Video materials on improving communication with patients, cross-cultural aspect

VIDEO: Interview with pregnant woman who has low back pain

The patient is 29 years old, has 2 children and has to live with her husband’s family because they do not have a house at the moment due to the earthquake.  She is 5 months pregnant and has been complaining of intense back pain for the last 3 weeks. Her husband has to work to provide for the household and cannot help with housework and childcare, she also has difficulty to spare time for herself as there are geriatric people at home and they also need care.

PART I

PT: Hello, welcome.

P: Welcome.

PT: How are you feeling today?

P: The same, my pain continues. Yesterday morning when I sent my son to school, I picked up his bag from the floor and the pain got so bad that I had to stay in bed all day. I couldn’t cook at home, the whole family was miserable.

PT: I see, now we will use a scale to assess your pain. One end of the scale indicates that you have no pain and the other end indicates that you have excruciating pain. Where would you mark on this scale for the intensity of your current pain? (We assess the patient’s pain by applying VAS)

P: My pain is very severe right now. So I will mark here

PT: Thank you. And do you do the exercises we gave you regularly?

P: No, I tried to do them in the first days but I didn’t see any effect, and I don’t have time for exercise, I don’t think it works.

PT: You can see the effect of the exercises if you do them regularly, we just started our treatment last week. It is not possible to see an effect in such a short time. You need to continue for at least 6-8 weeks to see the effect of the exercises. If you do the exercises regularly and attend the treatment sessions regularly, your pain will decrease and you will be able to take care of your son and do your daily chores more easily.

P: I already move and do chores all day long, doesn’t that count as exercise?

PT: The activities you do during the day constitute your physical activity, but they do not count as exercise because they are not purposeful. For this reason, doing selected exercises for your low back pain will help reduce your pain by strengthening the muscles that support your lumbar region.

(PHONE RINGING)

P: Excuse me. Yes, mother?

(MOTHER-IN-LAW SPEAKS. She tells them when she will finish her work and that she will have company for the evening. There is a lot of work to be done at home. The patient hangs up the phone)

PT: Look, my mother-in-law called, she has company coming in the evening. She wants to know when I will be home. The house needs to be tidied up and food needs to be cooked, how am I supposed to find time to exercise in all this hustle and bustle?

(Patient speaks in a bored and frustrated manner)

PT: Ms. Meral, I understand your responsibilities, but you should do your exercises regularly to reduce your pain and to be useful for your baby. If you do not attend the treatment regularly and do not do your exercises regularly, your back pain may get worse and your quality of life may decrease even more.

P: Mrs. Therapist, you are right, but how can I find time to exercise? They expect me to work at home, my husband is at work all day and I have to take care of the child.

PT: You need to be good at exercise so that you can do well at home. So please take at least 1 hour a day for yourself and do the exercises given to you regularly. You are about to enter the last trimester, you should take steps for your own and your baby’s health by not doing heavy work anymore. Would you like to talk to a social worker about your heavy responsibilities in the family? I believe they will be able to guide you in these matters and in solving the problems in the family.

P: I don’t know how much they can help us, but I would like to try. As you said about the exercises, I will try to do them regularly.

PT: I am very glad that you have changed your mind. I would like to hear at our next check-up that your pain has subsided and that you are feeling much better. Take care of yourself. See you soon.

P: Thank you, see you soon.

PART II

(Ms. Meral was referred to the Social Service Unit. An appointment was made for Ms. Meral and her family and a home visit was made. Mediation was provided by talking to the family. Options were evaluated in order to provide assistance in the presence of a Social Worker. Ms. Meral’s sister came from Izmir, saying that she could help with housework and taking care of the other 2 children until after the birth. She was able to easily attend physiotherapy sessions once a week with the car allocated by the Social Service Unit).

1 MONTH LATER

PT: Ms. Meral, welcome. How have you been since we met?

P: Hello Ms. therapist, I am much better. As you said, I have been doing the exercises regularly for 5 weeks and my pain has eased a lot. Now I can take care of my son more and I can easily do daily chores without pain. My husband and his family are also helping me more.

PT: I am very happy to hear that. If we were to assess your pain as we did in our last session, where would you mark on the scale? (Patient marks at a much lower level)

PT: Very good, your pain intensity is much lower now. As long as we continue with the exercises, your life will be much easier, you are doing very well.

P: At first I didn’t believe that these pains would ever go away, but as you said, they started to ease after 3 weeks and now I don’t even have pain as long as I don’t tire myself.

(Therapist smiles)

PT: Now that you are in the last trimester, we will change a few exercises and add new ones. Please continue to do the exercises regularly.

(Patient nods with more conviction and joy)

P: Sure. Thank you very much.

(Shaking hands, the therapist shows the patient the new exercises)

PT: Earlier we showed you the squat exercise and now we will continue with another version of this exercise. (Split squat exercise is shown)

Another exercise was the bridge building exercise and now we will do this exercise by placing a ball between our legs.

PT: Now let’s do the bird dog exercise together.