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Leung L, Mandrusiak A, Martin R, Ma TW, Forbes R. Prescribing exercise therapy for the management of musculoskeletal pain: new-graduate physiotherapists' perceptions and perceived training needs. Physiother Theory Pract 2024; 40:2321-2330. [PMID: 37534976 DOI: 10.1080/09593985.2023.2242461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Pain management is a challenging area of practice for new-graduate physiotherapists during the transition from student to clinician. The attitudes and beliefs of new-graduate physiotherapists toward the use of exercise therapy as part of the management of musculoskeletal pain remain relatively unknown. PURPOSE The aim of the study was to investigate the perspectives of new-graduate physiotherapists toward prescribing exercise therapy in musculoskeletal pain management, and their perceptions of training and support needs in this area of practice. METHODS A qualitative study with a general inductive approach was used to investigate new-graduate physiotherapists' perspectives. Semi-structured interviews were conducted with 16 participants. Interview data was subjected to thematic analysis. RESULTS Four themes were generated following analysis: 1) Balancing the value of exercise with practical challenges; 2) Communication and education are inherent in exercise; 3) Influence of support and training; and 4) The benefits of direct experience. CONCLUSION New-graduate physiotherapists acknowledge the pivotal role of exercise in managing musculoskeletal pain. Direct learning experiences in pre-professional training that develop knowledge and skills required for delivering exercise therapy were highly valued. New-graduates recognize pain management as a skill that requires further development and identify the importance of opportunities for professional development in exercise therapy.
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Affiliation(s)
- Letizia Leung
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Romany Martin
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Tsz Wun Ma
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Brindisino F, Sciscione S, Andriesse A, Cioeta M, Struyf F, Feller D. Frozen shoulder: subjects' needs and perspectives and clinicians' beliefs and management strategies: do they align? A cross-sectional study. BMC Musculoskelet Disord 2024; 25:745. [PMID: 39289654 PMCID: PMC11406753 DOI: 10.1186/s12891-024-07803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. AIM This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. METHOD This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. RESULTS A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. CONCLUSION This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | | | - Arianna Andriesse
- Medical Translation Private Practice c/o Andriesse Medical Translator, Lecce, Italy
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Daniel Feller
- Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy
- Centre of Higher Education for Health Sciences of Trento, Trento, Italy
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Barradell S, Scholten I. How, and to what end, is the WHO-ICF framework represented in physiotherapy? Insights from a qualitative research synthesis. Physiother Theory Pract 2024:1-18. [PMID: 38938207 DOI: 10.1080/09593985.2024.2370345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND It has been two decades since the World Health Organization's endorsement of the International Classification of Functioning, Disability and Health (ICF). It is timely to undertake a rigorous search that analyzes the discourses around the ICF's conceptual framework within physiotherapy, the kinds of enquiry to date and the professional areas where this is happening and how. PURPOSE The aim of this research is to synthesize the literature related to how the physiotherapy profession (practice, research and education) thinks about and puts to use the WHO ICF. RESULTS A final sample of 37 papers was agreed. Five overarching third-order interpretations were derived: (i) A way of thinking and practicing, (ii) Endorsed but not embedded, (iii) Striking a balance, (iv) Power of participation and (v) Moving forward. Together, these themes illustrate the evolving role of the ICF in physiotherapy over the previous two decades. They highlight the ICF's potential for shaping the future of physiotherapy practice, education and research. CONCLUSIONS Work is needed to connect existing literature about the ICF and related models and embed the ICF, its language and philosophy across physiotherapy education and practice. Re-representation of the model might help address misinterpretation of the ICF, but fundamentally, embedding the ICF in entry-level curriculum is likely to be the most significant driver of change in practice.
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Affiliation(s)
- Sarah Barradell
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ingrid Scholten
- Speech Pathology & Audiology, Flinders University, Adelaide, SA, Australia
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Barradell S, Peseta T. What can physiotherapy learn by looking more closely at 'how' research insights come about? The role of reflexivity and representation. Physiother Theory Pract 2024:1-11. [PMID: 38888095 DOI: 10.1080/09593985.2024.2368604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
In this paper, we draw on an example of heuristic inquiry - (Re)imagining becoming a physiotherapist: a phenomenological approach - to illustrate the role that reflexivity and representation can play in physiotherapy research outcomes and the meaning they might have for moving the profession forward. Qualitative research in physiotherapy tends to acknowledge reflexivity as a route to objectivity by making researcher biases overt, yet the debate about data representation (a researcher's decision-making about how data are represented in a text) barely feature. This contrasts with qualitative research in other fields, including other health professions, where matters of representation (i.e., how knowledge is conveyed) are routinely debated and contested. Reflexivity, in fact, is much more than being transparent. Together with representation, reflexivity helps to position both the voices of participants and researchers within the research. The heuristic inquiry described in this paper offers new insights about learning to be a physiotherapist; it challenged assumptions about care in physiotherapy practice and it changed the first researcher's identity and practice. These insights were generated through the synergies between reflexivity and representation, and we argue that physiotherapy research has an opportunity to be more expansive by taking a commitment to reflexivity and representation more seriously.
