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Consultation 1 – education
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Consultation 1 – education

Watch the educational component of the PEAK physiotherapy program for knee osteoarthritis delivered by telehealth
5.8
SPEAKER 1: Yeah, we’ll go through this education really quickly.
9.3
SPEAKER 2: Sure.
9.9
SPEAKER 1: And I’ll get the, yeah. Oh, you can angle that? Good on you. All right. Let’s start with purple book. Looks like this.
19.1
SPEAKER 2: Yep.
20.7
SPEAKER 1: Yep. Open it up to, basically, the first page. But I call it page three. They’re counting the cover as page one.
29.6
SPEAKER 2: Yep.
30.6
SPEAKER 1: So page three has got the purple box down on the bottom and just tells you about–
33.3
SPEAKER 2: Uh huh.
33.6
SPEAKER 1: [INAUDIBLE] knee arthritis. Have you had a chance to read through this book yet?
37.4
SPEAKER 2: No.
38
SPEAKER 1: Cool. No worries. That’s all good. That’s why you get the sessions with us. So page three talks about understanding knee arthritis and what arthritis is
49
SPEAKER 2: Yeah, just reading them, and that’s very interesting.
51.6
SPEAKER 1: Yeah.
53.1
SPEAKER 2: The first one surprises me, pain comes from wearing down of the cartilage.
57.4
SPEAKER 1: Not true.
58.8
SPEAKER 2: Really?
59.7
SPEAKER 1: Yeah.
60.4
SPEAKER 2: Where does it come from? This thing creaks to [INAUDIBLE].. I can hear it.
63.9
SPEAKER 1: Yeah, and creaking doesn’t mean that it’s going to be more or less painful. That doesn’t correlate with someone’s symptoms.
69.3
SPEAKER 2: Oh, doesn’t it? OK.
70.8
SPEAKER 1: All right. So where does it come from? It comes from, so it’s not just the cartilage. OK? It comes from–
76.8
SPEAKER 2: OK.
77
SPEAKER 1: –the whole joints. And the cartilage itself is what they call– it’s avascular and aneural. So it doesn’t have a nerve supply. So we can’t get cartilage pain.
87.4
SPEAKER 2: OK. But it is a component to the whole problem.
90.4
SPEAKER 1: It is a component. Yeah, yeah, it is a component.
92.8
SPEAKER 2: OK.
93.4
SPEAKER 1: But equally, the amount of wearing of that cartilage, thinning is a better word, doesn’t–
99.2
SPEAKER 2: Oh, OK.
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SPEAKER 1: –doesn’t relate to how much symptoms you have.
104.6
SPEAKER 2: OK.
105.2
SPEAKER 1: So we see people with really extreme radiographic changes, meaning changes on the x-rays and their MRIs, that have no knee pain whatsoever.
116.1
SPEAKER 2: Yep. OK.
117.6
SPEAKER 1: So it’s more than that. It’s more complex than that. And it’s not just related to, and actually doesn’t like very much, well at all, to the degree–
126.6
SPEAKER 2: OK.
127.2
SPEAKER 1: –of cartilage thickness you have. Yeah.
130.3
SPEAKER 2: OK. It’s interesting, because I see here, it talks about flare ups, which, I think, is the kind of thing I tend to have experienced.
136.6
SPEAKER 1: Yeah. Yeah.
137.7
SPEAKER 2: Yeah. Mm. Although there’s a base, I think there’s a base underlying–
141.5
SPEAKER 1: There’s like a grumble–
142.7
SPEAKER 2: –level.
143.4
SPEAKER 1: –with some peaks. And that’s really common with any chronic disease, but particularly with the chronic knee pain. Yeah.
151
SPEAKER 2: OK.
151.6
SPEAKER 1: The other thing that sometimes is of interest to people is how we diagnose arthritis. These days we don’t actually need to get an x-ray to diagnose it, because the X-ray doesn’t relate well to the symptoms.
166.3
SPEAKER 2: OK.
167.4
SPEAKER 1: And so the diagnosis of knee arthritis these days is that you are over the age of 45, you have knee pain with activity that’s lasted for more than three months, no morning stiffness for more than 30 minutes, and no history that might be suggestive of some alternate diagnosis.
186.1
SPEAKER 2: OK. What’s that, like, rheumatoid arthritis or something like that?
189.8
SPEAKER 1: Yeah, or a cancer or–
191.3
SPEAKER 2: OK.
191.6
SPEAKER 1: –or like a ligament injury–
193.1
SPEAKER 2: Yep.
193.3
