• Visit the attendees web-page and follow the steps to check your technology (microphone and camera in particular).  Contact the team at GLAD.Australia@latrobe.edu.au if you’d like to check things with someone else.
• Open links and documents beforehand (all you will need is either on this page or the attendees web-page).
• Try to avoid busy backgrounds and over-lighting when on-camera, especially for discussions and conversations.
• Attend the meeting/session from 10 minutes prior to the start.  Webinars don’t offer any private discussion once the session opens, and attendees get anxious if left waiting (and start ringing, emailing etc).  We will open sessions 5 minutes prior to the start time to allow for attendees to make technical adjustments and call for help.  If tutors need to have discussions once a prac session opens, we can allocate you to a breakout room.
• Here is a link to some good online meeting etiquette tips; not all applicable or appropriate but good to keep in mind.

In-person session at La Trobe University

• Jo Kemp (am)
• Christian Barton (am)
• Sally Coburn (am)
• Jane Rooney – 9.30-1.30
• Zuzana Perraton – 11.30-4.30
• Matt Francis – all day
• Ali Gibbs – 1.30-4.30
• Karen Dundules – all day

Module 1: Lectures – Friday 15 November 2024 (9.30am – 5.30pm, AEST)

Module 2 and 3: Saturday 16 November

Link to Current Versions of Presentations – Please do not edit here.  Send feedback, suggestions or amended presentations to Karen at GLAD.Australia@latrobe.edu.au.

Recorded Talks:

Full Library of Recorded Course Presentations

Module 1 (Theory Lecture session) Zoom link: https://latrobe.zoom.us/j/88604466184

Module 2 (Online prac sessions) Zoom link: https://latrobe.zoom.us/j/88356494756

Module 3 (Implementation session) Zoom link: https://latrobe.zoom.us/j/88604466184

PROGRAM HANDBOOK

Only a few pages, so you may wish to print it off.

PROGRAM MANUAL

Updated October 2023

Attendees Course Page

Clinicians’ Dropbox

OARSI Physical Tests

TREK NeMEx Site

• Ask participants to name their devices according to their own name and all present at that device.
• Reinforce that cameras should be on but can be switched off if there are issues – just let the host know in the chat.
• Introduce tutors and any observers.
• Highlight course webpage and resources found there
• Participant introductions will take place in breakout rooms
• If issues with camera/audio – can use a phone as a second device which can be added to the same breakout room

Please use the first breakout session (and more if needed) to assess the dynamics of the group and decide whether it would be better to redistribute people.  We work on the principle of 3 to 5 people per room (2 rooms per tutor).

• Go through presentation
• OARSI videos – direct links also embedded in presentation
• Demonstrate hop for distance (optional) – video here https://youtu.be/Gxs5nVnE4Yg – may add into presentation
• Breakout rooms – 7 minutes: Introductions and practice chair stand test (and record highest scores!)
• Questions and who got the highest score!

• Introduce the session – reminder that there are 2 formal education sessions but there will also be conversations 1:1 in consultations or during exercise sessions.
• Start Presentation
• Slide 2: Reminder about GLA:D Education
• Slides 3 and 4 are repeated from the lecture, as are the case scenarios.
• Slide 5 is new version of slide 4
• Slide 6 is from lecture – tips to go through
• Slide 7 highlights resources – GLA:D presentations, RACGP guidelines, Trek Education website, infographics.
• Then break out into groups and use the resources to role play the case scenarios – one at a time ie feed back in between each one. 10 minutes is allocated for each case scenario.
• MAKE SURE EACH ROOM APPOINTS A SPOKESPERSON FOR EACH BREAKOUT SESSION.
• Get each group to report back on a key observation or learning from their role playing, spend some time talking through the range of conversations that could be had with each scenario.
• Break out again with the common questions – allocate set 1 or set 2 to each group – role play again or discuss a question at a time (their choice) and use the Education tips to help improve the conversations. 10 minutes allocated for this activity.
• Come back and get each group to say something they did differently or that was useful or important.
• Go through tricky questions in big group.
• Perhaps now get people to pop in the chat one thing they will practice differently after the session.

Additional Tool: Teach Back

This is an excellent tool for 1:1 behaviour change work.  Here are a couple of 5-minute videos that highlight it https://youtu.be/d702HIZfVWs  https://youtu.be/cllXBnHBiD4 – it’s really straightforward but very effective and can be used with goal setting too to get a mutual understanding of next steps.