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Affiliation(s)
- Sarah Barradell
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Tai Peseta
- Educational Partnerships and Quality Portfolio, Division of the DVC Education, Western Sydney University, Sydney, Australia
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Cueto-Galdames B, Cifuentes M, Vedovo F, Sacomori C. Cross-Cultural Adaptation and Face Validation of the Chilean Version of the Operated Male to Female Sexual Function Index. Int Urogynecol J 2024; 35:1271-1280. [PMID: 38753049 DOI: 10.1007/s00192-024-05805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/08/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Transgender and gender-diverse people often experience discrimination or even outright exclusion when undergoing medical attention. It has been shown that gender-affirming treatments improve quality of life in transgender patients, and genital-affirming surgery (GAS) is increasingly spreading worldwide. Sexual function after male-to-female GAS has long been evaluated by using tools designed for assigned female at birth (AFAB), resulting in suboptimal assessments. Currently, the operated Male to Female Sexual Function Index (oMtFSFI) is the only validated questionnaire to assess the sexual function of operated transgender women. The current study was aimed at performing cross-cultural adaptation and to test the face validity of the Chilean version of the oMtFSFI. METHODS We carried out an observational descriptive study. The questionnaire was translated into Spanish, adapted, and face validated in five phases with eight participants. The study was approved by the Universidad del Desarrollo Scientific Ethics Committee. RESULTS According to participants, the questionnaire was shown to both pertinently and exhaustively evaluate the sexual function of post-feminizing genitoplasty transgender women. The questionnaire was well understood by the participants, except for a difficulty in understanding certain terms. Some participants criticized the perspective of the instrument in terms of the assumption of having a partner or having penetrative intercourse via the neovagina. The amendments to the Italian version of the questionnaire were discussed until an agreement on adaptation considering the patient´s perspective was reached. The present preliminary data support the face validity of the Chilean version of the oMtFSFI in the assessment of sexual function in operated transgender women. CONCLUSIONS This adapted questionnaire could be a valuable tool for clinicians and researchers.
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Affiliation(s)
- Betzabe Cueto-Galdames
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Santiago, Chile
- Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | | | - Francesca Vedovo
- Department of Medical, Surgical and Health Science, Urologic Clinic, University of Trieste, Trieste, Italy
| | - Cinara Sacomori
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Santiago, Chile.
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Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap 2024; 32:17. [PMID: 38773515 PMCID: PMC11110311 DOI: 10.1186/s12998-024-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. PURPOSE The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. METHODS A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. CONCLUSIONS Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.
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Affiliation(s)
- Roger Kerry
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Edward Lee
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- Nottingham CityCare Partnership, Bennerley Rd, Nottingham, NG6 8WR, UK
| | - Vasileios Georgopoulos
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA, UK
| | - Adam Meakins
- Department of Orthopaedics, West Herts Hospitals Trust, Watford, WD18 0HB, UK
| | - Chris McCarthy
- School of Physiotherapy, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Chad Cook
- Department of Orthopaedics, Duke University, 200 Morris Street, Durham, NC, 27701, USA
| | - Colette Ridehalgh
- School of Sport and Health Sciences, University of Brighton, Darley Rd, Eastbourne, BN20 7UR, UK
- Clinical Neuroscience, Trafford Building, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Amanda Banton
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | | | - Firas Mourad
- Department of health, LUNEX, Differdange, 4671, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Kurz R, Hebron C. "Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain". Physiother Theory Pract 2024; 40:983-998. [PMID: 36373211 DOI: 10.1080/09593985.2022.2144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.
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Affiliation(s)
- Raffaela Kurz
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Physiotherapy MSK Department, Sussex Community NHS Foundation Trust, Horsham Hospital, Hurst Road, Horsham RH12 2DR, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
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Yirdaw G, Adane B. Self-Reported Work-Related Musculoskeletal Problems and Associated Risk Factors Among Three-Wheel Car Drivers in Ethiopia: A Cross-Sectional Community-Based Study. J Pain Res 2024; 17:61-71. [PMID: 38196968 PMCID: PMC10775692 DOI: 10.2147/jpr.s429147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Background Globally, the demand for mobility is increasing. Three-wheel cars are one of the best options for meeting this demand and creating new job opportunities in most developing countries, including Ethiopia. Drivers are highly susceptible to developing musculoskeletal disorders (MSDs). Even though several studies on other groups of drivers have been conducted, little is done in Ethiopia among three-wheel car drivers. Objective This study investigated the prevalence of MSDs and identified their associated risk factors among three-wheel car drivers in Ethiopia. Methods A community-based cross-sectional research was conducted among drivers of three-wheel cars from August 05 to October 07, 2022. A stratified sampling followed by a simple random sampling technique was used to select 422 respondents. Structured and pretested questionnaires adapted from the Nordic Musculoskeletal Questionnaire were used to collect the data. Epi-data version 4.2.0.0 and SPSS version 20 were used to enter and analyze the collected data, respectively. Results In the previous 12 months, 62.45% of three-wheel car drivers had musculoskeletal disorders in any body region (95% CI: 58.36, 66.14). The back pain was the most frequently reported site of pain in this study. This study showed that the habit of doing physical exercise, work experience, site of service, taking rest breaks while driving, and having comfortable sitting posture was risk factor for musculoskeletal pain. Conclusion In this study, the overall 12-month prevalence of musculoskeletal problems among three-wheel car drivers was high. Periodic health checkups for drivers, lifestyle changes, delivering training, and creating awareness are important to address this high-burden occupation-related problem.
