Introduction to the Duffy-Rath System©

(“Linking Treatment & Prevention for Musculoskeletal Self-efficacy”)

Brief Description of the Course:

This is an online workshop designed for licensed physical therapy and rehabilitation professionals. It is the introductory course for those clinicians interested in learning the Duffy-Rath System© (DRS) for assessment, treatment and prevention of activity-related musculoskeletal disorders (ARMSD) and disability. This course is a pre-requisite for clinicians to participate in the remaining five workshops in our musculoskeletal series.

DRS is an interactive assessment-reassessment system designed to promote musculoskeletal self-efficacy. Our mission is to contribute to moving healthcare for activity-related musculoskeletal disorders (ARMSD) from a treatment to a prevention paradigm.

Upon registration the participant is provided access to a comprehensive manual consisting of over 200 PowerPoint slides to view and/or download one section at a time (there are 4 sections). Participants are provided up to eight weeks to study the course material and must pass a quiz at the end of each section (score ≥ 80%) to receive CE credits for successful completion. The quiz is open-open they are given multiple opportunities to the pass each section. A new textbook is available for purchase for more in-depth information (click here).

Goals for the Workshop Series: Promote the adoption of an objective, evidence-based approach to activity-related musculoskeletal disorders that fosters musculoskeletal self-efficacy skills, prevention of disability and impairment, and behaviors that maintain safe and acceptable lifelong physical performance capability.

Introductory Workshop Goals: Provide the preparatory information to learn the Duffy-Rath System© (DRS) approach to assessment, treatment and prevention of activity-related musculoskeletal disorders (ARMSD).

Workshop Instructional Objectives – upon completion participants will be able to:

1. Identify prevalence rates and risk factors for the most common musculoskeletal disorders; distinguishing onset, medical reporting, disability and chronic pain factors.
2. Analyze evidence for reliability, validity and applicability of musculoskeletal examination and diagnostic procedures.
3. Identify key components for an accurate, effective, and efficient patient ‘history-taking’; focused to root cause(s) and linked to facilitating self-efficacy.
4. Identify key elements of a basic orthopaedic examination for each musculoskeletal region and basic interpretation of positive findings; observation/inspection, neurologic testing, motion assessment, MMT/contraction assessment and auxiliary testing.
5. Identify and distinguish the three stages of musculoskeletal disorders (MSD): a) warning signals, b) non-specific stage and c) specific (pathological) stage.
6. Identify and match the patient’s status and response to the history and examination to an appropriate initial treatment strategy, including: expectations for PT utilization, progression of strategy and clinical outcome.
7. Identify key elements that enhance patient compliance with home instructions and promote musculoskeletal self-efficacy; relevant to habit change, self-determination and long-term physical performance capability.
8. Identify the four steps to recognizing cautions and contraindication to physical therapy treatment; in general and specific to regional ARMSD.
9. Identify basic components for outcome assessment in daily clinical practice; including factors that predict rapid, slow or no response to the DRS approach.

Course Description and Outline

The Duffy-Rath System© is based upon the clinical ability to accurately identify and effectively address the patient’s most relevant clinical findings with a focus to building patient self-management skills for long-term results. The ability to do this is dependent upon the clinician’s assessment and communication skills that starts at the first visit and continues through to the point of discharge. This workshop provides the clinician with the scientific background, the clinical orientation and identifies the basic components critical to learning the Duffy-Rath System© process; i.e. a biopsychosocial model of action.

Workshop Components:

The course is divided into 12 sections (chapters). The participant is provided a comprehensive notebook to read and use as a resource throughout the course. The course involves following an interactive PowerPoint presentation online and taking periodic tests to assess comprehension; each test requires a grade ≥ 80% to progress – participants are given multiple opportunities to pass each test – it is an ‘open-book’ format.

Chapter

Brief Description
Orientation

(7 pages)

Orients the participant to the course structure and requirements for successful completion.
1- Introduction

(13 pages)

Review course outline, goals, objectives and structure.
Define the three phases of musculoskeletal prevention.
Define basic concepts (axioms) of the Duffy-Rath System© (DRS) and review research evidence for the approach.
Review the PRIMA statement for transparency in systematic reviews and meta-analyses.
2- Musculoskeletal Epidemiology

(10 pages)

Review the STROBE statement.
Prevalence rates, risk factors and natural history relevant to the onset, medical reporting, disability and chronic pain associated with the most common MSD.
Identify and describe the importance of the biopsychosocial model to the assessment, treatment and prevention of MSD and disability.
3 – Research Methodology and Diagnostic Testing for Activity-related MSD

(12 pages)

