Personalized coaching helps patients
Program encourages knee replacement patients to increase activity levels
July 30, 2019
By Brenton Driedger, Social Media and Storytelling Advisor, Covenant Health
At age 72, Judy Stauffer is not about to slow down. She has several reasons to keep active: a new knee, the FitBit her physical therapist gave her, and the encouragement of her grandchildren.
“You don’t cheat on your FitBit,” she says laughing.
Judy is part of a study looking into the effects of helping knee replacement patients stay active before and after surgery. The Coaching for Older Adults for Community Health (COACH) program sees participants connect with a physical therapist every week via phone to discuss challenges, successes and set goals. Judy, who lives near Rimbey, is thankful for the advice and the motivation. Her other sources of inspiration, including her FitBit, also keep her moving.
Staying active is a challenge
“And the funny part was the grandchildren and friends would say “Oh, how many steps are you at now? What are you doing? Do you want to go out? And the kids would say ‘Let’s go for a walk’ and they’d want to write down how many steps we went on our walk,” says Judy. “Suddenly I had quite a number of coaches.”
Staying active is a challenge for many patients who received either hip or knee replacements. But it can be even more difficult for those living in rural areas, says University of Alberta researcher and professor Allyson Jones. That’s why the study, funded by a grant from the Covenant Health Network for Excellence in Seniors’ Health and Wellness (NESHW), kept a rural focus.
“We’re in a unique situation in the western provinces because we have these large centres but a large rural component that is underserved with rehabilitation professionals.”
After Judy’s surgery at St. Mary’s Hospital, she went to follow-up appointments at the nearby Camrose Musculoskeletal Clinic where study participants were identified and connected with a physical therapist who was from either Camrose or Edmonton. The patient and physical therapist connect through phone calls every week for 12 weeks, setting activity goals and tracking progress. Patients receive a Fitbit, set goals and track progress on a shared dashboard.
“The coaching is personalized,” says Allyson. “So it isn’t saying, ‘Here are some ideas to keep active.’ It’s helping the person to problem solve so that they can do activities that are important to them.”
The timing is important, too. Research shows joint replacement patients see the greatest improvement in pain relief and functional recovery in the first three to six months after surgery, says Allyson. Following surgery, joint replacement patients have scheduled appointments at two weeks, six weeks, three months and one year at the clinic with their surgeon and care team. The COACH program aims to bridge the gap between the three months and one year time span and help patients make the most of their recovery.
“People who are returning to work, and some of our patients are still working full-time, the average return to work is three months post-op,” says Physical Therapist Rose Powar, Judy’s coach. “They’re going back to work, they’re trying to juggle full-time jobs and have purposeful activity and exercise outside of work, so it’s a great time to catch certain things that would otherwise be missed.”
Finding fun ways to get and stay active can be a challenge in rural areas where there are fewer fitness options and less access to facilities. Creative solutions include finding spaces, such as community halls, that welcome people to walk indoors during the winter months or participating in free local Primary Care Network fitness classes and programs that may be offered. In Judy’s case, a friend approached the local Best Western hotel and asked if they could rent their small pool for an aquasize class.
“This was kind of unheard of, but they went for it,” says Rose. “And it’s been tremendously popular.”
Judy believes personalized coaching made a difference for her. Her goal-setting and weekly calls with Rose encouraged her to take daily walks, increase attendance at aquasize classes and return to one of her favourite activities, cross-country skiing.
“I found it very effective. I had forgotten how much less I was doing in the last three years before the surgery. When I started with Rose as a coach and we set goals together, that was really motivating. I would say I was doing more than I had even four years ago.”
Judy thinks farmers would benefit from this program. Getting back on the tractor after surgery is not adequate exercise. While farmers probably wouldn’t take a pool fitness class and can be reluctant to drive to the city for medical appointments, Judy thinks they’d likely sign up for a weekly phone call.
Allyson and the research team from Camrose and Edmonton are analyzing the study’s results and hope to secure funding for a larger study that involves more Alberta communities. Allyson hopes the COACH program can eventually be implemented at other hip and knee clinics in Alberta.
When Judy and Rose set their initial goals, they had a couple of milestones in mind: a hiking trip and a vacation in France. Judy set, exceeded and increased her daily step goals, while focusing on walking on uneven ground like the farm. When she wanted to get better at going down stairs she consulted Rose, who shared a video of helpful exercises.
“And then we went to Lake O’Hara and hiked for a weekend,” says Judy. “It was amazing. The progress on those goals was really important to me. And then getting to the mountains and being able to handle that, it was pretty wonderful.”