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Affiliation(s)
- Getasew Yirdaw
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Balew Adane
- Department of Environmental Health Science, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Rolland C, Lardon A, Bussières A. Sur la scène des consultations en chiropraxie : une lecture de la relation de soin. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2024; 36:57-67. [PMID: 38834525 DOI: 10.3917/spub.242.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
INTRODUCTION The caregiver-patient relationship has been the subject of numerous studies in the field of medicine, but has received little attention in the context of chiropractic care, particularly in France. PURPOSE OF THE RESEARCH This ethnographic and sociological study aims to gain a better understanding of the characteristics of the chiropractic relationship in chiropractic care through the observation of consultations followed by interviews with both patients and caregivers. These observations were carried out in the Franco-European Chiropractic Institute’s two outpatient clinics and in three private practices. RESULTS The data were collected between October 2022 and March 2023. Most of the patients treated their health as an asset to be preserved or even improved, and had a good knowledge of their body as a tool for work and/or sports performance. They turned to chiropractic care to find relief from their pain and a form of care combining technical and interpersonal skills. Chiropractic care is based on manual therapy, combined with a dimension of self-management by the patient. Follow-up of the exercises and advice given by chiropractors varies greatly from patient to patient, from diligent application to non-application, and with everything in between. CONCLUSION Trust is the foundation of all care, and even more so in manual therapy, because of the way the hands act on the body. To establish a working alliance with the patient, the chiropractor has to adapt his or her professional ethos and accept compromises regarding the treatment plan envisaged. Cooperation between a patient and a chiropractor is based on trust, the negotiation of objectives, and the division of tasks between the two parties.
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Leteurtre C, Cocking C, Novelli D. "Learning by osmosis": the transformative social identity journey of physiotherapists developing psychologically-informed practice, a reflexive thematic analysis. Physiother Theory Pract 2023:1-12. [PMID: 38131314 DOI: 10.1080/09593985.2023.2297290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Despite efforts to support physiotherapists in integrating psychosocial aspects of care to biological ones, clinical practice remains dominated by biomechanistic priorities. To facilitate change, attention and actions need to consider not only the individual level of the therapists but also the cultural and structural levels of the profession. How these multi-layered social dynamics shape practice have not previously been investigated. The Social Identity Approach (SIA) provides a relevant framework to this exploration. AIM This study aimed to identify the social identity processes involved in the development of psychologically-informed physiotherapy (PIP) to understand how they may influence practice change. METHODS Nine semi-structured interviews were conducted with self-identified psychologically-informed physiotherapists. A Reflexive Thematic Analysis informed by SIA principles enabled to consider meaning as the product of social processes. FINDINGS The analysis of participants' experiences in moving from a primarily biomechanistic practice toward the integration of psychosocial aspects of health demonstrated: 1) a transformative "mind-blowing" identity journey; 2) a journey that is not made in isolation; and 3) where leadership matters. CONCLUSION Changes in clinical practice involve dynamics at the collective level of the practice environment and of the physiotherapy profession itself, rather than solely at the individual level of clinicians. An understanding of these complex social processes at a managerial level could be important to better support leaders and clinicians in implementing PIP in clinical practice.
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Affiliation(s)
- Camille Leteurtre
- Medical Specialities Department, INPUT Pain Management, St Thomas' Hospital, London, United Kingdom
| | - Chris Cocking
- School of Humanities and Applied Social Sciences, University of Brighton, Brighton, United Kingdom
| | - David Novelli
- Medical Specialities Department, INPUT Pain Management, St Thomas' Hospital, London, United Kingdom
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Nicholls DA, Vieira A. Physiotherapy, movement, and action. Physiother Theory Pract 2023; 39:2520-2538. [PMID: 35854424 DOI: 10.1080/09593985.2022.2095954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
Movement has always been central to physiotherapy practice and theory. But physiotherapists have largely focused on forms of human bodily movement governed by the neuro-mechanical body system in illness or injury. Many other forms of movement exist though, and we argue here that the exploration of these other movements might give physiotherapists new language, concepts, and tools, to guide its adaptation to forms of healthcare that are becoming increasingly complex, diverse, and inclusive. Drawing on Hannah Arendt's concept of vita activa (or "active life"), we examine how physiotherapists have traditionally captured and defined movement. Critiquing past practices for over-emphasizing what Arendt called labor, and work, we suggest that an approach governed by her concept of action, might offer physiotherapists a way to give movement greater significance. We explore what active life might mean for a revised approach to movement, and highlight examples of vita activa already emerging in physiotherapy. We close the paper by calling for a reevaluation of what movement means for the profession and its clients.
