Cockpit Model PDF

MPTY03 – The cockpit model A multimodal tool for patient centered care Michael PHILIPPE, Msc, OMT Module outline Bio-psycho-social model Cockpit Model : concept Multimodal tool - Psycho-social : Shared-decision planning - Bio : dosing tool Practice Case 1 : Role dist...

MPTY03 – The cockpit model A multimodal tool for patient centered care Michael PHILIPPE, Msc, OMT Module outline Bio-psycho-social model Cockpit Model : concept Multimodal tool - Psycho-social : Shared-decision planning - Bio : dosing tool Practice Case 1 : Role distribution Case 2 : Manual therapy prescription 2 The bio-psycho-social model Reminder Holistic approach that consider biological, psychological and social factors in understanding patient’s heath Biological factors These include the physical aspects of health, such as the anatomy, physiology, and pathology of the patient. Psychological factors Factors like stress, anxiety, depression, and pain perception are critical in understanding the patient's overall health Social factors Social determinants of health include the patient’s environment, support systems, work or family responsibilities, socioeconomic status, cultural background, and access to healthcare. These factors can have a significant impact on the patient’s ability to participate in therapy or follow through with prescribed exercises. 3 The bio-psycho-social model Reminder When designing a treatment plan, BPS model should consider Patient’s work demands (e.g., a physically demanding job) Family obligations Social isolation, lack of support, or financial difficulties Could also hinder a patient’s recovery and adherence to treatment Understanding social factors helps physiotherapists tailor treatments that fit within the patient’s life context, making interventions more practical and achievable. 4 The bio-psycho-social model REINFORCING MESSAGE : slide from Dr.MOURAD’s lecture “multidimensional pofile” THE INFLUENCE OF EACH OF THE BIOLOGICAL, LIFESTYLE, PSYCHOLOGICAL AND SOCIAL DOMAINS ON EACH INDIVIDUAL’S WILL VARY. THE BIOPSYCHOSOCIAL APPROACH HAS IN SOME AREAS OF HEALTH CARE BEEN MISCONSTRUED TO FAVOUR A DOMINANTLY PSYCHOSOCIAL APPROACH TO MANAGING MUSCULOSKELETAL PAIN DISORDERs. TISSUE-BASED FACTORS WILL BE THE DOMINANT CONTRIBUTING FACTOR IN A PROPORTION OF CASES, INCLUDING SOME INDIVIDUALS WITH CHRONIC | PERSISTENT MUSCULOSKELETAL PAIN DISORDERs. 5 Therapeutic alliance Why it matters for therapeutic success Improved Adherence to Treatment When patients feel connected to their physiotherapist and understand the purpose of the treatment, they are more likely to follow through with the prescribed plan. Better Patient Outcomes The quality of the therapeutic alliance is a predictor of better clinical outcomes in physiotherapy. Patients with a strong therapeutic alliance often experience greater reductions in pain, improved functional outcomes, and a quicker recovery. Enhanced Patient Satisfaction Closely linked to their perception of the therapist’s empathy, communication, and respect 6 Therapeutic alliance Why it matters for therapeutic success Reduction in Drop-Out Rates This is particularly important in long-term or complex rehabilitation cases, where patients may face periods of slow progress. The physiotherapist’s ability to maintain motivation and adjust treatment plans in response to patient needs helps to prevent disengagement and drop-outs. Empowerment and Self-Management A strong therapeutic alliance helps foster this empowerment by educating patients about their condition, giving them tools for self-management, and reinforcing their role in their own recovery. Patients who feel empowered are more likely to adopt long-term healthy habits, such as continuing with exercises or lifestyle changes after formal treatment has ended. 7 The cockpit model What is it The Cockpit Model in physiotherapy is a metaphor for collaborative patient care, where the physiotherapist and patient work together as if they were co- pilots navigating a shared journey toward rehabilitation and recovery. This model emphasizes the importance of communication, shared responsibility, and active participation from both the therapist and the patient in achieving optimal outcomes. The Cockpit Model advocates for a collaborative approach to healthcare, where both the physiotherapist (pilot) and the patient (co-pilot) share decision- making responsibilities 8 The cockpit model Pilot and co-pilot The physiotherapist, as the healthcare expert, provides knowledge and guidance, but the patient’s preferences, values, and feedback are integral in tailoring the treatment plan. Just as a pilot and co-pilot share responsibilities in flying a plane, both parties need to work in sync for the “flight” to succeed—where the destination is the patient’s recovery. 