Risk, Uncertainty & Benefit – Being Risk Savvy in an Uncertain World
Authors: Catherine Moore & Pete Rumble
Life can be tough.
Just when all your ducks are in a row and the sun is shining on your parade, the rain comes along. This is the risk of undertaking a worthwhile activity. Everything in life carries risk: getting in the car to drive to an appointment, setting up a business, finding love, crossing the road to get to an exercise venue, or falling whilst in an exercise class.
In therapy terms, the risk of harm to a patient
is ever present and should be at the forefront of every clinician’s mind (BMJ Best
Practice 2020). However, there are times
when the risks seem to outweigh the benefits, and this has the potential to
stifle your clinical brain to the point of paralysis. I was discussing this
with a patient recently, lamenting that I might go and work in Tesco (other
supermarkets are available) as that just seemed so much easier, less wounding.
I thought I would share their response with you;
As Chartered Physiotherapists, we consistently push people to the limit of their abilities because this is where the therapy happens. We push people to the limits of their strength, their endurance, their balance. Anyone who has done this alone in the gym or at home will know that occasionally this doesn’t work out. Occasionally you will push your tissues beyond what they can cope with and strain a muscle, push your balance beyond what you can cope with and topple over. Because we have experience in classes and clinics, we risk-assess the activities patients undertake and we explain to them the benefits, risks, harms and uncertainties of what we intend to do. This duty of candour (HCPC Standards), enshrined in our code of conduct, allows both patient and therapist to make informed choices about what they undertake. However, in spite of all the risk assessments and disclaimers in the world, accidents do still happen, and it worries clinicians.
So, what is the alternative? Stop people moving? You can’t injure yourself if you never move… or can you? Immobility and not exposing the human movement system to physical stress has profound detrimental effects. Astronauts return from space with weaker bones due to a lack of gravitational loading. The human body is engineered for movement – how else would we have obtained food when we were in the wild? Our skin, the largest organ of the body, needs regular pressure relief in order to remain healthy. Skeletal and cardiac muscles need activation to maintain their strength and most joints need movement to prevent them getting stiff (Atlay 2001, Wu, Li, Cao et al 2018). It is possible (and very likely, probable) that the consequences of not moving are more likely to make you fall than if you keep moving (Salgado, Lord, Packer et al 1994; Sherrington and Tiedemann 2015).If you, the individual, have the capacity to decide on taking the risk to push yourself to new limits of ability, then you have also taken responsibility to retain and use information given therein and communicate any concerns. It could reasonably be asserted that we are doing more harm by not engaging in physical activity than an occasional harm that occurs during exercise.
Take Home message:
We strongly believe the benefits of exercise far outweigh the risks.
I have deleted my application to Tesco (sorry Tesco, I actually would have been
a great employee – punctual, reliable and honest). I have recoated myself with
Teflon, licked my wounds and readjusted my risk benefit analysis. Right then… everyone
on your feet.
References:
Atlay, A. (2001) Systemic and local effects of immobility, Journal of Rheumatology and Medical Rehabilitation 12(4):271 – 276.
BMJ best practice guidance (2020), Weighing up
risks and benefits. Available online at https://bestpractice.bmj.com/info/toolkit/practise-ebm/weighing-up-risks-and-benefits/(accessed
19/02/2020)
Health & Care
Professions Council : Standards of conduct, performance and ethics
https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/
(accessed 19/02/2020)
Salgado, R., Lord, S., Packer, J., and Ehrlich, F. (1994) Factors associated with falling in elderly hospital patients; Gerontology. 40 96), 325-331.
Sherrington, C. and Teidemann, A. (2015) Physiotherapy in the prevention of falls in the older person, Journal of Physiotherapy, 61 (2) 54-60.
Wu, X., li, Z., Cao, J., Wang, Y., Liu, G., Liu, Y., Fangfang, L., Song, B., Jin, J., Liu, Y., Cheng, S. and Wan, X. (2018) The association between major complications of immobility during hospitalisation and quality of life among bedridden patients: A 3 month prospective multi-center study. PLoS ONE 13(10): e0205729
Feature image credit:: https://jamanetwork.com/journals/jama/article-abstract/2679279