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Affiliation(s)
- David A Nicholls
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Northcote, New Zealand
| | - Adriane Vieira
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande Do Sul, Jardim Botânico, Brazil
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Kleiner MJ, Kinsella EA, Miciak M, Teachman G, Walton DM. The 'responsive' practitioner: physiotherapists' reflections on the 'good' in physiotherapy practice. Physiother Theory Pract 2023; 39:2625-2638. [PMID: 35794693 DOI: 10.1080/09593985.2022.2092567] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Being 'responsive' is named as an element of ethic of care theories, yet how it is enacted is not clearly described in health professional practice. Being 'responsive' is implied within patient-centered approaches and promoted as important to health care practices, including physiotherapy. However, ways of being a responsive practitioner have not been explicitly examined. Practitioners' perspectives about how a 'good' physiotherapist enacts responsiveness have potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, and patient interactions. PURPOSE The purpose of this research was to explore experienced musculoskeletal (MSK) practitioners' perceptions of 'responsiveness' in the practice of a 'good' physiotherapist. METHODS A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of what constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on 'responsiveness,' which emerged as a major theme in the original study. FINDINGS Six themes were identified related to 'Being responsive' in a 'good' physiotherapist: Being person-centered, Being attentive, Being open, Being a listener, Being validating, and Being positive. CONCLUSIONS As a relational way of practicing, being responsive may facilitate person-centered approaches including a relational understanding of autonomy, inviting dialogue, and sharing power and decision-making with patients. Pivotal to the practice of a 'good' physiotherapist, being responsive in the ways underscored by participants suggests researchers, educators, and practitioners consider relational ways of practicing as a balance to the technical aspects of physiotherapy.
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Affiliation(s)
- Michelle J Kleiner
- QuinnRehab, Barrie, ON, Canada
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Elizabeth Anne Kinsella
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gail Teachman
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, London, ON, Canada
| | - David M Walton
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, Elborn College, London, ON, Canada
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Lotz JC, Ropella G, Anderson P, Yang Q, Hedderich MA, Bailey J, Hunt CA. An exploration of knowledge-organizing technologies to advance transdisciplinary back pain research. JOR Spine 2023; 6:e1300. [PMID: 38156063 PMCID: PMC10751978 DOI: 10.1002/jsp2.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic low back pain (LBP) is influenced by a broad spectrum of patient-specific factors as codified in domains of the biopsychosocial model (BSM). Operationalizing the BSM into research and clinical care is challenging because most investigators work in silos that concentrate on only one or two BSM domains. Furthermore, the expanding, multidisciplinary nature of BSM research creates practical limitations as to how individual investigators integrate current data into their processes of generating impactful hypotheses. The rapidly advancing field of artificial intelligence (AI) is providing new tools for organizing knowledge, but the practical aspects for how AI may advance LBP research and clinical are beginning to be explored. The goals of the work presented here are to: (1) explore the current capabilities of knowledge integration technologies (large language models (LLM), similarity graphs (SGs), and knowledge graphs (KGs)) to synthesize biomedical literature and depict multimodal relationships reflected in the BSM, and; (2) highlight limitations, implementation details, and future areas of research to improve performance. We demonstrate preliminary evidence that LLMs, like GPT-3, may be useful in helping scientists analyze and distinguish cLBP publications across multiple BSM domains and determine the degree to which the literature supports or contradicts emergent hypotheses. We show that SG representations and KGs enable exploring LBP's literature in novel ways, possibly providing, trans-disciplinary perspectives or insights that are currently difficult, if not infeasible to achieve. The SG approach is automated, simple, and inexpensive to execute, and thereby may be useful for early-phase literature and narrative explorations beyond one's areas of expertise. Likewise, we show that KGs can be constructed using automated pipelines, queried to provide semantic information, and analyzed to explore trans-domain linkages. The examples presented support the feasibility for LBP-tailored AI protocols to organize knowledge and support developing and refining trans-domain hypotheses.
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Affiliation(s)
- Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | | | - Paul Anderson
- Department of Computer Science & Software EngineeringCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Qian Yang
- Department of Information ScienceCornell UniversityIthacaNew YorkUSA
| | | | - Jeannie Bailey
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - C. Anthony Hunt
- Department of Bioengineering & Therapeutic SciencesUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
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McGrath RL, Shephard S, Parnell T, Verdon S, Pope R. Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review. Physiother Theory Pract 2023:1-31. [PMID: 38009858 DOI: 10.1080/09593985.2023.2284823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope. OBJECTIVE To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress. METHODS A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically. RESULTS 3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management. CONCLUSION While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Sarah Verdon
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Rodney Pope
- Department of Rural Health, University of Melbourne, Shepparton, Australia
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Cormack B, Stilwell P, Coninx S, Gibson J. The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiother Theory Pract 2023; 39:2273-2288. [PMID: 35645164 DOI: 10.1080/09593985.2022.2080130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel's original BPSM. These deviations have led to confusion and suboptimal patient care. OBJECTIVES 1) To review Engel's original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an "enactive" modernization of the BPSM. METHODS Critical narrative review in the context of musculoskeletal pain. RESULTS The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a "humanistic" interpretation based on person- and relationship-centredness. The second version is a "causation" interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations. CONCLUSION The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an "enactive-BPS approach" to musculoskeletal care aligns with Engel's vision yet addresses theoretical limitations and may mitigate misapplications.
