This section is for AHPs whose work regularly has a focus on discussions about healthy lifestyles eg Physiotherapists, Occupational Therapists, though may be applicable to any AHP who feels that this is part of their role.
You may deliver MECC for LBP opportunistically or also may deliver it routinely. you may consider putting some brief questions about back pain into your documentation if not already there e.g. do you experience back pain?
In Level 2 MECC, you usually have a little longer with your patients/clients. You may have an ongoing relationship with them, so have already developed rapport.
In Level 2 MECC, think about including the Behaviour Change Techniques which we saw earlier ie:
giving personalised feedback of risk or consequences
encouraging people to consider the benefits of change
encouraging people to have a belief that they can succeed
helping people to consider what support they need to change
helping people to access services that will support them.
Still following the broad ASK, ADVISE, ASSIST template, a Level 2 MECC conversation may look something like this:
ASK: "As part of your assessment, I would like to ask you a few questions about back pain. Is that OK with you?"
"You have told me that you have experienced back pain recently, and that you tried to cope with the pain by going to bed. You were worried about doing too much as you felt you might damage your back. Is that right?"
PATIENT: "Yes, I've heard that it can make your back much worse"
ADVISE: "Actually being active is the best thing that you can do to help your back pain to recover. It may feel a little uncomfortable at first, but I can assure you that exercise will not damage your back. in fact bed rest will make your back pain worse. "
"As you have had a recent bout of back pain, it is important that you keep active now in order to reduce your risks of developing back pain again."
"May I ask, what sorts of activity do you regularly do?"
PATIENT: "Not a lot really"
AHP: "You may not be aware, but the recommended amount of physical activity for adults is 30 minutes five times a week. What sorts of physical activity do you enjoy doing?"
"What sorts of physical activities could you fit easily into your everyday routines?"
PATIENT: "Well I like a bit of gardening and I do enjoy a nice walk"
AHP: "OK, I understand that you have been fearful of doing physical activity when you've had back pain, and I hope I have reassured you that actually keeping active is the best thing that you can do when you have back pain"
"Can you tell me what the benefits of doing some activity every day would be for you, given our discussion?"
PATIENT: "Well from what you say it will help my back get better sooner. It will also help me to feel less stressed I think, and maybe help me to get to sleep a bit better too. That's been a real problem"
AHP: "Good, it sounds like you can see a lot of benefits from making some small changes to your exercise pattern" (motivation)
"What will help you to stick to your plan?" (capability)
PATIENT: "My wife likes a walk, so I will ask her to come with me."
AHP: "Sounds like a good plan."
ASSIST: "We've covered a few things about exercise and how to manage back pain better...here's a great leaflet to remind you of some of the things that we have talked about."
"Have a look at the NHS Choices website / Arthritis UK for some more tips to reduce back pain" (opportunity)
ASK: "I wanted to mention to you that it's Back Care Week this week. You may not be aware that 8 out of 10 people in the UK experience back pain at some point"
PATIENT: "Really? I didn't know that! I've had back pain in the past...I was laid up for a week!"
ADVISE: "Keeping active by taking regular exercise is one of the best ways to look after your back health...and actually is one of the best things to do if you do experience back pain too. It wasn't the best idea to stay on your back for a week, so next time remember to keep active....it will help you to recover, and take a painkiller too".
"Staying independent in your own home is very important to you, so looking after your back health can play a part in that. How much physical activity do you think you do each day at the moment?"
PATIENT: "I try to do a little bit now and again, just a walk to the local shops, that sort of thing".
AHP: "That's great, it's good to hear that you try to do a little bit. Doing a little more might give you some real benefits. (motivation)
(gives advice re the importance of physical activity and the recommended guidelines)
"What sort of support would be helpful for you to do some more physical activity?" (capability)
PATIENT: "To be honest I find it hard to do it on my own"
AHP: "How about joining a local walking group. What are your thoughts on that idea?"
PATIENT: "Yes, that would be a help" (capability)
AHP: "OK, I will sort out the number for you of the nearest group. I also notice that you smoke. Can you think of any benefits of quitting?"
PATIENT: "Well I guess I would save some money and wouldn't have this cough so often" (motivation)
AHP: "Yes, that's right. Quitting smoking is actually the single most beneficial thing that you can do to improve your health"
"You may not be aware that smoking can play a part in back pain too, as smoking affects tissue health in the body, including the back. We do know that smoking can affect recovery from all sorts of conditions, including back pain. So, lots of benefits for you it seems!"
PATIENT: "Well I do want to quit but never seem to succeed"
AHP: "If you do want to quit, then getting help from local Stop Smoking Services means that you are 4 times more likely to successfully quit than going it alone. What are your thoughts about that?" (Capability)
PATIENT: "Well I wouldn't mind giving it a go"
AHP: "Fantastic. This is a great opportunity for you to make some real changes that will improve your health and your well-being. Let me sort out the number of the local service for you, and they can chat to you about what the best type of nicotine replacement therapy would suit you best. Oh, and do let me know how you got on, I would be really interested to know...." (Opportunity)