MDST
Over some years we have evolved a multi-disciplinary approach to the treatment of back or spinal pain. There is strong research evidence to support its use. By including a number of different disciplines under one roof, we can discuss issues of management regularly, the best course of action and the most appropriate practitioner to deal with specific problems. At times, joint consultations may be helpful. We have now established a formal team approach with regular weekly meetings to discuss specific patient management. Reasons sited by practitioners for valuing a team working approach include:
- Any one discipline being good for some patients, but not for all.
- The need to facilitate the best way forward for each patient.
- Wanting to see the end result of a care episode.
- To gain a better understanding of what other team members can offer.
- Achieving the best use of resources.
- Better communication.
Most common reasons for discussing patients at the MDST meeting
- For consideration of the widest range of diagnostic opinion and treatment options at the outset of care.
- Patients progress not meeting expectations with treatment from any given discipline.
- Complex X-ray or MRI findings.
- Complex or confusing cases.
- Conditions requiring treatment by one or more disciplines at the same time or sequentially.
Aims of the Team
- Early referral to the most appropriate discipline
- To enhance understanding and communication between all parties, ourselves, the patient, the patient’s GP.
- To be a central point of contact for GPs.
- To have a flat, ie non-hierarchal structure.
- To enhance professional learning experience.
- Opportunities for research and audit.
Team structure consists of:
- 0.1 Spinal Surgeon
- 0.1 Consultant in Pain & Anaesthesia
- 0.2 Spinal Physician
- 1.6 Osteopath
- 0.8 Physiotherapist
- 0.1 Co-ordinator
How the disciplines are used Osteopathy Aims to maximise function within structural constraints. Generally hands on treatment, manipulative in nature with the patient as the passive participant. Most helpful for:
- Acute mechanical spinal pain.
- Altered postural mechanics.
- Single segment dysfunction.
- Soft tissue overstrain/overuse.
- When more aggressive intervention needed, but its use contra-indicated.
Physiotherapy Physiotherapist, Marc Rapkin, uses mainly exercise rehabilitation and core muscle stabilisation techniques with the patient as the active learning participant. He also uses acupuncture/dry needling techniques. Patients are generally
- Chronic rather than acute
- Postural underlying issues
- Many have reoccurring episodes of similar types of pain
Patient characteristics These are generally patients who have reached a stage in their condition where they are positively motivated towards helping themselves and are willing to actively participate in learning how to control/manage their condition and learn preventative strategies. Consultant in Anaesthesia & Pain Management Dr Mike Bailey’s input to the Team is mainly concerned with patients who present with:
- yellow flags
- require drug manipulation
- require local anaesthetic/steroid blocks
Spinal Surgeon The role of Mr David Sharp is mainly in the arenas of diagnosis, investigation and invasive diagnostic techniques. Diagnosis
- Further assessment of nerve root pain
- Red flags
- Neurological disorders
- Cauda equina syndrome
- Inflammatory disorders
- Failed conservative treatment
Investigation
- Specialised blood tests
- Special X-ray reviews
- CT
- MRI
- Ultrasound
- Bone Scan
Invasive diagnostic techniques
- “probing”
- discography
- pars injections
- spinal biopsy
Pain Management Therapy
Pain Management Therapist, Bev Karia aims to help patients manage their pain more effectively by addressing issues such as:
· Goal setting
· Pacing
· Dealing with emotions
· Relaxation skills
Further details can be found at the following website: www.spinalteam.com |
