[GRAPHIC: Assessment]
PRESENTER [Piece to camera] After the issue has been raised, the next
step is to screen for inactivity using our three simple questions.
This is known as the Scottish Physical Activity Screening Questionnaire or Scot-PASQ for short.
[GRAPHIC: Scot-PASQ]
PRESENTER [Piece to camera] Let's take a look at the first question in
assessing a patient's level of physical activity.
In the past week how may days have you been physically active for a total of 30 minutes
or more?
[GRAPHICS: Graph showing flowchart questions]
PRESENTER [Piece to camera] Physical activity can include walking, cycling,
gardening, housework and exercise or sport anything that gets the heart rate or breathing
rate up a little.
Remember, the 30 minutes can be divided into bouts of 10 minutes or more.
If your patient is getting over 30 minutes on 5 days or more, great!
Encourage them to keep up the good work!
If not, move on to Question 2.
If 4 days or less - have you been physically active for at least 2 and a half hours or
one hundred and fifty minutes over the past week?
[GRAPHICS: Close up moving flow chart]
PRESENTER [Piece to camera] If your patient's physical activity totals
two and half hours, or 150 minutes each week, encourage them to keep this up, and exit the
pathway.
Remember the purpose of the screening tool is to identify those not getting enough activity,
so if someone is meeting the guidelines, it is ok to simply offer a sentence or two of
positive reinforcement.
If your patient's total physical activity is less than one hundred and fifty minutes,
the next step is to ask Question 3, which determines their readiness to change.
Every patient not meeting the guidelines should reach question 3 of Scot-PASQ.
Are you interested in being more physically active?
[GRAPHIC: Graph showing flowchart questions]
PRESENTER [Piece to camera] If your patient indicates they are ready to
consider increasing their activity levels, there are several options.
It may be appropriate to simply highlight the guidelines you have just used during the
screening.
[GRAPHICS: Close up moving flow chart]
PRESENTER [Piece to camera] Or you can continue on the Pathway to deliver
Brief Advice or Brief Intervention.
Let's see some scenarios showing Scot-PASQ screening and assessment in action.
The first takes place in a diabetic outpatient clinic.
Dr Fiona Green is an Endocryne Consultant reviewing a patient, recently diagnosed with
type 2 diabetes.
Knowing how important being active is in the management of such patients, she is keen to
make use of the Physical Activity Pathway.
[DRAMA SCENARIO]
CONSULTANT: Susan, earlier on you spoke about your gran
who had diabetes and you also mentioned she had some problems with her eyes as a consequence
of that.
You mentioned you didn't like the idea of having to take more tablets for your diabetes.
SUSAN: Yes, that's right, I'm not very good with
tablets.
CONSULTANT: One of them I wanted to do now is maybe ask
you a few questions to look at your lifestyle, to see if there's anything you can do to try
and prevent progression of your diabetes and reduce the need for tablets.
So, do you smoke, Susan?
SUSAN: No, I smoked one cigarette when I was in school
and never again.
CONSULTANT: I suppose that's good enough.
And what about alcohol, do you drink?
SUSAN: Hardly ever Dr, maybe a glass of Sherry a
couple of times a year.
CONSULTANT: Okay, that sounds good too.
Now I'd like to ask you a few questions about physical activity, because we know that physical
activity is a really good way to manage your diabetes.
SUSAN: Right, okay.
CONSULTANT: On a typical week, how many days do you think
you are physically active for more than 30 minutes?
SUSAN: One or two?
CONSULTANT: And if you were to add up those one or two
episodes, do you think you're active for more than 2 and a half hours?
SUSAN: No probably not, I don't do that much really.
CONSULTANT: That's ok.
Would you be interested in being more physically active?
SUSAN: Yes, I suppose so doctor, but I wouldn't really
know where to start
CONSULTANT: Don't worry about that, it's sometimes difficult
to get started, but we can help with that.
It's really great to hear you're interested in being more physically active.
It will help to reduce the amount of tablets you take, and also help to reduce the complications
we spoke about earlier.
Would you be interested in seeing Sally who's our dietician?
She can help you look at your exercise and look at the barriers to put in place with
your exercise.
SUSAN: That sounds really good, do I have to make
another appointment?
CONSULTANT: No, no.