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Affiliation(s)
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sabrina Coninx
- Institute for Philosophy II, Ruhr University Bochum, Bochum, Germany
| | - Jo Gibson
- Physiotherapy Department, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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Dillon M, Olson R, Mescouto K, Costa N, Setchell J. How physiotherapists attend to the human aspects of care when working with people with low back pain: a thematic analysis. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:277-293. [PMID: 36632019 DOI: 10.1080/14461242.2022.2161927] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Pain is a multidimensional experience. Physiotherapy has attempted to enhance earlier biomedical approaches to patient care through approaches like the 'biopsychosocial' model. Nevertheless, physiotherapy continues to focus on biomedical and/or behavioural aspects of care. We critically investigated how physiotherapists attend to human (psychosocial, emotional, existential, and moral) aspects of low back pain care. We co-analysed ethnographic data with researchers, patients, and physiotherapists using concepts of conforming, tinkering and abandoning 'scripts'. Data included observations of 28 physiotherapy interactions between 26 patients and 10 physiotherapists and 7 researcher-clinician dialogues. Analysis suggests when conforming to scripts, clinicians have difficulty recognising and responding to emotions; time pressure limited clinicians focus, and a biological focus often distracted from psychosocial aspects of people's back pain experiences. In contrast, tinkering with or abandoning scripts allowed space to broaden the focus. Drawing from theorists such as Butler (1999) and Gibson et al. (2020) our analysis contributes to health sociology, arguing that 'tinkering' with or 'abandoning' scripts can foster more humanistic, flexible and reflexive approaches to care. Although health sociologists have explored tinkering, abandoning is new; within physiotherapy, it encapsulates being able to respond with agility to non-physical elements of care without constraint from traditional ways of thinking and doing.
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Affiliation(s)
- M Dillon
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R Olson
- School of Social Science, The University of Queensland, Brisbane, Australia
| | - K Mescouto
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - N Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - J Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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17
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Hebron C, Juniper J. The lived experience of exercise in persons with depression: A journey to finding a sense of contentment. Physiother Theory Pract 2023; 39:2120-2130. [PMID: 35469545 DOI: 10.1080/09593985.2022.2069063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/02/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is often part of the embodied experience of persons living with pain and other health conditions. In addition to other benefits, exercise has been recognized to reduce depressive symptoms. Physiotherapists help persons to develop multidimensional understanding including an understanding of how exercise can help manage symptoms, and how they can individualize exercise to them. Thus, physiotherapists need insights into how exercise is experienced and meaningfully related to depression. PURPOSE This study aimed to explore the lived experience of exercise in persons with depression. METHODS In this interpretive (hermeneutic) phenomenological study, participants with depression were purposively recruited and data collected via semi-structured interviews. Hermeneutic analysis was used alongside the crafting of hermeneutic stories to reveal the meaning of exercise for these participants. FINDINGS Participants conveyed their experience of exercise as a journey to finding a sense of contentment. Two master themes: 1) Finding the exercise for me; and 2) the experienced importance of the environment, illuminated participants' journey to finding a sense of contentment through exercise. Two subthemes 1) changing sense of self; and 2) building resilience further described participants' experience. CONCLUSION Physiotherapists may reflect on these individual exercise stories and share these insights with persons receiving their care to explore if exercise may help them to find a sense of contentment.
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Affiliation(s)
- Clair Hebron
- School of Sport and Health Science, Univerity of Brighton, Eastbourne, UK
| | - Jack Juniper
- Physiotherapy department Medway Maritime Hospital, Gillingham, UK
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Nicholls DA, Ahlsen B, Bjorbækmo W, Dahl-Michelsen T, Höppner H, Rajala AI, Richter R, Hansen LS, Sudmann T, Sviland R, Maric F. Critical physiotherapy: a ten-year retrospective. Physiother Theory Pract 2023:1-13. [PMID: 37688439 DOI: 10.1080/09593985.2023.2252524] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy's historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the "posts". In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.
