Jim Hopkins had been around the health care system. Three years ago, he was diagnosed with sarcoma on the exterior of his right knee.
Eight surgeries and two years later, he was still having trouble walking up and down stairs, his leg constantly throbbing. His issues with his leg caused chronic back pain. He tried physical therapy, which helped, but the experience was unpleasant.
He was referred to the Osher Center for Integrative Health at Vanderbilt, where he met physical therapist Amy Larkin and a new approach to physical therapy. Larkin recently completed the Vanderbilt Health Coaching Program course to become a health coach — a health care professional who has taken additional training in the science of supporting patients to change behavior.
She is one of the first at Vanderbilt to integrate health coaching into physical therapy, and Hopkins said it made a big difference in his recovery.
“Health coaching focuses on the relationship between the health coach and the patient, and the patient is in charge,” Larkin said. “The patient makes the decisions, and the health coach is not telling the patient what to do but providing guidance, asking questions to help the patient have their own insight and to figure out what is the best action to take.”
Hopkins, 72, of Nolensville, Tennessee, said Larkin made him feel personally involved in his care since he began receiving weekly therapy from her starting in April.
“She was always asking me about what my emotional state was, did I have any strong feelings one way or the other, was I happy with the progress, anything we need to tweak. She was always looking for my input,” he said.
“She’s not telling you what to do; she’s making strong suggestions with an explanation. Don’t just do this, but if you should do this, then here’s why.”
When Hopkins started his therapy, he was feeling pretty low. He had been riding motorcycles for more than 50 years. Now he wasn’t able to do what he loved, and was “pretty inactive.”
“I tried hard to form a connection with him,” Larkin said. “I listened to what he likes to do, what his hobbies are, what he can do, what he can’t do, what frustrates him, what makes him happy, what makes him smile,” she said. And then she tailored weekly exercise goals.
Larkin never asked yes or no questions, Hopkins said. She would push him to do strengthening exercises, teaching him to stop once he met a certain pain threshold. “She was really, really good in explaining the whys and the wherefores of the exercises she introduced me to,” Hopkins said.
Larkin, a physical therapist at VUMC for five years, learned these techniques through VUMC’s 18-month Health Coaching Program. The program is open to a variety of health care professionals; her cohort included nurses and nurse practitioners.
“It is so exciting to see diverse health care professions like physical therapy utilizing coaching skills, getting better outcomes and more satisfaction from their work,” said Ruth Wolever, PhD, NBC-HWC, professor of Physical Medicine & Rehabilitation and director of Vanderbilt Health Coaching. “We train medical providers and just about any allied health professionals you can think of. The health coaching skill set is relevant whenever the care involves an interpersonal relationship, and the patient’s behavior is important to healing.”
Larkin is now pursuing the last step in the program, taking the certification exam from the National Board for Health & Wellness Coaching (NBHWC). She said it has radically changed how she approaches physical therapy with her patients.
“Changing the way that we communicate with patients can make or break a patient experience,” she said. “It has a huge impact, the way that we listen to the patient, make them feel heard. Making sure that they feel that we’re listening, understand and are empathetic with their situation is huge, and it really is a big component to helping patients get better and improving the outcomes that each of us as a clinician and as a health care provider wants.”
Bit by bit, Hopkins’ mobility improved, and he was discharged from Larkin’s care in September. That same month, he completed a weekend trip on his motorcycle to Birmingham, Alabama, walking a lot, too.
He came to realize through his sessions that he isn’t returning to exactly the same physical state as before his sarcoma, but he is doing much better than he was at his worst.
“They’ve kind of changed my mindset,” he said of the Osher Center. “I’m not looking for temporary illumination; I’m now looking at a long-term management/acceptance.”
