the health roundtable “burdening the shoulder? don’t shoulder the burden!” presenter: judy...
TRANSCRIPT
![Page 1: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/1.jpg)
The Health Roundtable
“Burdening the Shoulder? Don’t Shoulder the Burden!”
Presenter: Judy Chen
Hospital Code Name: The Prince of Wales Hospital
Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012
![Page 2: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/2.jpg)
The Health Roundtable
KEY PROBLEM
![Page 3: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/3.jpg)
The Health Roundtable
AIM OF THIS INNOVATION
Empower patients Self management strategies Avoid protracted course of therapy Improve quality of life Decrease utilisation of health services
![Page 4: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/4.jpg)
The Health Roundtable
BASELINE DATA High prevalence of ongoing shoulder pain with ageing
population (Chard et al 1991; Chakravarty & Webley 1990; Vecchio et al 1995)
> 30% still has shoulder pain after 2-3 years (Linsell 2006; Winters 1999; Zheng 2005)
POW QA Survey of Referrals for Shoulder Dysfunction:
1993: 10% shoulder referrals
2008: second largest group of all referrals
2009: 50%
C/S
L/S
T/S
Sh
Elbow
Wrist
Hip 0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Cx spine Tx spine Lx / SIJ hip / thigh knee / lowerleg
ankle / foot shoulder /upper arm
elbow /forearm
wrist / hand
Problem area
![Page 5: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/5.jpg)
Occasions of Service per Diagnosis, 2008 C/S 4.5 L/S 5.6 T/S 3.6 Shoulder 6.3 (NSW 9.2) Elbow 5.3 Wrist 2.5 Hip 4.7 Knee 3.5 Ankle 3.8 Foot 4 # Shoulder 4.2 # Ankle 4.2 # Others 5.8 Sx Shoulder 7.9 Sx Ankle 5.4 Sx Others5.8 Deconditioned 0
C/S
T/S
L/S
Hip
Knee
Ankle
Shoulder
Elbow
Wrist/Hand
80% non-shoulder problems improved to 80-90%
All shoulder patients : 30 – 50%19.6 “frequent flyers”
![Page 6: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/6.jpg)
The Health Roundtable
KEY CHANGES IMPLEMENTED
Chronic care model: 8 week twice weekly group programInclusion criteria: One-on-one treatment Chronic shoulder pain- after 4 sessions Exhausted allocated sessions Achieved maximum benefit after 1-1, need further
education/ exercise to prevent recurrenceEducation (goal setting, shoulder anatomy, treatment
options, shoulder specific/general exercise, joint care, healthy living etc)
Exercise (neuromuscular control exercises, general fitness exercises)
Use existing staff, cost-neutral(Plan: RCT for patients on waiting list for shoulder surgery)
![Page 7: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/7.jpg)
OUTCOMES SO FAR
NO RE-REFERERALSNo “Frequent flyers” re-
presenting
Fig 1 Improvement (higher score) in lifting ability over time.
Fig 2 Measurement of active shoulder range of motion- flexion and hand-behind-back (HBB) reach. A high score in flexion indicates improvement whereas a decrease in HBB indicates improvement .
Fig 3 Physical function tests- 6 minute walk test (distance walked in 6 minutes -in metres), and stair climbing (steps climbed in 2 minutes).
Fig 4 Outcome of SF36 quality of life questionnaire- both physical component score (PCS) and mental component score (MCS) demonstrates improvement in all domains of physical and mental function.
Fig 5 Patient self-perceived improvement in pain measured on an 11-point visual analogue scale. 0 = no pain; 10 = the worst pain imaginable.
![Page 8: The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation](https://reader030.vdocuments.mx/reader030/viewer/2022032709/56649ed45503460f94be47a2/html5/thumbnails/8.jpg)
LESSONS LEARNT
Great for team building
Worthwhile problem-solving process
Recruitment of participants
Upskill staff in program delivery & exercise prescription
Refine recruitment process (information brochure, explanation to patient)
Consider entry to Exercise program while waiting for commencement of educational program
Involve all staff to ensure continuity