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The Clinical Importance of Active Care in Manual Therapy

The importance of active care, i.e., the patients’ active participation in their management, is critical to the effectiveness of such management and prognosis of their neuromusculoskeletal disorder. Manual therapy is moving away from the paradigm of extensive passive care, i.e., the clinician does all the work with little patient input indefinitely. Patients might interpret this hands-off approach as clinician laziness, disinterest or incompetence, but this is certainly not the case, and the evidence supports this notion.

What is active care and why is it important?
Active care refers to progressive and purposeful increase in patient participation, or self-management, in conservative management. Active participation comprises patient education, rehabilitation programs (exercises, muscle strengthening and stretching etc.), good nutrition, healthy lifestyles and positive mental attitude.

The biggest difference between active care and passive care is that in active care the patient is included in their treatment—giving them control over their own management, which is especially important with chronic pain patients. Chronic pain patients are at a higher risk of developing peripheral or central sensitisation, which complicates management and is associated with a poorer prognosis. Studies have shown that incorporating active care interventions early in the management of these chronic pain patients is associated with a better prognosis and effectiveness of care. The psychosocial factors (e.g., stress, anxiety, depression) associated with chronic pain would also benefit from the empowerment aspects in active care.

What does this mean for the patient?
Patients often interpret active care as clinician laziness or incompetence; however, this is not the case. As mentioned previously, patient independence and empowerment is associated with better clinical results. You must be prepared to do your part to help yourself. This will involve actively participating in physical activity and perhaps altering some lifestyle factors. Initially, this may feel impractical and easily dismissive, but these changes can be crucial to your management and prognosis.

Listen to your physical therapist. Ask questions. Be engaged and involved. Follow through with your exercises. Active care can be seen as team involvement: you and your clinician must work together to reach health goals.
The most recent government guidelines state that the earlier an injured person begins active care, the quicker results are obtained. This is true for both acute (sudden) and chronic (longstanding) pain patients.

Australian guidelines

Australia’s Physical Activity and Sedentary Behaviour Guidelines (APASB) are supported by rigorous review of the current evidence. APASB conclude that the relationship between physical activity (including the amount, frequency, intensity and type of physical activity) and health outcome indicators, including the risk of chronic disease and obesity; and the relationship between sedentary behaviour/sitting time and health outcome indicators, including the risk of chronic disease and obesity are directly related.

In other words, inactivity and poor lifestyle and dietary choices are associated with poorer health and wellbeing outcomes. Therefore, the recommendation is to encourage earlier active care interventions to reduce these risks.

Final thoughts

Active care fosters patient independence, responsibility and empowerment and provides the patient with long-term solutions and education to manage their condition. This improves clinical outcomes and prognosis. Active care involves patient participation, which may initially seem impractical to the patient, but is important to reach health goals. These principles are supported by current evidence and Australian guidelines and recommendations.

More information

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Chris Knee

Chris is an experienced and qualified chiropractor, sports chiropractor, McKenzie Credentialed practitioner, nutritionist and Certified Strength and Conditioning Specialist (CSCS) and is finishing of his Doctor of Physiotherapy at Macquarie University.