I was prompted to write this article by two separate circumstances. Firstly, is my present recovery from a broken bone in my arm hoping for a full recovery from my injury? Moreover, I was fully aware some injuries could result in chronic pain - something I didn't want!
Secondly, was an article on self-management of chronic pain written by a patient who decided a patient's voice should be heard in their pain treatment plan.
Why Do We Stop Doing The Health Plan That Made Us Feel Better?
I have been in recovery mode for three months after I fell and broke my arm on Christmas day. Unfortunately, I'm now discovering as I get better there is an inverse relationship to doing, or even remembering to keep doing, my self-care or self-help activities.
This tends to be a habit of mine, definitely not a 'stick with it' kind of girl.
At the same time as I was beginning to feel guilty about not sticking to my rehab plan, I read an article by Pete, "Pain Toolkit" guy, a worldwide advocate as a chronic pain patient for many years. His article stressed the need for each person to have his or her own chronic pain plan.
Having a plan is necessary to help them continue with their own self-care. For example having a plan to make regular small changes, gradually upgrading what they could do.
Additionally, "bad day" plans are essential to avoid emotional and physical setbacks.
"Do we need to have our own plan, aside from those given to us by a practitioner?"
"Would we benefit from being involved in treatment?"
What's in a Medical Word? A Lot it Seems.
Changes to words, phrases and what is acceptable happen over the years. The research for this article was interesting. Older articles talked about treatment compliance. Compliance has now been replaced with adherence. Why?
I was rather taken aback (often happens as I plough through medical research papers). Rotar (2015) found that
"compliance reinforces patient passivity and stigmatises independent patient judgement about self treatment as deviant."
Interesting in the research and development of health care, a word is seen as not appropriate anymore. This is an area of healthcare that I find frustrating, much of the language used and the idea that when a word is changed healthcare for patients will improve. I feel I should apologise for the reading level of the quotation. Regardless, the word now used for sticking to our health plan is adherence!
As I mentioned above, Pete, the chronic pain self-management guy, was stressing the need to develop and have a plan, a pain management plan.
Perhaps if we all had, or drew up for ourselves a health plan we would be more inclined to stick with activities that could improve our health.
But staying or sticking with a "get healthy plan" is, I believe daunting, it certainly is for my ongoing hand rehab self-help plan.
What Happened in My Naturopathic Practice?
Let's have a look at what happens in my naturopathic practice and client health plans. In my practice I've known patients both adults and children that have carefully followed their health plan, agreed by both of us, whether exercise, diet or supplements. The changes they experienced were often amazing.
Mindful Breathing Story
- A woman grinning ear to ear with happiness because she had practiced mindful breathing, little and often. Also, though not included in my plan she began to organise walking business meetings, outside.
Working with Autistic Child and His Mother
-An autistic 10-year-old who developed balance and focus by practicing warrior yoga poses. After six weeks of practice, that began with his mother and me holding up his arms and, supporting his legs, he was able to support himself. The change was amazing but, yes it took time, it was definitely sticking to a plan, to practice and that's exactly what this mother did.
Practitioners Encourage Patients to Follow Self Help Plans
Practitioners both medical and naturopathic have these stories. If patients follow their health plan amazing and I must add, rewarding changes can happen. Patients feel good and so do we, as we'd helped them get to a better place by making changes.
At the same time we have clients and patients who walk out of our door and do nothing for themselves. Not taking their medication or supplements, unable to change anything they eat or to move more. I used to find this frustrating, now it just makes me sad.
For this article, those in the previous paragraph are not discussed, perhaps the time will come when they get a strong enough life incident or message that could inspire change.
My real concern is the "in betweeners". I'm certainly one of these. When I have symptoms I will adhere to advice or my own self-help treatments. However as symptoms resolve irregularity appears in my treatment behaviour. And due to my own clinical practice I certainly should know about the positive changes that are possible!
Recovery Plan After Cast Removed From Broken Arm
My recent failure to be consistent is doing my rehab after a broken arm. When the cast was removed my hand was very stiff and sore due to inactivity. I quickly found suitable hand exercises, did little and often and saw a rapid improvement in both pain reduction and increased movement and flexibility of my hand and my wrist.
I enjoyed the changes, my enthusiasm increased; my physiotherapist added more. Thank you. The more the better!
Adherence Helps Promote Patient's Health And Recovery
Unfortunately my enthusiasm has waned, if not completely departed. I had great feedback from my physiotherapist. To the point where she even cancelled my next appointment.
"You've done exceptionally well so I don't need to see you for a month."
Of course more exercises went into my rehab plan, more strengthening and weight bearing exercises, which I must admit for some reason I haven't really leapt into.
Getting Back to Normal Living
Most importantly the crux of this article is while I'm getting back to normal living and I no longer have those small reminders of stiffness or soreness to remind me to do self-care for my hand and arm.
On the other hand unlike other people I don't have: -
Ø A family member or friend to nag or remind me.
Ø In fact reminders don't really work for me.
