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Consultation 1 – assessment

Watch an assessment of knee osteoarthritis delivered by telehealth for the PEAK physiotherapy program for knee osteoarthritis
SPEAKER 1: Yeah, so– what I want to start with, is maybe just some questions about you and your knee while I get my booklets out. So, tell me a little bit about your knee. And tell me about–
SPEAKER 2: It’s given me a bit of grief on and off over the years, but to be truthful, it probably started a while ago. I’ve had bits of pain that I used to manage with some– I think, sort of strong anti-inflammatories for a bit. And yet, like, it used to be at the stage where sometimes, I’d be laying in bed, and it would be painful– just laying there. I haven’t had pain like that for– touch wood– for– about four years, probably. Three years. But, it’s clear– I mean, I’ve clearly got some osteoarthritis. It’s been X-rayed, looked at, et cetera. And, it’s not bad, bad, pain, but it does impact on what I can and can’t do to a degree.
So, that’s the frustrating [INAUDIBLE] I do exercise, as soon as the topography has the most gentle of slopes, I feel it. It’s like, uh! you know.
SPEAKER 1: Uphill?
SPEAKER 2: Yeah, and it has to be pretty gentle. So yes, stairs are a pain. I remember when I was doing Pilates last year– I’ve been a bit slack this year, and anything to do with squatting, I just didn’t bother to do it.
SPEAKER 1: Yeah.
SPEAKER 2: So, that said, I found this miracle tablet about six months ago, the collagen.
SPEAKER 1: That’s helping?
SPEAKER 2: Yeah, because I was– I was increasing my walking distance significantly last year when I thought I might try and do a European walking holiday, maybe a mini Camino or something like that. And, as I increased my distance– daily distance, I noticed it was getting sorer, and a friend said, oh, you know, I take blah blah, blah. And I did a bit of research into these collagen supplements. She does the serious powder stuff, beef collagen powder or something. So I just wanted the strongest– I went with the strongest tablet supplement I could find and I took that– let’s see, I took that for about a week and I just went, Oh my God this stuff is like miracle cure.
Well, not miracle cure, but look– it helped a bit. I don’t take it all the time, now. I don’t tend to take– I’ve just started taking it, actually, because my tennis elbow has crept back in, I thought, oh, where are those tablets? I’ll take them again for another week or two. See if I get any relief, and then I tend to knock them off again and I don’t like taking stuff but I need to.
SPEAKER 1: Yeah fair enough. OK, that’s good. That’s helpful for you.
SPEAKER 2: So that’s the background to the knee so it’s just up and down a bit but, I noticed– strengthening was the next thing that I was going to look to try and do funnily enough, because I thought, I’ve tried supplements, I know I use stuff, but I need to clearly– I’m not doing anything to build the muscles up and I think that that’s the next thing I should be looking at.
SPEAKER 1: Yeah. Yeah, absolutely. Well, lucky you’re here.
SPEAKER 2: So, when I saw the study I went, that was what I was thinking of doing.
SPEAKER 1: All right, just to, maybe, give us some things to touch back on as we go through the programme, can I ask about and confirm– you mentioned in one of the questionnaires is that, sort of the amount of pain you get on average over the last week was about 6 out of 10? Is that about right?
SPEAKER 2: Yeah, sometimes. Look, it’s really difficult to answer those questions. What’s the pain? It’s like, when the pain’s there that’s the level it is. But that doesn’t mean it’s there all the time.
SPEAKER 1: OK. That’s good. That’s good to know. [INAUDIBLE] And then, and you mentioned before, any sort of slight incline will give you knee pain, up stairs–
SPEAKER 2: Yeah, yeah.
SPEAKER 1: And you also mentioned, like, sitting in a car?
SPEAKER 2: I notice if I sit in a car for– I drive up and– I live at the coast, so I drive up and down to Brisbane a bit. So, about an hour is the key period. And I noticed that I caught a flight back from Sydney two days ago. Same thing, if I’m sitting and that knee’s at that angle, it starts to get a pain through it.
SPEAKER 1: Yeah. Yeah. OK. All right. And is it pain while you’re sitting, or is it pain when you don’t get up and move?
SPEAKER 2: No, it’s pain while I’m sitting, I think. That’s starting, that’s starting, I need to get up and move this leg.
SPEAKER 1: OK Very good. Now, we do need to, then, do a bit of a physical assessment.
SPEAKER 2: Right. This should be interesting.
SPEAKER 1: So, I don’t know how well can your device be angled there? Because it kind of looks like you’re holding it, but is it propped up on something?
SPEAKER 2: No, no. It’s propped up on a table. I’m sitting at a table. And I’m figuring if I need a tiny bit of space. I’ve got a little tiny bit of a corridor thing, and I’ve got a chair there. This [INAUDIBLE]