Review the STARD statement.
Identifies the process and sequence of investigating the diagnostic accuracy of musculoskeletal examination and diagnostic testing.
Identify and discuss gold standards relevant to ARMSD.
Identify and discuss issues related to socioeconomic, clinical and psychosocial impact of diagnostic labeling.
4 – Pain Physiology, Definitions & Classification

(18 Pages)

Provides definitions of applicable pain terms according to IASP.
Review current concepts regarding acute vs. chronic musculoskeletal pain. Identify and discuss Loeser’s conceptual model of pain and the “Glasgow Illness Model”.
Provide an update for chronic widespread pain and complex regional pain syndrome type 1 and 2.
Define and identify relevance of fear avoidance behavior (kinesiophobia), central sensitivity and application modern neuroscience approaches.
Post-test SECTION 1 25 Multiple Choice Questions (“Open-book” test with multiple opportunities to pass prior to continuing on with the course)
5 – Musculoskeletal History-taking

(28 pages)

Identify the critical role of the history-taking process to effective treatment, building patient self-efficacy, setting appropriate functional goals and identifying cautions and contraindications. The focus is to key questions, how to avoid leading the patient, and effective time utilization. The use of self-rated pain and function measures reviewed and gold standards identified for the different musculoskeletal regions. Clinical expectations and correlations to the basic examination reviewed.
 6 – Basic Muscoloskeletal Examination

(26 pages)

Identify the critical role of a basic orthopaedic examination to identify the most relevant signs and predict the structural source of the patient’s symptoms. This includes correlating the examination findings to the history for proper classification of the MSD. The role of adjunct testing is covered; cautions and contraindications reviewed; effective time utilization and how to connect the examination to building patient self-efficacy.
 7 – Initial Assessment Conclusions 

(16 pages)

Evidence for and against the following conclusions is identified and reviewed:
– Specific versus non-specific diagnosis
– Clinical state of the patient (irritable to stable)
– Mechanical verses non-mechanical patterns of response
– The DRS response-based conclusion groups
– Expectations for treatment and choosing a starting point for treatment.
 Post-test SECTION 2  25 Multiple Choice Questions (“Open-book” test with multiple opportunities to pass prior to continuing on with the course)
 8 – Manual Therapy Guidelines

(29 pages)

– Historical review, “primum non nocere”, definitions.
– Procedures for assessment of response and the ‘progression of force’ concept (McKenzie)
– Guidelines for safe and effective application of joint and soft-tissue mobilization, combined performance techniques and high velocity thrust.
– Introduction of a system to learn, problem-solve and grade manual therapy techniques.
 9 – S/P Trauma Guidelines

(29 pages)

– Biology of healing and repair.
– Blunt trauma to neck; Glasgow Coma Scale, Canadian C-spine Rule and NEXUS low risk criteria.
– QTF Whiplash Associated Disorders
– Blunt trauma to thoracic and lumbar spine
– Blunt trauma to the shoulder; Hill-Sachs, Bankart, Clavicular and Rockwood grading system for ACJ.
– Trauma to the elbow and wrist; including carpal instability and TFCC lesions.
– Lower limb trauma
 10 – Cautions & Contraindications

(13 pages)

-Definition, incidence and literature review related to red flags (contraindications) and yellow flags (cautions).
-3-step process of identification
-S/P trauma, undiagnosed or recurrent diseases, specific progressions of MSDs, psychosocial factors, medication side effects comorbidities and other factors.
 Post Test SECTION 3  25 Multiple Choice Questions (“Open-book” test with multiple opportunities to pass prior to completing the course)
 11 – Treatment, Reassessment & Problem-solving

(21 pages)

Identify six treatment strategies that address the spectrum of ARMSD, including: indications for correct matching, progressions and changes of strategy, PT utilization and outcome expectations. Review this third step to identifying cautions and contraindications, and decisions to refer the patient for further diagnostic or therapeutic help.
Identify a process for reassessment to maximal results in the most efficient timeframe and utilization of service. Principles and guidelines for problem-solving the most common obstacles to patient recovery – examples of common problems with solutions provided.
 12 – Discharge & Long-term Efficacy

(17 pages)

 Review of how the influence of the patient’s experience from start to finish can influence their long-term function. Overview of discharge instructions aimed towards prevention of recurrence and preservation of physical performance capabilities. Identifies prevention (primary, secondary and tertiary) as the primary goal for healthcare, including: patient compliance issues, self-determination theory and self-efficacy research. Reviews basic components of outcome assessment.
 References

(19 pages)

 Provided for the 12 sections of the course.
 Post-test SECTION 4  20 Multiple Choice Questions (“Open-book” test with multiple opportunities to pass prior to completing the course)
 Course Conclusion Summarize learning experience and the next courses in the workshop series.
Course Critique and Certificates Once successfully passes the examination a course certificate is provided after a critique of the course has been submitted. This is emailed to the participant in a pdf file format.