Ø I love making plans, it's a favourite occupation; but rarely follow them for long.
What Happens When Life Stops Your Personal Health Plan?
This problem can arise for any of us, and not just for chronic pain or chronic diseases such as diabetes and high blood pressure. Life can and will interfere with any health improvement plan we begin. We may have a busy time at work, not only an extra commitment of our time, but also needs our energy and focus.
Consequently, it's easy to put our health plan to one side. Although we are well meaning and plan to restart when stress, family trauma or work pressures have passed. Will it happen - I'd guess usually not?
From my experience and that of my clients putting our health plans and changes on the shelf, is not a good idea. Those amazing changes, I mentioned above, that may only need a short time period might never happen. Research by DiMatteo, has shown 26% more patients had a good outcome by sticking with their treatment plan. Life happens roadblocks in clients' treatment plans can be very frustrating and disheartening for many types of practitioners who rely on people being continually motivated by feeling better. By feeling better they apply themselves more to their health plan and so the cycle continues.
"This cycle will eventually change the health profile of the person and also their disease risk profile."
The power of integrating lifestyle changes or continual use of self-help cannot be understated. Family and friends and colleagues may notice changes. I imagine or would wish for a wave of health care changes - like dropping a stone in a pond the waves of health may spread to others.
"I guess this is a wish that I have most days - when I do my health care research and writing then send it out to the world. I'd love it to create waves of health around the globe."
How to Prevent Personal Health Plan Failures
How can we prevent this health plan slippage? If we begin to slack off, as I've done with my rehab - can anything be done when we meet a roadblock, stress, trauma or just too busy?
Opinions on this differ; a colleague, who's a personal trainer, suggested just letting go of some parts of their fitness plan. Unfortunately, you will then have the problem of picking up those activities at a later time. Personally I'd be more inclined to be encouraging choice, for a client to choose a part, or parts of their health plan that's easier or more enjoyable. Just for a short time.
At the same time we need to discuss what is putting them under pressure:
Ø If stress, provide stress relieving techniques;
Ø If work or family, listen to their challenges;
Ø Then help them decide what they can do to remodel the present roadblock that’s interfering with their health plan.
Examination of a Client's Health Plan Roadblock.
Could this health plan roadblock actually be of benefit? Perhaps a client's response to changes and challenges in life are an opportunity to examine if other parts of their work or living environment could be causal in nature. I like the philosophy of examining change in food or movement that doesn't happen and why? But perhaps that's for another day, for another article.
Conclusion - Health Plans that go Awry.
If I want to fully recover the strength and flexibility in my wrist and hand it will not happen without considerable effort on my part. Research has shown that there are orthopedic surgeries and injuries when people don't return to their former fitness and abilities, which they had before surgery.
This article considered two problems that could help explain the limitations on any health plan. Whether that health plan is for rehab, chronic pain, chronic diseases such as diabetes and cardiovascular problems. It's human nature to stop doing activities that promote recovery when we feel better. Choosing rather to get on with normal living.
The importance of keeping to our treatment plan is important to our health outcomes, but few of us will let our doctor or clinician know of these behaviours and perhaps too few doctors will be able to ask "are you sticking to your health plan?" Perhaps they should in an understanding way otherwise we may lie and say yes.
It can be as many as 50% of patients with chronic disease don't adhere to treatment (Rich, 2015), therefore fail to get full benefit of medication. More concerning is "a third of patients may be taking medication in a manner that posed a serious threat to their health."
Finally any health plan can partially or completely collapse if stuff gets in the way. When put under stress our bodies are affected by stress hormones that can increase chronic pain or impact our blood sugar levels. The action of excessive stress is to prepare us for fight or flight and when that happens one of the changes is an increase in blood pressure.
I expect readers are now waiting for solutions or at least my ideas for solutions. How to ensure compliance, or should I say adherence, to their health plan. Unfortunately as I said at the beginning of my article I've been slacking off myself.
References
DiMatteo, M.R., Giordani, P.J., Lepper, H.S., Croghan, T.W.
Medical Care, Vol. 40, No. 9 (Sep., 2002), pp. 794-811
Fenerty SD, West C, Davis SA, Kaplan SG, Feldman SR. The effect of reminder systems on patients' adherence to treatment. Patient Prefer Adherence. 2012;6:127-35.
Rich A, Brandes K, Mullan B, Hagger MS. Theory of planned behavior and adherence in chronic illness: a meta-analysis. J Behav Med. 2015 Aug;38(4):673-88.
Roter, D.L., Hall, R.M., Nordstrom, B., Cretin, D.,Svarstad, B.
Medical Care, Vol. 36, No. 8 (Aug., 1998). pp. 1138-1161
Link to Pete's Tool Kit
Jean Jordan
Want to find simple effective ways to enhance resilience, improve your health so you can begin to use self help ways to feel different. This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques. After over 20 years of having my own pain clinics I started natural pain solutions to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home. Learn more about me here.
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