9 The cockpit model Pilot - Physiotherapist The physiotherapist acts as the pilot Guiding the treatment process through clinical reasoning, evidence-based practice, and the application of professional expertise. The therapist’s responsibilities include: Providing education Clear communication Monitoring patient progress Adjusting the plan as needed Ensuring the patient understands their role in the recovery process 10 The cockpit model Co-Pilot - Patient The patient acts as the co-pilot Just as a co-pilot provides real-time feedback to help adjust the flight plan: Symptoms Challenges Progress This continuous feedback loop is essential for optimizing care, as it enables both the therapist and the patient to respond to changes and adjust the "course" as needed. It allows the physiotherapist (the pilot) to make necessary modifications to the treatment. 11 The cockpit model Communication Trust and clear communication are at the core of the Cockpit Model. Both parties must communicate openly and transparently for the partnership to succeed. The patient must feel comfortable voicing concerns, while the physiotherapist must create an environment where the patient’s input is valued. Communication isn’t one-directional (therapist to patient) but bidirectional, ensuring that both parties are aligned on goals, expectations, and responsibilities. 12 The cockpit model Shared responsabilities Responsibility for the success of the rehabilitation process is shared between the therapist and the patient. The physiotherapist is responsible for providing a safe and effective treatment plan The patient is equally responsible for implementing the plan, providing feedback, and adhering to lifestyle recommendations. Therapist as an obligation of mean, but no obligation of success as it relies on patient’s will to implement change. 13 The cockpit model Challenges Non-Adherence: One of the key challenges can be patient non-adherence, where the patient fails to perform the exercises or follow through with the rehabilitation plan. Communication Barriers: Miscommunication or lack of understanding between the physiotherapist and patient can lead to a breakdown in the collaborative process. Patient Readiness: Not all patients may be ready or willing to take on an active role, requiring the physiotherapist to work on strategies to enhance patient engagement and motivation. 14 The cockpit model Application – Hands-off approach Co-Create Goals: The therapist and patient work together to define the goals of therapy. This often involves the use of SMART (Specific, Measurable, Achievable, Realistic, Time-bound) goals that are aligned with the patient’s personal aspirations and capabilities. Prescribe Exercises: Exercise programs are developed in collaboration with the patient, ensuring that they understand the purpose of each exercise and are willing to perform them. The patient’s feedback helps fine-tune the program over time. Monitor Progress: Progress is monitored not just by objective measures, but also by patient-reported outcomes. Regular check-ins allow the patient to voice concerns or successes, and the therapist adjusts the plan accordingly. 15  Adapted from “Principi di Terapia Manuale e Fisioterapia Muscoloscheletrica” The cockpit model Application – Hands-on approach Rhythm of mobilisation Amplitude Direction Concept derived from the control panel of cockpit Reasoning model for the Target Type of movement Number of component application and adaptation of parameters in manual therapy techniques. Number of repetition Grade of mobilisation Overpressure Many Small Few Big 16 The cockpit model Application – Hands-on approach Concept derived from the control panel of cockpit Based on S.I.N (Severity, Irritability, Nature) of condition. Severity : “How much does it hurt ?” Irritability : “When does pain appears and for how long will it hurt ?” Nature : NAD I, NAD II, NAD III, NAD IV ? Trauma ? Rhythm of mobilisation 17  Adapted from “Principi di Terapia Manuale e Fisioterapia Muscoloscheletrica” The cockpit model Application – Hands-on approach Rhythm of mobilisation Amplitude Direction HIGH SIN: I keep the indicators of the cockpit on the left! Fast rhythm; Nonspecific location (outside painful ROM); Target Type of movement Number of component Many repetitions; Small amplitude; Translation and traction; Grade 1-2; Grade of mobilisation Number of repetition Overpressure Indirect techniques; 1-2 components of motion; Many Small Few Reduced force; Big 18  Adapted from “Principi di Terapia Manuale e Fisioterapia Muscoloscheletrica” The cockpit model Application – Hands-on approach Rhythm of mobilisation Amplitude Direction LOW SIN: I keep the indicators of the cockpit on the right Slow pace; Position specific; Target Type of movement Number of component Few repetitions; Large amplitude; Angular movements and rotation (spin); Grade 3-4; Direct techniques; Number of repetition Grade of mobilisation Overpressure 3-4 movement components; Greater degree of strength Many Small Few Big 19