A week in my . . . physiotherapy clinic

Obesity

I live in Malahide, Co Dublin, and have worked at Temple Street Children’s University Hospital for almost 10 years.

My research and clinical practice is mainly in the area of childhood obesity and I am director of the W8TOGO Healthy Lifestyles programme, a service that treats children and teenagers with clinical obesity, in conjunction with their families.

It has been running at the hospital since 2005. There are 200 children currently receiving treatment, who range in age from 18 months to 16 years, and we have 100 on the waiting list.

Monday

I am in the final year of a Health Research Board PhD Fellowship into childhood obesity and Monday is a pure research day for me.

The focus of the PhD is on using technology to improve the management of childhood obesity.

It includes a clinical trial of a smartphone app called Reactivate, to see whether children who are using the app are doing as well as those involved in face-to-face follow-up. The app allows users to monitor their eating, drinking, activity and sleeping patterns, as well as to set goals.

It’s a really interesting project and 70 teenagers are currently using it.

I get up at the reasonable hour of 8am. After breakfast, I check emails/post. I will also log in to the app and plan the education and content for users.

The rest of the day is spent writing chapters for my PhD, analysing data for various projects, preparing research papers, and so on. I try to take lunch at the same time each day and get outside for a walk or cycle.

Working from home has its drawbacks and one of those is getting sucked into my computer screen without being aware that it’s no longer lunchtime but now dinnertime.

Tuesday

This is our W82GO clinic day for new patients at Temple Street, so after my cycle to work, our multidisciplinary team meets before our first patients arrive at 9am.

I, or another member of the team (which includes a paediatrician, dietician, nurse and psychologist), meet and greet families as they arrive.

Many of them have travelled from around the country and the children and their parents are often anxious about coming to the hospital, so a friendly smile can really help to get everyone settled.

Sometimes the media coverage of childhood obesity is very unhelpful, and children and their parents can be discriminated against, so it is our job to put the family at ease and let them know our team is there to support them in every way we can.

Often the first reason parents will look for help is they might find it difficult to get a school uniform that fits. Otherwise the child could have problems at school with bullying or problems with breathing and pain.

About 11 per cent of the kids we see have been severely bullied and they don’t want to go to school. Self-harm is more prevalent in this group than we see in the general child population.

Parents may not be aware of the medical complications caused by weight and they are taken aback when they hear that the child’s cholesterol is up or that their blood pressure is high.

Clinic finishes at lunchtime and the team meets over lunch to agree a treatment plan for each family (they can attend a group programme or have one to one treatment) and to ascertain whether any of the teenagers might be eligible for a smartphone clinical trial.

For the past 10 years we’ve been trying to run the obesity service with a team that is working in lots of other areas in the hospital, but thankfully our research has led to some HSE funding for two half-time posts at the service for the next two years.

In the long term, we need to make sure that there are more staff working exclusively in the service. Obesity is a chronic disease like diabetes or cystic fibrosis, but it’s not really seen that way.

Wednesday

I have a physiotherapy clinic where children eligible for our smartphone trial come for fitness testing before they start [the trial] and after they finish. Fitness is probably one of the best measures to indicate overall health.

During their appointment, I will learn whether the child or teenager is getting their recommended 60 minutes of daily activity.

I screen the child for any physical barriers to exercise and activity, for example hip pain, knee pain or breathlessness, and may need to treat these barriers before the child joins our programme.

I use a treadmill test to monitor the child’s exercise tolerance. They usually love this bit as they get to wear heart-rate and oxygen monitors and feel like athletes preparing for a competition.

Wednesdays are busy as I have patients until 4.30pm and at 5.30pm we have our group programme, where the children do physical education (PE) and where they and their families learn how to read food labels and to shop healthily.

One of our main objectives would be to get people to omit sugar-sweetened drinks such as sports drinks from their diet, as they are of no nutritional benefit at all to children.

I check our app and send content and by 8pm, I’m on my bike cycling home.

Thursday

This is another research day where I focus on the smartphone trial, analyse data and spend one to two hours in the evening on research or advocacy meetings.

I may travel to Cork or Belfast to meet my academic supervisors, Prof Ivan Perry (UCC) or Prof Mike Clark (QUB).

I might have a phone or online meeting with the Association for the Study of Obesity on the Island of Ireland (ASOI) Committee.

Friday

On Friday I usually commute by train and walk to work.

I used to use the Dublin Bikes, but I cannot cycle around the city advertising a product that is useless for children’s health and wellbeing. (The Dublin Bikes scheme is sponsored by a soft-drinks company.)

I have another physiotherapy clinic on Fridays for teenagers, most of whom are using the smartphone app, and the day is filled with either assessments or treatment sessions.

I schedule new participants for the smartphone trial and spend some time showing those randomised to use the app how it works.

I also try to keep an eye on our operating budget and our short- and long-term plans for the service.