Biopsychosocial care and the physiotherapy encounter: physiotherapists’ accounts of back pain consultations

BMC Musculoskeletal Disorders

Bie Nio Ong¹  Annette Bishop¹  Nadine E Foster¹  Tom Sanders¹ 

[1] Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, ST5 5BG, UK

关键词: Clinician-patient communication;    Biopsychosocial;    Back pain;    Physiotherapy;   

Others  :  1133992
DOI  :  10.1186/1471-2474-14-65

 received in 2012-11-13, accepted in 2013-02-18,  发布年份 2013

【 摘 要 】

Background

The physiotherapy profession has undergone a paradigmatic shift in recent years, where a ‘biopsychosocial’ model of care has acquired popularity in response to mounting research evidence indicating better patient outcomes when used alongside traditional physiotherapy. However, research has not examined how this new dimension to traditional physical therapy is implemented within the therapeutic consultation.

Methods

The study aimed to investigate physiotherapists’ reported approaches to back pain care in the context of increasing pressure to address patients’ psychosocial concerns. A secondary analysis of semi-structured qualitative interviews with 12 UK physiotherapists was conducted. Respondents were sampled from a national survey, to include a broad mix of physiotherapists. Data were analysed thematically, adopting the constant comparative methodology.

Results

The combination of traditional physical therapy with a broader biopsychosocial approach presented significant challenges. Physiotherapists responded by attempting to navigate patients’ biopsychosocial problems through use of various strategies, such as setting boundaries around their clinical role and addressing lay health beliefs of patients through the provision of reassurance and lifestyle advice.

Conclusions

As psychosocial issues, alongside biomechanical factors, command a prominent place within the back pain consultation, physiotherapists may benefit from further specific training and mentoring support in identifying specific strategies for combining the best of traditional physiotherapy approaches with greater focus on patients’ beliefs, fears and social context.

【 授权许可】

   
2013 Sanders et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D: Low Back Pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.
• [2]Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Preferences of patients for patient centred approach to consultation in primary care: observational study. Brit Med J 2001, 3221:1-7.
• [3]Liddle SD, Baxter GD, Gracey JH: Chronic low back pain: patients’ experiences, opinions and expectations for clinical management. Disabil Rehabil 2007, 29(24):1899-1909.
• [4]The Health and Social Care Bill: Greater Voice for Patients[http://www.dh.gov.uk/healthandsocialcarebill] webcite
• [5]Slade SC, Molloy E, Keating JL: The dilemma of diagnostic uncertainty when treating people with chronic low back pain: a qualitative study. Clin Rehabil 2011.
• [6]Parsons S, Harding G, Breen A, Foster N, Pincus T, Vogel S, Underwood M: The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain 2007, 23(1):91-98.
• [7]Savigny P, Watson P, Underwood P, on behalf of the Guideline Development Group: Early management of persistent non-specific low back pain: summary of NICE guidance. Brit Med J 2009, 338:1441-1442.
• [8]Verbeek J, Sengers MJ, Riemens L, Haafkens J: Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004, 29:2309-2318.
• [9]Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C: The course of low back pain in a general population. Results from a 5-year prospective study. J Manip Physiol Ther 2003, 26(4):213-219.
• [10]Pincus T, Foster NE, Vogel S, Santos R, Breen A, Underwood M: Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp. Manual Ther 2007, 12:167-175.
• [11]Frantsve LME, Kerns RD: Patient-provider interactions in the management of chronic pain: current findings within the context of shared medical decision-making. Pain Med 2007, 8:25-35.
• [12]French S, Sim J: Physiotherapy: a psychosocial approach. London: Butterworth and Heineman; 2004.
• [13]Foster NE, Delitto A: Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice–challenges and opportunities. Phys Ther 2011, 91(5):790-803.
• [14]Chartered Society of Physiotherapy: Quality Assurance Standards for physiotherapy service delivery. 2012.
• [15]Jeffrey JE, Foster NE: A qualitative investigation of physical therapists’ experiences and feelings of managing patients with nonspecific low back pain. Phys Ther 2012, 92:266-278.
• [16]Corbett M, Foster N, Ong BN: GP attitudes and self-reported behaviour in primary care consultations for low back pain. Fam Pract 2009, 26:359-364.
• [17]Charmaz K: Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks: Sage; 2005.
• [18]Long-Sutehall T, Sque M, Addington-Hall J: Secondary analysis of qualitative data: a valuable method for exploring sensitive issues with an elusive population? J Res Nurs 2010, 16:335-344.
• [19]Hallowell N: Doing the right thing: genetic risk and responsibility. Sociol Health Ill 1999, 21:597-621.
• [20]Blaxter M: The causes of disease: women talking. Soc Sci Med 1983, 17:59-69.
• [21]Pill R, Stott CH: Concepts of illness causation and responsibility: some preliminary data from a sample of working class mothers. Soc Sci Med 1982, 16:43-52.
• [22]Hay EM, Dunn KM, Hill JC, Lewis M, Mason EE, Konstantinou K, Sowden G, Somerville S, Vohora K, Whitehurst D, Main CJ: A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT Back Study Protocol. BMC Musculoskelet Disord 2008, 9:58. BioMed Central Full Text
• [23]Kinnersley P, Stott N, Peters TJ, Harvey I: The patient-centredness of consultations and outcome in primary care. Br J Gen Pract 1999, 49(446):711-716.
• [24]Savage R, Armstrong D: Effect of a general practitioner’s consulting style on patients’ satisfaction: a controlled study. BMJ 1990, 301(6758):968-970.
• [25]Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM: Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011, 378(9802):1560-1571.
• [26]Langendoen J: The patient-centredness of evidence-based practice. A case example to discuss the clinical application of the biopsychosocial model. Manual Ther 2004, 9:228-233.
• [27]May C, Doyle H, Chew-Graham C: Medical knowledge and the intractable patient: the case of chronic low back pain. Soc Sci Med 1999, 48:523-534.
• [28]Breen A, Austin H, Campion-Smith C, Carr E, Mann E: “You feel so hopeless”. A qualitative study of GP management of acute back pain. Eur J Pain 2007, 11:21-29.
• [29]Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP: A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New Engl J Med 2002, 347:81-88.
• [30]Pincus T, Vogel S, Breen A, Foster N, Underwood M: Persistent back pain: why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists. Eur JPain 2006, 10(1):67-76.
• [31]Potter M, Gordon S, Hamer P: The physiotherapy experience in private practice: the patients’ perspective. Aust J Physiother 2003, 49:195-202.
• [32]Glasziou P, Haynes B: The paths from research to improved health outcomes. Evid Based Nurs 2005, 8:36-38.