Sally just works down the corridor, I can ask her if she can see you today if you like.
SUSAN: Ok.
PRESENTER [Piece to camera] By initiating the pathway, Dr Green has raised
the important issue of physical activity, and discovered that Susan could benefit from
doing more.
Involving other members of the diabetic team allows Dr Green to respond to the early motivation
to change, displayed by her patient.
We'll come back later and see how Susan gets on.
Let's now take a look at some other possible outcomes from the screening process.
The next scenario takes place in a pre-operative assessment clinic, an ideal setting to ask
patients about their physical activity levels.
[DRAMA SCENARIO] NURSE:
If it's ok with you I'd like to ask a few questions regarding your physical activity
levels.
PETER: Yes, that will be okay
NURSE: In a typical week, how often do you exercise
for 30 minutes or more?
PETER: Well, I take the dog out for long walks every
second day, and I play golf once a week, so say four days.
NURSE: Over those 4 days, have you been physically
active for more than 2 hours?
PETER: Yes, the golf takes around 3 hours, walking
the dog another couple over the week.
NURSE: That's good you're doing that, because keeping
it up for 30 minutes, 5 days a week, will help to keep you fit and healthy and continuing
to do that will help reduce the change of conditions such as Heart disease and stroke,
Alzheimer's and Colon Cancer.
PETER: I didn't know that.
That's good to hear.
I must try and get my wife out on a few walks with me.
PRESENTER [Piece to camera] So it's clear that even those who are active
can benefit from being assessed.
By hearing from his nurse in advance of his operation that an active lifestyle is beneficial
for his health, the patient is more likely to keep it up and may even share this message
with others.
But not every patient will be able or willing to consider changes to their activity levels
at that particular time, and that's okay.
But without asking the questions there is no way to know which patients are ready for
positive change.
Here's the sort of situation you might encounter.
[DRAMA SCENARIO]
NURSE: Now that you're feeling a bit better Tony,
and we're getting you away home, we should have a chat about your physical activity levels,
and how that can help your blood pressure control.
Would that be alright?
PATIENT: Yeah, that would be fine.
I didn't know that.
NURSE: Ok, we'll go through a couple of quick questions
to see if you're doing enough exercise just now.
So, in a typical week, how many days would you be physically active for a total of 30
minutes or more?
PATIENT: Well do a bit of gardening if that counts,
so probably two days.
NURSE: Yes gardening can be good exercise.
So would you say you get at least 2 and a half hours of activity over an average week
doing that?
PATIENT: No, if I'm being honest it's probably about
an hour.
NURSE: That's quite good that you're already getting
your hour of exercise in a week, but do be honest would you be interested in doing a
bit more do you think, because 2 and a half hours is the recommended guidelines for physical
activity.
PATIENT: No I don't think, what with work and my wife
not being well at the moment, I don't really get that much time.
NURSE: That's understandable Tony.
You've obviously got quite a lot on your mind just now.
It might be something to think about in the future though because increasing your physical
activity can help your health and wellbeing quite substantially but we'll leave it just
now.
PATIENT: Yes it's something I can certainly look at
later on when thinks calm down a bit.
PRESENTER [Piece to camera] Although this wasn't the right time for Tony
to make some changes, the assessment process is still a critical part of this healthcare
contact.
It's the first time he has been made aware of the important link between his health and
his activity levels, and may be the trigger for positive change in the future.
If a patient isn't ready or doesn't feel confident enough to become more physically active when
you see them, simply highlight the national guidelines, and remind them that any activity
is better than nothing.
Whether young or old, and whatever shape or size, almost every patient should be assessed,
as they could all benefit from getting more active.
You'll find that some will be meeting the guidelines whilst others might be quite far
off.
Some patients will be interested in becoming more active, whereas others may not feel quite
ready.
Some situations will not lend themselves to asking about physical activity, such as severe
ill health but trust your own professional judgment here.
Every patient is different and unique, what is important is that they are given the correct
information in order to make an informed choice regarding what is important for their own
health.
With 2,500 Scots dying prematurely every year because of inactivity, assessing a patient's
physical activity levels should become as much a part of your day-to-day clinical practice
as asking about smoking and alcohol habits.
Using the Scot-PASQ questions will make this much easier.
[END OF TRANSCRIPT]