[GRAPHIC: Brief advice]
PRESENTER [Piece to camera] Okay, so now that we've taken care of assessing
a patient, the next step on the Pathway is Brief Advice.
[GRAPHIC: Flowchart style:
Brief advice] PRESENTER [Piece to camera]
Brief Advice is a short, structured conversation with your patient, where you can raise awareness
of the importance of physical activity and point them in a healthier direction.
You might find it helpful to learn how physical activity relates to the patients you see most
regularly as the advice may vary for patients with different conditions.
And if you deal with a range of conditions, giving general advice can be just as good.
We all have our own style of communicating with patients, adding that essential human
touch to put them at ease, and you'll soon develop your own way of delivering Brief Advice.
You might find it helpful to include the following information in your conversation: The National
Recommendations, The many Benefits of physical activity, The Barriers often faced and the
Solutions to these Barriers
[GRAPHIC:  Reinforce the recommendations
 Promote the benefits  Overcome barriers
 Identify solutions] PRESENTER [Piece to camera]
Most inactive patients have perceived barriers to becoming more active, and it can be very
helpful to explore these concerns a little within the brief advice.
That way our advice has a much better chance of being taken on board.
Inactive patients not only need to know why it is important to be more active, but need
support to think about how to go about doing so.
Brief Advice is an ideal opportunity to quickly chat about realistic ways to get started that
are right for them.
This information can be supported with handouts detailing local opportunities.
Or by directing the patient to www.activescotland.org.uk, so they can find out the different ways to
be active in their area.
[GRAPHIC: activescotland.org.uk
let's get active]
We also know that taking home a written resource can consolidate Brief Advice, and add value
for some patients.
So let's now take a look at a couple of examples of professionals delivering brief advice.
In this first scenario we'll see how a routine ante-natal booking appointment creates an
opportunity to talk about the importance of physical activity during pregnancy.
[DRAMA SCENARIO]
NURSE: So, Victoria, as you aren't meeting the recommended guidelines for physical activity,
would you be interested in getting involved in more physical activity?
PATIENT: Yes, Well I would be interested, I just wonder
is now the right time though, so early in my pregnancy?
NURSE: It's a great time for you to start being active,
for the benefits for you and your baby.
It's also safe for you and your baby that you get some exercise.
So It's actually really important that you try to build and get 30 minutes, 5 days a
week.
PATIENT: Oh, okay that will help with the pregnancy
then?
NURSE: Yes, We now recommend that women stay active
during their pregnancies.
Because it's known that if you stay physically active your energy levels will increase and
you may well get a better night's sleep.
PATIENT: Oh, that would be good, I remember feeling
awfully tired during my first pregnancy.
NURSE: Being more active could certainly help with
that.
We also find being active can help with swelling legs and reduce varicose veins during pregnancy.
If you get into the habit of exercising now, you are more likely to keep it up, during
pregnancy, after pregnancy and it may just help shed those extra few post-baby pounds,
along with all the other long term health benefits of keeping physically active.
Is there anything you can think of that might stop you actually being physically active
during your pregnancy?
PATIENT: My back was pretty sore during my first pregnancy,
I am not sure if I will be able to do very much if I get that again.
NURSE: Yes, lower back pain is very common during
pregnancy, I appreciate that and I understand what you're saying.
But the right kind of physical activity can actually alleviate back pain.
Ideal activities, things like walking, jogging, light jogging, swimming, swimming's a great
exercise, maybe yoga.
Whatever you feel and if it's class led, just make sure to let your instructor know that
you are pregnant.
PATIENT: That sounds good, but how do I know if I'm
doing too much?
NURSE: Like I said, it is safe, but there are a few
things to take note of.
You're slowly trying to build up to 30 minutes 5 days a week.
If you notice any pain, bleeding or shortness of breath you should stop exercising and ask
your midwife or your GP advice about that.
These really aren't common symptoms, but it's important that you're aware of these for you
and baby.
Other things to take into account are you really need to make sure you drink plenty
of fluid before and after exercise, and you certainly shouldn't be doing any contact sports
after 16 weeks gestation.
I've got this booklet here that you might want to take away with you.
Have a flick through it, see if there are any other ideas that can maybe get you a bit
more physically active and I'll see you the next time you've got an appointment with me.
PRESENTER [Piece to camera] Delivering brief advice allowed the midwife
to clear up some of the commonly perceived barriers to being active during pregnancy,
which should make for a happier and healthier pregnancy this time round for Victoria.
But what if your patient's condition initially makes it difficult for them to get more active?
Let's take a look at the pathway in action, and delivery of brief advice in the Physiotherapy
outpatient department.
[DRAMA SCENARIO]
PHYSIO: That's great that you're interested in doing
more physical activity.
It's really important for your arthritis that you do become more active as it can help reduce
the pain and stiffness in the joint.
PATIENT: I was told it was wear and tear and so I thought
I should do as little as possible so not to make it any worse?
PHYSIO: Unfortunately that is a common misunderstanding,
but it's actually very important for your arthritis that you do keep active.
We spoke before about you feeling a little overweight.
This weight will actually be giving you more pain as it's putting more strain through your
knee joints.
If we can get you a little more active and reduce a little bit of weight you may find
it reduces the pain, and you can get off some of the painkillers you have been taking.
PATIENT: But it's sore when I try to do anything.
PHYSIO: I know it can be sore when you first start
moving your knees.
You may need to take a few extra pain relief over the first couple of weeks, but then you
should find that your pain does start to reduce.
It's important to remember that any pain does not mean you are causing any further damage.
Try and find something you enjoy doing and something you will stick at, as this is a
long term plan.
You also want to avoid putting excess load on the joint, so trying to choose things that
put less stress through the knees, activities like swimming or cycling are good for that
reason.
Think of getting some exercise as part of your treatment plan along with the strengthening
exercises that we've been through today.
PATIENT: Well I used to do a bit of swimming, so I
think I should probably get back to that.
PHYSIO: That's great.
You said earlier you were worried about surgery, the good thing about getting active is it
can delay the need for joint replacement as your pain will have improved.
We will do a training programme to get you started and make the first couple of months
easier, but the most important thing is to incorporate physical activity into your daily
life.
So do you feel confident in trying to do a bit more?
PATIENT: I think so.
It's definitely the way to go from what you have told me.
PHYSIO: That's great.
See how you get on.
We can always talk in greater detail at a later date.
PRESENTER [Piece to camera] So you can see that knowing just a few key
facts about how physical activity can benefit your patients can make a big difference.
Think about your own practice and consider how you could incorporate this approach to
improve the quality of care you provide.
Let's review what we've covered so far.
Brief Advice is a further step on the Physical Activity Pathway.
By delivering brief advice to your patients you can highlight the national guidelines
for physical activity, promote the benefits physical activity can offer in both prevention
and treatment, identify barriers and overcome patient uncertainties and Identify appropriate
solutions to help patients overcome these.
[GRAPHIC: > Reinforce the recommendations
> Promote the benefits > Overcome barriers
> Identify solutions]
PRESENTER [Piece to camera] Brief advice can be really simple.
Learn a few key facts you think your patients should know and get started.
[GRAPHIC: activescotland.org.uk
let's get active]
PRESENTER [Piece to camera] There's plenty of helpful information we can
pass on, and taking away a leaflet or going online when they get home can help build on
your conversation.
[END OF TRANSCRIPT]