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Affiliation(s)
- David A Nicholls
- School of Clinical Sciences, A-12, Auckland University of Technology, Auckland, New Zealand
| | - Birgitte Ahlsen
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Wenche Bjorbækmo
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Tone Dahl-Michelsen
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Heidi Höppner
- Interprofessional Health Care, University of Applied Sciences, Berlin, Germany
| | - Anna Ilona Rajala
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Robert Richter
- Hochschule Furtwangen, Studienzentrum Freiburg, Freiburg, Germany
| | - Louise Søgaard Hansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University, Roskilde, Denmark
| | - Tobba Sudmann
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Randi Sviland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Filip Maric
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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19
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Chau A, Steib S, Whitaker E, Kohns D, Quinter A, Craig A, Chiodo A, Chandran S, Laidlaw A, Schott Z, Farlow N, Yarjanian J, Omwanghe A, Wasserman R, O’Neill C, Clauw D, Bowden A, Marras W, Carey T, Mehling W, Hunt CA, Lotz J. Theoretical Schemas to Guide Back Pain Consortium (BACPAC) Chronic Low Back Pain Clinical Research. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S13-S35. [PMID: 36562563 PMCID: PMC10403312 DOI: 10.1093/pm/pnac196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic low back pain (cLBP) is a complex with a heterogenous clinical presentation. A better understanding of the factors that contribute to cLBP is needed for accurate diagnosis, optimal treatment, and identification of mechanistic targets for new therapies. The Back Pain Consortium (BACPAC) Research Program provides a unique opportunity in this regard, as it will generate large clinical datasets, including a diverse set of harmonized measurements. The Theoretical Model Working Group was established to guide BACPAC research and to organize new knowledge within a mechanistic framework. This article summarizes the initial work of the Theoretical Model Working Group. It includes a three-stage integration of expert opinion and an umbrella literature review of factors that affect cLBP severity and chronicity. METHODS During Stage 1, experts from across BACPAC established a taxonomy for risk and prognostic factors (RPFs) and preliminary graphical depictions. During Stage 2, a separate team conducted a literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to establish working definitions, associated data elements, and overall strength of evidence for identified RPFs. These were subsequently integrated with expert opinion during Stage 3. RESULTS The majority (∼80%) of RPFs had little strength-of-evidence confidence, whereas seven factors had substantial confidence for either a positive association with cLBP (pain-related anxiety, serum C-reactive protein, diabetes, and anticipatory/compensatory postural adjustments) or no association with cLBP (serum interleukin 1-beta / interleukin 6, transversus muscle morphology/activity, and quantitative sensory testing). CONCLUSION This theoretical perspective will evolve over time as BACPAC investigators link empirical results to theory, challenge current ideas of the biopsychosocial model, and use a systems approach to develop tools and algorithms that disentangle the dynamic interactions among cLBP factors.
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Affiliation(s)
- Anthony Chau
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Sharis Steib
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Evans Whitaker
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - David Kohns
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexander Quinter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anita Craig
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Anthony Chiodo
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - SriKrishan Chandran
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Ann Laidlaw
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Zachary Schott
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Nathan Farlow
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - John Yarjanian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashley Omwanghe
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Ronald Wasserman
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Conor O’Neill
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Dan Clauw
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anton Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, USA
| | - William Marras
- Department of Integrated Systems Engineering, Ohio State University, Columbus, Ohio, USA
| | - Tim Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wolf Mehling
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - C Anthony Hunt
- Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, California, USA
| | - Jeffrey Lotz
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
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20
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Li C, Li X, Li Y, Niu X. The Nonlinear Relationship Between Body Mass Index (BMI) and Perceived Depression in the Chinese Population. Psychol Res Behav Manag 2023; 16:2103-2124. [PMID: 37325255 PMCID: PMC10263158 DOI: 10.2147/prbm.s411112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Existing studies on the association between BMI and depression report conflicting results with some demonstrating a positive relationship, while others a negative link or insignificant correlation. Very limited research on the nonlinear relationship between BMI and depression has yet to clarify the reliability and robustness of the potential nonlinearity and whether a more complex association exists. This paper aims to systematically investigate the nonlinear relationship between the two factors applying rigorous statistical methods, as well as explore the heterogeneity of their association. Materials and Methods A large-scale nationally representative dataset, Chinese General Social Survey, is used to empirically analyze the nonlinear relationship between BMI and perceived depression. Various statistical tests are employed to check the robustness of the nonlinearity. Results Results indicate that there is a U-shaped relationship between BMI and perceived depression, with the turning point (25.718) very close to while slightly larger than the upper limit of the range of healthy weight (18.500 ≤ BMI < 25.000) defined by World Health Organization. Both very high and low BMIs are associated with increased risk for depressive disorders. Furthermore, perceived depression is higher at almost all BMI levels among individuals who are older, female, lower educated, unmarried, in rural areas, belonging to ethnic minorities, non-Communist Party of China members, as well as those with lower income and uncovered by social security. In addition, these subgroups have smaller inflection points and their self-rated depression is more sensitive to BMI. Conclusion This paper confirms a significant U-shaped trend in the association between BMI and depression. Therefore, it is important to account for the variations in this relationship across different BMI categories when using BMI to predict depression risk. Besides, this study clarifies the management goals for achieving an appropriate BMI from a mental health perspective and identifies vulnerable subgroups at higher risk of depression.
