A group physical therapy program by VA Geriatric Scholar Ralph Magnuson and colleagues from the Redding VA Clinic in Northern California combines exercises with instruction on the neuroscience of pain to help older Veterans increase mobility, reduce chronic pain, and improve quality of life.
Pain neuroscience education (PNE) is a way of understanding the brain’s role in producing pain with the aim to decrease the severity of how patients perceive chronic pain.
Traditionally, physical therapy falls into a biomedical model of care, explained Dr. Magnuson. “We assess that shoulder or back and try to identify the pain generator. When we find it, we try to fix it. Therapeutic neuroscience is more on the bio-psychosocial model where we focus on the whole person.”
At the start of the program, Magnuson asked participants about their pain management goals. “We’re moving towards patient-focused goals versus the primary care physician or therapist-driven goals.”
Veterans told him, “I just want to walk with my grandkids,” or “I want to be able to go out to dinner with my wife and shop in the community,” and “I want to know if there’s anything else I could possibly do.”
Engaging patients in their own care
Before and after the program, participants were assessed for the presence of chronic pain and its intensity to test the effectiveness of physical therapy combined with PNE. Average pain scores improved for all participants by more than 20%.
“We saw a significant change as a group. When they worked together, with camaraderie that was exercise-based, they just in general felt better,” Magnuson explained. “They were observed moving better. I think that relates to, If I feel better, and I move better, my pain must be better.”
Magnuson encourages Veterans to commit to exercise after the program to maintain improvements. Though COVID-19 physical distancing measures at the Redding VA Clinic gym have temporarily halted group physical therapy, he helps patients stay active using VA Video Connect. He also delivers virtual therapy to rural Veterans in Yreka, Mount Shasta, and Burney.
Pictured above, Magnuson conducts a physical therapy telehealth visit for a shoulder impingement and rotator cuff condition.
Telehealth consultations with specialists for Veterans in rural areas
When patients with chronic pain need advanced care, Magnuson uses telehealth to connect patients with Kathryn Schopmeyer, Physical Therapy Program coordinator for Pain Management at San Francisco VA Medical Center.
Schopmeyer is a nationally recognized PNE specialist who collaborates with physical therapists throughout VA Northern California Health Care System. “The three of us work together. I’m a local resource for that patient instead of them having to drive to San Francisco,” she said.
VA Geriatric Scholars Program
Magnuson’s program was inspired by and developed as part of his engagement in the VA Geriatric Scholars Program Quality Improvement Workshop and Practicum.
The Geriatric Scholars Program is a national workforce development program that trains primary care providers in geriatric medicine and teaches fundamental skills in quality improvement based on the IHI Model for Improvement and PDSA Cycle.
Magnuson’s experience with the VA Geriatric Scholars Program led to another quality improvement opportunity. He joined the coaching program within VA known as VA Transformational Coaching Network. “It’s a way to give back. We’re paying it forward and helping somebody else get to the end result like I did.”
Maureen Jerrett is a communications contractor for the VA Geriatric Scholars Program.