Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele ST5 5BG, United Kingdom.
Phys Ther. 2011 May;91(5):790-803. doi: 10.2522/ptj.20100326. Epub 2011 Mar 30.
As the biopsychosocial model of health has become increasingly understood, it has become clear that there are complex, interdependent relationships between the physical and biomedical features of low back pain and the psychological and social factors that present concomitantly. Epidemiological studies have not only highlighted that psychological and social factors are associated with back pain and disability but also have shed light on the way in which these factors serve as prognostic indicators, or obstacles to recovery, predicting which patients will have a poor prognosis. Integrating the assessment of these obstacles to recovery into physical therapist practice and using this information to guide clinical decision making have the potential to improve the quality of care offered by physical therapists by improving the targeting of treatments to individuals and enhancing the therapist-patient relationship and adherence to management advice and treatment programs. In turn, such approaches may improve both patients' clinical outcomes and the efficiency and effectiveness of service provision, helping direct interventions to those who need them. This article summarizes the key challenges to embedding psychosocial perspectives within physical therapist practice for patients with low back pain and the opportunities that could be realized by doing so, and it highlights new developments in research, clinical practice, and education that are shaping future directions in this field.
随着对健康的生物-心理-社会模式的理解不断深入,人们越来越清楚地认识到,腰痛的身体和生物医学特征与同时存在的心理和社会因素之间存在着复杂的、相互依存的关系。流行病学研究不仅强调了心理和社会因素与背痛和残疾有关,还揭示了这些因素作为预后指标或康复障碍的作用方式,预测哪些患者预后不良。将这些康复障碍的评估纳入物理治疗师的实践中,并利用这些信息指导临床决策,有可能通过针对个体治疗和增强治疗师-患者关系以及对管理建议和治疗方案的依从性来提高物理治疗师提供的护理质量。反过来,这种方法可能会改善患者的临床结果以及服务提供的效率和效果,有助于将干预措施针对那些需要的人。本文总结了将心理社会观点嵌入腰痛患者物理治疗实践中的主要挑战,以及这样做可能带来的机会,并强调了塑造该领域未来方向的研究、临床实践和教育方面的新发展。