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Affiliation(s)
- Chao Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Xiang Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Yuming Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Xiaoru Niu
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, People’s Republic of China
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21
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Smart KM. The biopsychosocial model of pain in physiotherapy: past, present and future. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2177792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Keith M. Smart
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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22
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Wingood M, Peters DM, Shea JL, Gell NM. Addressing Physical Activity among Adults 50+: An Ethnographic Study of Physical Therapists. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2095074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mariana Wingood
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Denise M. Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Jeanne L. Shea
- Department of Anthropology, University of Vermont, Burlington, USA
| | - Nancy M. Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
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23
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Unsgaard-Tøndel M, Søderstrøm S. Building therapeutic alliances with patients in treatment for low back pain: A focus group study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 27:e1932. [PMID: 34739185 DOI: 10.1002/pri.1932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE Low back pain is a multidimensional disorder and a biopsychosocial management approach is recommended. However, recent data indicates that physiotherapists mainly focus on biomechanical aspects in treatment and struggle with addressing psychosocial barriers for recovery. We wanted to explore how physiotherapists express their experiences of building therapeutic alliances within a biopsychosocial perspective of low back pain. METHODS Qualitative focus-group interviews were performed with five physiotherapists on two occasions with 6 months in between. Data were analyzed within a hermeneutical perspective with decontextualization and recontextualization, and identification of themes. RESULTS Four main themes were identified from the analyses: (1) An ideal standard: Presence, empathy and applying the biopsychosocial perspective is central for building therapeutic alliance. (2) Time-consuming: Active listening and personally adapted treatment is important and time-consuming. (3) Challenging area: Advanced clinical reasoning is needed to understand and modify complex barriers for recovery. Clinical experience is sometimes necessary to integrate the psychological and social domains into physiotherapy management. (4) The art of balancing: Important to apply sensitive communication to help patients gain new insight. Some heavy psychosocial demands on patients may be outside physiotherapists' professional competence. DISCUSSION The physiotherapists in this focus group study expressed a shared view that therapeutic alliance should build upon person-centering, motivational communication, and facilitation of lifestyle adjustments within a biopsychosocial perspective of low back pain. Complex clinical reasoning necessary as the optimal cause-corrective treatment strategies were often not obvious. Time and tools to uncover and modify relevant psychological obstacles for recovery were perceived challenging and partly dependent on clinical experience. Addressment of psychosocial obstacles for recovery should be included in basic as well as postgraduate curriculums for physiotherapists. Collaborative practice support strategies like peer guidance and better platforms for interprofessional collaboration and decision support could contribute to improve practice in the psychosocial domain.
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Affiliation(s)
- Monica Unsgaard-Tøndel
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physical Therapy, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sylvia Søderstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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24
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Cowell I, McGregor A, O’Sullivan P, O’Sullivan K, Poyton R, Schoeb V, Murtagh G. Physiotherapists' Approaches to Patients' Concerns in Back Pain Consultations Following a Psychologically Informed Training Program. QUALITATIVE HEALTH RESEARCH 2021; 31:2486-2501. [PMID: 34617473 PMCID: PMC8579327 DOI: 10.1177/10497323211037651] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient-focused style of communication where trained physiotherapists demonstrated a collaborative and responsive style of verbal and nonverbal communication to solicit, explore, and validate patients' concerns.
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Affiliation(s)
- Ian Cowell
- Imperial College, London, United Kingdom
- Brook Physiotherapy Ltd., Essex, United Kingdom
| | | | - Peter O’Sullivan
- Curtin University, Perth, Western Australia, Australia
- Bodylogic Physiotherapy, Perth, Western Australia, Australia
| | - Kieran O’Sullivan
- University of Limerick, Limerick, Ireland
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Veronika Schoeb
- University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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25
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Lobet S, Timmer M, Königs C, Stephensen D, McLaughlin P, Duport G, Hermans C, Mancuso ME. The Role of Physiotherapy in the New Treatment Landscape for Haemophilia. J Clin Med 2021; 10:jcm10132822. [PMID: 34206923 PMCID: PMC8267623 DOI: 10.3390/jcm10132822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
The physiotherapist plays an essential role for people with haemophilia, an inherited bleeding disease responsible for musculoskeletal complications. Yet, with the advent of new and advanced therapies, the medical landscape is changing, and physiotherapy must adapt alongside. This paper considers whether there will still be a need for physiotherapy in the era of advanced therapies, and discusses ways in which services should evolve to complement emerging treatment paradigms for haemostasis in people with haemophilia. Ultimately, physiotherapy will remain an important element of care, even for people with little joint damage and low risks in the era of the new mild phenotype. However, competencies will need to evolve, and physiotherapists in both primary care and specialist treatment centres should work with haematology colleagues to develop more sensitive tools for detecting early joint changes. Physiotherapists will also play a crucial role in counselling and physically coaching, monitoring the musculoskeletal status of people with haemophilia who have transitioned to new treatments.
