Lifestyle Redesign - A Successful Tool for Pain Management

Lifestyle Redesign速 A Successful Tool for Pain Management Susan McNulty, OTD, OTR/L

Disclosure Information Susan McNulty, OTD, OTR/L –Nothing to Disclose

Barbara L. Kornblau, JD, OTR/L, CPE –Nothing to Disclose

Learning Objectives Define Lifestyle Redesign® Describe the current state of clinical evidence of successful outcomes for Lifestyle Redesign® Explain 3 benefits of Lifestyle Redesign® for patients with pain and indications for patient referral

OT’s Role in Chronic Pain Occupational therapists consider the impact of chronic pain on occupational performance, emphasizing pain’s effects on functional ability in work, leisure, and activities of daily living

Chesney, OT Practice Online, 10/9/2000.

ÂŽ What is Lifestyle Redesign

The process of acquiring health promoting habits and routines into one’s daily life

Clark, et al., JAMA, (1997).

® What is Lifestyle Redesign

 Delivery Methods and Tools1 – Occupational Self-Analysis – Didactic – Storytelling – Habit change techniques – Coaching techniques – Direct experience

 Sessions 1x/week,50 min (average 6-8 wks)  Group and Individual 1. Mandel, et al ., Lifestyle redesign: Implementing the well elderly program, AOTA Inc.,1999.

® Lifestyle Redesign History

 Well Elderly Study1 – 360 seniors in community settings, RCT

 Outcomes – Improved physical & mental health – More vitality – Fewer role limitations – Less bodily pain

 Well Elderly Study2  Interventions found to be cost-effective 1: Clark, et al., JAMA, 1997.

2: Clark, et al., Journal of Epidemiology in Community Health, 2011.

Lifestyle Components Physical Activity Patterns Stressors and Stress Management Relaxation & Sleep Eating Routines and Nutrition Social Relationships, Demands, Support, & Community

Lifestyle Components Daily Habits & Routines Time Management Pacing & Energy Conservation Pleasure, Play and Leisure Personal Motivation and Habit Change

OT Evaluation History & prior functional levels in ADLs, work, and other productive activities Ask about lifestyle components Functional activities that the client can and cannot perform Client’s ST and LT goals

OT Evaluation Helpful Questions –How long can you sit, stand, walk, drive, concentrate?

–When is your best energy time?

–What activities aggravate or alleviate your pain?

–Is there an activity you want or need to do that is affected by pain?

OT Intervention Treatment goals are framed to maintain balance of activities in spheres of self-care, productivity, and leisure to maintain quality of life

Occupational Therapy Guidelines for Client-Centered Practice. Toronto, Ontario: Canadian Association of Occupational Therapists; 1991.

Managing Chronic Pain: What Can An OT Do?  Identify specific activities/behaviors that aggravate pain, suggest alternatives  Teach methods for decreasing frequency and duration of painful episodes  Facilitate increased functioning for daily activities at work and home  Collaborate with healthcare team  Recommend adaptive equipment 6 Tips for Living: Managing Chronic Pain. http://www.aota.org/Consumers/consumers HealthandWellness/Pain/35137.aspx?FT=.pdf

Intervention Approach  Establish/Restore

– Structure a daily routine needed to complete activities

 Maintain

– Maintain independence by introducing adaptive equipment, e.g. button hook, grab bars in bath/shower

 Modify

– Modify body position, home/office equipment to support posture and performance skill abilities

 Prevent

– Prevent social isolation by encouraging activities in group contexts, e.g. family events, volunteer/work, community activities

Pacing Pacing is a technique that aims to spread activity throughout the day as to most effectively manage your energy and avoid exacerbating pain Goal: Increase the overall activity through strategically choosing when to do activities and how to perform activities

Pacing Intervention

 Activity:_______________________

Lifestyle Balance Too Little Rest

Too Much Rest

Lifestyle Balance Intervention Balance Wheel

Values Checklist

Korb-Khalsa K, et al., Life Management Skills I-V. Wellness Productions, Inc.; 1991.

