in management of patients with LBP

Method of Instruction
The workshop is developed as a blended educational and interactive program with live presentations combined with group discussions. Lectures will be delivered using PowerPoint presentation and animated illustrations where necessary. Electronic handouts will be distributed to registered participants prior to the course date. Pre-conference readings will be assigned to participating physical therapists.

Course schedule and outline

• 8:00 – 8:30 General background information
• 8:30 – 9:00 Review of Evidence for diagnostic process and intervention
• 9:00 – 9:30 Psychosocial issues in patients with LBP
• 9:30 – 10:00 Review of medical screening
• 10:00 – 10:30 Tea break
• 10:30 – 11:00 Patient examination scheme and staging
• 11:00 – 12:00 Evidence-based classification system for patients with low back pain
• 12:00 – 1:00 Break
• 1:00 - 2.00 Cognitive behavioral interventions for patient with low back pain
• 2:00 – 4:00 Putting it together: Interactive case reports and problem-solving

2. CARDIOPULMONARY PHYSIOTHERAPY

INTENSIVE CARE PHYSIOTHERAPY

Using relevant physiology, assessment skills will be developed to identify the key problems of the intensive care/ ventilated patient. Mechanical ventilation, chest drains, monitoring and support systems will be covered including safety factors. Physiotherapy techniques for the mechanically-ventilated patient will be critically evaluated in conjunction with a practical session on pressures for manual hyperinflation and modifications for specific disorders. This will facilitate informed and effective clinical practice. Scenarios will be used to equip participants to review the skills and questioning necessary when on call. These will all be accompanied by current literature and critical thought. Problem solving will be encouraged by the use of case studies.

The workshop will include lectures, group work, X-ray analysis and, if the equipment is available, practice in manual hyperinflation.

Tutors

• Jaiyesimi Adeoluwa Olugbenga
• Odunaiya Nse
• Okikiolu Babatunde
• Anaesthetist from UBTH

Objectives

• To provide an evidence-based approach to the assessment and management of the ventilated patient.
• To link assessment skills to the relevant physiology, and use these to identify the problems of the intensive care patient.
• To provide an understanding of mechanical ventilation, chest drains, monitoring and support systems, including safety factors.
• To critically evaluate physiotherapy techniques for the mechanically-ventilated patient, including a practical session on pressures for manual hyperinflation, and modifications for specific disorders.
• To stimulate critical thought, and reinforce problem-solving skills by the use of case studies.

Course preparation
An extensive pre-workshop reading list will be provided. This information will be made available to intending participants through their e-mail addresses on pre-registration. It is highly recommended that as much of the pre-workshop reading is completed prior to attendance. 

Programme

As a result of completing this course, the participant will be able to:

1. Apply biomedical and behavioural scientific knowledge to the physiotherapy evaluation and management of complex pulmonary and cardiovascular dysfunction.
2. Conduct an appropriate examination of patients with complex cardiopulmonary dysfunction, inccluding history and physical examination
3. Appropriately select, modify as necessary, and correctly demonstrate measurement and testing procedures commonly used in assessing patients with complex cardiopulmonary dysfunction.
4. Appropriately select, modify as necessary, and correctly demonstrate advanced physiotherapeutic treatment procedures commonly used in the management of complex cardiopulmonary dysfunction.
5. Apply advanced clinical reasoning skills and a sophisticated evidence based approach to decision making in cardiopulmonary physiotherapy practice.
6. Apply advanced treatment evaluation and outcome processes appropriate for cardiopulmonary physiotherapy practice.

N.B.
Please send the evidence of payment for this Pre-Conference Workshop to goldenbelt1@yahoo.com in order to receive the pre-workshop reading list and materials in good time.

3. WOMEN’S HEALTH

Role of Physiotherapists in Antenatal Care

Objective:
To equip participants with the knowledge and skills necessary to competently and confidently deliver antenatal classes.

Outcomes:
On completion of the workshop participants should:

1. Be able to understand the physiological changes in pregnancy.
2. Acquire the skills to help their obstetric patients stay active during pregnancy, cope with the stress of labour and regain their fitness afterwards.
3. Be equipped with basic skill to provide safe and effective antenatal classes.
4. Confidently and effectively justify and when necessary defend the role of Women Health Physiotherapists within antenatal care and education.

Syllabus

Physiologic Changes of Pregnancy and their implications:
Physiologic changes of pregnancy will be reviewed. The musculoskeletal implications of these changes and role of physiotherapy in their management will be discussed.

Common conditions of pregnancy managed by PTs:
These will be enumerated and discussed.

Roles of PTs in Pregnancy and Labour:
Here the educative, preventive and curative roles of PTs in pregnancy will be discussed. The roles of PTs at each stage of labour and delivery will be discussed too.

Planning Exercise Programme for the pregnant population:
Participants will be guided on how to plan group and individualised exercise programme for pregnant women putting into consideration the woman’s previous activity level.