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Affiliation(s)
- Sébastien Lobet
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200 Brussels, Belgium
- Secteur de Kinésithérapie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
- Correspondence:
| | - Merel Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Christoph Königs
- Department of Paediatrics and Adolescent Medicine, Haemophilia Treatment Centre, Goethe University, 60323 Frankfurt, Germany;
| | - David Stephensen
- Kent Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury CT1 3NG, UK;
- Haemophilia Centre, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London NW3 2QG, UK;
| | - Gaetan Duport
- Association Française des Hemophiles, 75739 Paris, France;
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
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Haavik H, Niazi IK, Kumari N, Amjad I, Duehr J, Holt K. The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:536. [PMID: 34071880 PMCID: PMC8226758 DOI: 10.3390/medicina57060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic has necessitated the need to find healthcare solutions that boost or support immunity. There is some evidence that high-velocity, low-amplitude (HVLA) controlled vertebral thrusts have the potential to modulate immune mediators. However, the mechanisms of the link between HVLA controlled vertebral thrusts and neuroimmune function and the associated potential clinical implications are less clear. This review aims to elucidate the underlying mechanisms that can explain the HVLA controlled vertebral thrust--neuroimmune link and discuss what this link implies for clinical practice and future research needs. A search for relevant articles published up until April 2021 was undertaken. Twenty-three published papers were found that explored the impact of HVLA controlled vertebral thrusts on neuroimmune markers, of which eighteen found a significant effect. These basic science studies show that HVLA controlled vertebral thrust influence the levels of immune mediators in the body, including neuropeptides, inflammatory markers, and endocrine markers. This narravtive review discusses the most likely mechanisms for how HVLA controlled vertebral thrusts could impact these immune markers. The mechanisms are most likely due to the known changes in proprioceptive processing that occur within the central nervous system (CNS), in particular within the prefrontal cortex, following HVLA spinal thrusts. The prefrontal cortex is involved in the regulation of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and the immune system. Bi-directional neuro-immune interactions are affected by emotional or pain-related stress. Stress-induced sympathetic nervous system activity also alters vertebral motor control. Therefore, there are biologically plausible direct and indirect mechanisms that link HVLA controlled vertebral thrusts to the immune system, suggesting HVLA controlled vertebral thrusts have the potential to modulate immune function. However, it is not yet known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity. Further research is needed to explore the clinical impact of HVLA controlled vertebral thrusts on immune function.
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Affiliation(s)
- Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Jenna Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
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Brandt C. Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1538. [PMID: 34192209 PMCID: PMC8182461 DOI: 10.4102/sajp.v77i1.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/05/2021] [Indexed: 11/06/2022] Open
Abstract
Background Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education. Objectives My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM). Method Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements. Results My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another. Conclusion Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice. Clinical implications Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.
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Affiliation(s)
- Corlia Brandt
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for a new approach? Disabil Rehabil 2020; 44:3270-3284. [PMID: 33284644 DOI: 10.1080/09638288.2020.1851783] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Low back pain (LBP) is the leading cause of disability worldwide. Clinical research advocates using the biopsychosocial model (BPS) to manage LBP, however there is still no clear consensus regarding the meaning of this model in physiotherapy and how best to apply it. The aim of this study was to investigate how physiotherapy LBP literature enacts the BPS model. MATERIAL AND METHODS We conducted a critical review using discourse analysis of 66 articles retrieved from the PubMed and Web of Science databases. RESULTS Analysis suggest that many texts conflated the BPS with the biomedical model [Discourse 1: Conflating the BPS with the biomedical model]. Psychological aspects were almost exclusively conceptualised as cognitive and behavioural [Discourse 2: Cognition, behaviour, yellow flags and rapport]. Social context was rarely mentioned [Discourse 3: Brief and occasional social underpinnings]; and other broader aspects of care such as culture and power dynamics received little attention within the texts [Discourse 4: Expanded aspects of care]. CONCLUSION Results imply that multiple important factors such as interpersonal or institutional power relations, cultural considerations, ethical, and social aspects of health may not be incorporated into physiotherapy research and practice when working with people with LBP.IMPLICATIONS FOR REHABILITATIONWhen using the biopsychosocial model with patients with low back pain, researchers narrowly focus on biological and cognitive behavioural aspects of the model.Social and broader aspects such as cultural, interpersonal and institutional power dynamics, appear to be neglected by researchers when taking a biopsychosocial approach to the care of patients with low back pain.The biopsychosocial model may be inadequate to address complexities of people with low back pain, and a reworking of the model may be necessary.There is a lack of research conceptualising how physiotherapy applies the biopsychosocial model in research and practice.
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Affiliation(s)
- Karime Mescouto
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca E Olson
- School of Social Science, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Cosgrove J, Hebron C. 'Getting them on board': Musculoskeletal physiotherapists conceptions of management of persons with low back pain. Musculoskeletal Care 2020; 19:199-207. [PMID: 33135325 DOI: 10.1002/msc.1524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Low back pain (LBP) is the leading cause of disability worldwide; however, the majority of LBP is non-specific in nature with no clearly identifiable source of pain. Contemporary understanding of LBP highlights the multidimensional nature of LBP and as a result clinical practice and guidelines have evolved and advocate a multidimensional approach to managing persons with LBP. This change in understanding and practice provides challenges for physiotherapists and persons with LBP, many who have biomedical views. The aim of this study was to explore musculoskeletal physiotherapists conceptions towards the management of LBP. METHOD The research employed a phenomenographic inspired approach which aims to explore variations in conceptions, beliefs and understanding of a phenomenon. Six participants (physiotherapists) were interviewed via semi-structured interviews to explore their experiences of managing persons with LBP and the data was analysed using a phenomenographic framework. RESULTS Three main categories emerged from the participants descriptions: the perceived role of preferences and expectations, therapeutic alliance development and getting the person "on board". CONCLUSION Participants descriptions implied a therapist centred view towards the care they provided for persons with LBP. The perceived role of expectations was a significant aspect within the participants descriptions of the management of LBP. Last, the participants described the perceived development of a therapeutic alliance. These categories suggest how the physiotherapists interviewed in this study conceive the management of LBP, and these findings will provide a greater understanding around the physiotherapy management of LBP.
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Affiliation(s)
- Josh Cosgrove
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
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