Here is a handout on using Teach-Back from the Centre for Ethnicity and Health: CEH_Teach-back

• Share NeMEx program on-screen – attendees can refer to manual or the link in clinicians’ dropbox
• Go over pain monitoring, warm-up. Both sides is the goal, although maybe not initially – may focus just on most affected joint/side, or least affected if irritability is an issue.
• Highlight – program is not a ‘recipe’, but is a framework.  Exercises are personalised to the individual (560 “group” vs 561 “class”).  Important to ‘breed success’ through using clinical judgement for progression.  For GLA:D program, theraband should be used – portable and good for home.  Machines are progressions after program.
• Timing for breakout sessions:
  • Core strength 7 minutes
  • Sliders 10 minutes
  • Hip/Knee strength 8 minutes
  • Functional 5 minutes
• Plenty of time for discussion in between breakout sessions

Guidance questions for NeMEx practice – things for clinicians to consider during breakout sessions: (word doc)

1. Core: Q1: How could you modify exercises if the patient finds it difficult to get down and up off floor? Q2: How could you modify the bridging exercises if the patient starts complaining of back pain?
2. Sliders: Q1: How can you modify/alter exercise if the patient has really poor balance?
3. Strength: Q1: How can you modify/alter theraband exercises for abd/add if patient starts complaining of hip and/or knee pain (or an increase)? Q2: How can you modify knee E exercise if a patient complains of PFJ/knee pain in the last 15 degrees of extension?
4. Functional: Q1: How can you modify/alter exercises if patient has balance issues with stairs? Q2: Often patients will have difficulty with steps/stairs. Other than within the home where else may they have difficulty with stairs (e.g. tram/bus), refer to your own clinical experience and what patients have told you in the past?

Issues that may be raised – don’t go through all of these (time is not likely to be enough) but be ready to respond if they are raised:

1. Trunk strength: cover continence issues, acute LBP, osteoporosis (if it is raised by attendees – otherwise no need), getting on/off floor benefits – backward chaining
2. Sliders/Lunges: progressions use level of support / stability vs instability / range of motion. Monitor knee flexion / HKA alignment. Highlight working leg as per picture. Can start with backwards lunge. Main focus is dynamic control. Use a mirror, XR slider or substitute eg ice cream lid, laminated page.
3. Hip/Knee strength: Hip abd – if too hard, keep toes on floor; stand supporting leg inside the band too. Hip add – don’t cross midline; use a small raise to elevate stance leg to stop risk of dragging moving leg; big jump L3-4 (Copenhagen) rare progression but can shorten lever; L4 can flare up pes anserinus, shoulder issues; can get same EMG activity in adductor longus with band as with Copenhagen so don’t have to progress to that. Hips – Use antr/postr pelvic tilt to adjust. Knee fl – knee below hip rather than above to reduce hip hitching and hip flexor overload; sit forward on chair to reduce potential pressure on bursae; if band irritating AT, can loop around heel of shoe. Knee ext – show NeMEx video for looping theraband around foot (39 sec onwards). Can start as isometric if needed eg PFP.
4. Functional: Sit to stand – monitor alignment, use ball/theraband, consider pelvic position, can progress to single leg. Step – use mirrors and broomstick to help with alignment, step down onto a book to decrease load on PFJ.

Worksheet for participants – this is also in the Clinicians’ Dropbox under Exercise Resources, in the Manual and linked under Module 2 on the course web-page
Updated presentation – content is all in the worksheet
Day 1 Goal Setting presentation – for your reference

Guide to presentation: (there are additional notes with the presentation)

Slide 1. Remind about the importance of goal setting to guide exercise prescription and progression in the longer term, which was covered at the end of Day 1. GLA:D is a great starting point and addresses key impairments in people with hip and knee osteoarthritis, but clinical reasoning can help keep patients progressing.

2.Discuss exercise progression and regression using pain and RPE as guide (the relevant slide will guide you)

3-5. Discuss differences in prescription of endurance, strength and power

6-7. Go back over the case examples of goals from Day 1 – they were set some homework related to this case. First review choice of exercise (see points 5-7). Then you will discuss prescription specifics to achieve goals which they were asked to have a go at.

8-9. Revision from Day 1: first goal – “Be able to step up and down to get on and off the tram within 3-months.”

• Suggestions = Functional strength – step up/down, focus on the task that is problematic;
• Knee strength, continue to build and exercise that is already familiar to the patient which will help; and
• Hip strength, continue to build and exercise that is already familiar to the patient which will help. Another key option could be to add hip extension strength

8. Revision from Day 1: second goal – “Walk down the street (500m flat ground) without stopping and without fear of falling in 3-months”.

• Suggestions = keep things simple. You could keep the same exercises as for Goal 1, but have a greater emphasis now on power. Muscle power is particularly important for falls prevention.
• Remember muscle strength is the ability of the muscle to generate force. Muscle power is the ability of the muscle to generate force quickly. So you can do the same exercise as you would for strength, but add speed to the movement (and consider lightening the load)

9. Revision from Day 1: Stay on the second goal. “Walk down the street (500m flat ground) without stopping and without fear of falling in 3-months”.

• The GLA:D® program will not address all needs to optimise the chance to achieve this goal.
• Suggestions = There are many things we could added, but an important consideration for falls is calf strength. Aerobic capacity will be vital to improve Mrs A’s ability to walk down the street. Due to persistent fear avoidance, she is likely to be very deconditioned.

Now get participants to discuss what their prescription specifics were for each exercise – if time do this for 5-8 minutes in small groups. If running out of time, then do it all together in the main room.

10. Final slide is an optional worksheet they can use for home work if they wish, or you can begin discussing if still time.