SPEAKER 1: Yeah, OK.
SPEAKER 2: I don’t know what it is exactly you want to do, so, yeah. Bit of a mystery. I’m not holding it.
SPEAKER 1: OK, look. We’ll need a chair, probably.
SPEAKER 2: Yep. Yep.
SPEAKER 1: Because– probably the easiest thing for us to have a look at in this setting will be your, like your squatting slash sit to stand. Because you said that keeps giving you trouble in the past. If there’s a step handy– I don’t know what your hallway looks like, but if there’s a step handy, we could look at that. Not really, OK.
SPEAKER 2: I’d probably lock myself in the fire escape to get to a step.
SPEAKER 1: Don’t do that. I think the squats and sit to stand will be enough. So, do we need to then, reposition where you are now to be–
SPEAKER 2: Oh, absolutely. So what do you want to see– I can just walk you around, what do you need? [INAUDIBLE]
SPEAKER 1: Yeah, perfect, yeah. Set it up so we can see that.
SPEAKER 2: So you want me to put the hardware where you can see the chair.
SPEAKER 1: Yeah.
SPEAKER 2: Oh, OK. Let me just find my stepladder rather than another chair. I am in the process of recovering chairs. So let me just, you wanna see that. OK. If I put that there, and I put you there. What can you see? Nothing, probably.
SPEAKER 1: Needs to be angled more, a little bit more. That’s going to be close to perfect there.
SPEAKER 2: If I can make that happen, OK.
How’s that?
SPEAKER 1: That’s good. That’s great.
SPEAKER 2: Good?
SPEAKER 1: Good. OK. So, just have a seat and quickly show me with your left knee, just looking briefly at range can you sort of, hug your knee up like that?
SPEAKER 2: Left knee?
SPEAKER 1: Left knee. Yeah that’s good, and then right knee.
Yeah, they look similar. Yeah. Maybe a bit stiffer on the right there.
SPEAKER 2: This one’s a bit stiffer, yeah.
SPEAKER 1: Yeah. And then what about knee straight? Can you get your left knee fully straight?
SPEAKER 2: Yeah.
SPEAKER 1: Yeah, that’s good. Yep. Yeah, well done. And then the other way. Other leg. Yeah, go on. Turn side on. Yes, good. Very good, very good. OK, great. Look, all we’re going to do is the simplest of tests for you. Simple, in that all you have to do is stand up and sit down on your chair.
SPEAKER 1: Yeah and–
SPEAKER 2: Front on or side on for you?
SPEAKER 1: Front on will be fine.
SPEAKER 1: Practise run in a second, but the actual test runs for 30 seconds. I’m going to count how many times you can do it in 30 seconds.
SPEAKER 2: Oh, OK. That’s exciting!
SPEAKER 1: It is exciting. But the practise. I’ll do it side on for you, so you see what it looks like. You count each rep from when your back leaves the backrest.
SPEAKER 1: And then you go–
SPEAKER 2: Hands-free.
SPEAKER 1: Hands-free. You’ve got it.
SPEAKER 2: Oh that’s me.
SPEAKER 1: Yeah, and so the idea is– and with sit to stand is that you can always get your weight moving forward to get up, OK?
SPEAKER 2: Right.
SPEAKER 1: So you lean forward at the hips first, then stand up. And we can– you’ve got to go back to the backrest each time, and–
SPEAKER 2: Did you say three minutes?
SPEAKER 1: No, thirty seconds.
SPEAKER 2: Oh, that’s good. I was thinking three minutes is a long time.
SPEAKER 1: Yeah, that would probably be just a touch too mean, maybe.
SPEAKER 2: Yeah, OK.
SPEAKER 1: All right. Then show us a practise run with this angle. So, have a go. Stand up, sit down, practise run. Yeah, good. OK, that’s perfect. That’s enough. They look perfect. Do you reckon you could do it side on to the camera?
SPEAKER 2: Yeah.
SPEAKER 1: And that way I can see your back touching the backrest each time.
SPEAKER 2: So you’re wanting to make sure I touch the backrest, and not cheat?
SPEAKER 1: Yeah, that’s it, that hands. All right. So, I’ll count you down. Yeah. When I say go, that’ll be the timer starting 30 seconds. So, three, two, one, go. Go. One, that’s it, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, stop there. Good. 14. Good. How do you feel?
SPEAKER 2: Fine.
SPEAKER 1: Fine, no pain?
SPEAKER 2: No, I just used the other knee a bit more than this one.
SPEAKER 1: OK, all right, good to know, that’s good to know. What do you reckon the split was, was it like, 60-40 70–
SPEAKER 2: Yeah, that.
SPEAKER 1: Yep. OK. I’m just typing some notes here, you’ll hear me typing occasionally. [INAUDIBLE] 14 reps, no knee pain,

This short clip shows a segment of a real consultation, during the PEAK clinical trial, via videoconferencing, and recorded via Zoom. Sound and picture quality may thus be less than ideal.

What did you take away from this video? How will you need to change your usual assessment to suit a telehealth consultation?

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Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK)

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