SPEAKER 1: –or something like that.
194.3
SPEAKER 2: Yeah, OK. Uh huh. Uh huh.
195.9
SPEAKER 1: Fractures, maybe, and–
197.5
SPEAKER 2: Yep. Got it.
198.4
SPEAKER 1: 60, 70–
199.4
SPEAKER 2: OK.
200
SPEAKER 1: –that sort of injury.
201.4
SPEAKER 2: Yep. Uh huh.
203.2
SPEAKER 1: The other ones that sometimes surprise people is that it’s actually false that exercise will further damage the joint. And you know–
213.6
SPEAKER 2: Oh yeah, I don’t think of– [INTERPOSING VOICES]
215.2
SPEAKER 1: You might have heard of people saying things like wear and tear when they refer to arthritis.
221.2
SPEAKER 2: Yep.
222.8
SPEAKER 1: But actually exercise doesn’t increase the rate of cartilage thinning at all. In fact, if anything, it has a beneficial effect in maintaining the thickness of your cartilage.
233.6
SPEAKER 2: OK.
234.2
SPEAKER 1: And that makes sense when we think about, the body is a living, healthy, adaptable thing. And the–
240.6
SPEAKER 2: Yeah.
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SPEAKER 1: –cartilage is part of our body. And it can adapt as well, right?
244.2
SPEAKER 2: Yep.
245.3
SPEAKER 1: And so exercise is actually really important to knee health. Not just–
250.4
SPEAKER 2: OK.
250.8
SPEAKER 1: –helping the cartilage, obviously, it helps the muscles, it helps with flexibility.
254.1
SPEAKER 2: Uh huh.
254.9
SPEAKER 1: It helps with your body health. It helps with body composition, all of these things.
259.7
SPEAKER 2: OK.
260.4
SPEAKER 1: Yeah. And then the last part of this is a joint replacement surgery is always needed in the end, with arthritis. And that is–
268.8
SPEAKER 2: Awesome.
269.6
SPEAKER 1: –absolutely not true. Yeah. Very few people who have knee arthritis actually progress to a joint replacement.
278.3
SPEAKER 2: Fantastic.
279.4
SPEAKER 1: Which is good news. Now–
280.9
SPEAKER 2: Yeah.
281.6
SPEAKER 1: –flipping over of the page, page 405. Treatment options.
286.5
SPEAKER 2: Yep.
287.1
SPEAKER 1: Yep.
291.3
Most people, including physios sometimes, believe that the best things for arthritis are medications, and injections, and surgeries. But that’s actually not the case. The best first line, what we should invest all our efforts and time into treatment, is exercise and physical activity, and–
313.3
SPEAKER 2: Uh huh.
313.7
SPEAKER 1: –weight maintenance. For you, weight maintenance, for other people, it’s weight loss. OK?
317.6
SPEAKER 2: Yep.
318.1
SPEAKER 1: They’re the best things that we can do. You get–
320.3
SPEAKER 2: Yep.
320.6
SPEAKER 1: –the best bang for buck, you get the best outcomes, all of that stuff.
323.7
SPEAKER 2: Uh huh.
324.4
SPEAKER 1: Uh huh. And the exercise, it can be a combination of things. But we really like to have some strengthening there, and you’re on board with that. We also like to have some cardiovascular.
333.6
SPEAKER 2: Cardio.
334.4
SPEAKER 1: Yes, some huff and puff exercise in there, as well.
338.1
SPEAKER 2: Uh huh.
339
SPEAKER 1: The other thing you might not have maybe heard of as much, in this context, are some pain coping activities. But you might have heard of them in other contexts. So pain coping activities include things like mindfulness, and relaxation, and meditation. Yeah.
355
SPEAKER 2: Yeah, yeah, yeah, yeah. Got it.
356.6
SPEAKER 1: You’re on board with that?
358.3
SPEAKER 2: I’m retired now, life is quite calm–
361.3
SPEAKER 1: –stress free–
362.3
SPEAKER 2: –and lovely.
362.8
SPEAKER 1: Yeah, beautiful. Oh that’s nice. That’s great. So, what I’ll ask you to do is have a read of those–
368.5
SPEAKER 2: Yep.
369.1
SPEAKER 1: –and a bit of extra homework that’ll give you as well, but reread those.
373.1
SPEAKER 2: Before I talk to you next, yep.
374.9
SPEAKER 1: That would be great.

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 education provision to suit a telehealth consultation?

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Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK)

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