Stress Management Identify activities that lower stress

Create a stress free environment

Leisure & Community Participation Leisure Checklist

Volunteer Opportunities

Ergonomics Home/Office Visits Go to the worksite Make a match between the work, the worker, and the workplace Have patient bring in pictures if you can’t see the workplace Adaptations to the way the work is performed Adaptations to tools and equipment Stretches Breaks

Sleep Routine Analyze current nighttime routine Create new sleep routine to start 2-3 hours before bed Incorporate sensory input –are the activities you do before bed calming or alerting?

Case Example Elizabeth –40 years old –Diagnosis of Fibromyalgia, Trigeminal Neuralgia, Depression –Pacing –Eating Routine –Exercise-walking, yoga –Assertive Communication/Socializing –Volunteer

Outcomes Canadian Occupational Performance Measure (COPM) Pain Self-Efficacy Questionnaire

1: Law et al., The Canadian Occupational Performance Measure. CAOT Publications; 2005.

2: Nicholas, Annual Conference of the British Psychological Society; 1989.

Occupational Therapy A covered service under workers’ compensation, Medicare, and most insurance In addition to Lifestyle Redesign®, occupational therapists who work in pain management sometimes incorporate aquatic therapy, tai chi, or yoga as part of their treatment* Andersen, L. T., Kornblau, B. L., & Broderick, J. (2006). Occupational therapy. In M. V. Boswell & B. E. Cole (Eds.), Weiner’s Pain management: A practical guide for clinicians (7th ed.). Boca Raton, FL: CRC Press LLC.

Indications for Referral The overwhelmed patient “Women who do too much” “I’ve tried everything” Motivated patients who want to regain control of their lives in spite of pain Patients who want an alternative to medication

Indications for Referral Patients who complain about all of the things they can’t do Patients who don’t complain but you know they are struggling to do things Patients with disabilities who have pain associated with a secondary conditions Older adults who are becoming limited in their activities because of pain

Outcomes & Benefits Patient/client empowerment A sense of control A changed lifestyle designed that decrease the pain in one’s life A balanced lifestyle

Outcomes & Benefits A focus on one’s self in a positive way Getting patients/clients back to “doing”10 Healthy match between patients/clients, their environment, & the tasks they want to or need to do Increased participation in family & community life

Andersen, L. T., Kornblau, B. L., & Broderick, J. (2006). Occupational therapy. In M. V. Boswell & B. E. Cole (Eds.), Weiner’s Pain management: A practical guide for clinicians (7th ed.). Boca Raton, FL: CRC Press LLC.

References  Andersen, L. T., Kornblau, B. L., & Broderick, J. (2006). Occupational therapy. In M. V. Boswell & B. E. Cole (Eds.), Weiner’s Pain management: A practical guide for clinicians (7th ed.). Boca Raton, FL: CRC Press LLC.  Chesney A, Brorsen N. (2000). OT’s role in managing chronic pain. October 9: 10–13.  Clark F, Azen SP, Zemke R, Jackson J, Carlson M, Mandel D, et al. Occupational therapy for independent-living older adults: A randomized control trial. JAMA. 278;16:1321-1326,1997.  Mandel D, Jackson J, Zemke R, Nelson L, Clark F. Lifestyle Redesign: Implementing the Well Elderly Program. Bethesda, Maryland; The American Occupational Therapy Association Inc.; 1999.  Clark F, Jackson J, Carlson M, Chou C, Cherry BJ, Jordan-Marsh M, et al. Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomized Controlled Trial.

Journal of Epidemiology in Community Health, doi:10.1136/jech.2009.099754, 2011.  Occupational Therapy Guidelines for Client-Centered Practice. Toronto, Ontario; Canadian Association of Occupational Therapists; 1991.  Tips for Living: Managing Chronic Pain. http://www.aota.org/Consumers/consumers/HealthandWellness/Pain/35137.aspx?FT=.pdf accessed June 15, 2012.  Korb-Khalsa K, Azok S, Leutenberg E. Life Management Skills I-V. Beachwood, OH; Wellness Productions, Inc.; 1991.  Law M, Baptiste S, Carswell A , McColl MA, Polatajko H, Pollock N. The Canadian Occupational Performance Measure (4th ed.). Ottawa, ON; CAOT Publications; 2005.  Nicholas MK. Self-efficacy and Chronic Pain. In paper presented at the annual conference of the British Psychological Society, St. Andrews, Scotland; 1989.