Emilson C, Åsenlöf P, Pettersson S, Bergman S, Sandborgh M, Martin C, Demmelmaier I
Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden.
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
BMC Musculoskelet Disord. 2016 Jul 27;17:316. doi: 10.1186/s12891-016-1173-x.
Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain.
A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice.
Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings.
Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy.
行为医学（BM）治疗被推荐用于物理治疗中的疼痛管理。其实施需要物理治疗师（PT），他们要擅长基于身体、心理和行为评估进行功能性行为分析。本研究的目的是探索和描述物理治疗师在与因肌肉骨骼疼痛寻求初级医疗保健的患者进行初次咨询时的评估、分析以及他们对行为改变技术（BCT）的使用情况。
采用描述性和探索性研究设计，使用来自12名初级医疗保健物理治疗师的视频记录数据。基于一个特定协议进行演绎分析，该协议对物理治疗师对身体和心理预后因素（分别为红色和黄色警示信号）的评估、临床问题分析以及行为改变技术的使用进行了定义。还进行了额外的归纳分析以识别和描述物理治疗师临床实践中的差异。
大多数病例都进行了红色和黄色警示信号的评估。分析主要基于生物医学评估，没有物理治疗师进行功能性行为分析。所有物理治疗师都使用行为改变技术，主要是指导和信息提供，以促进身体活动和改善姿势。选取了四个最具临床相关性的病例来说明物理治疗师临床实践中的差异。研究结果基于瑞典12名经验丰富的初级医疗保健物理治疗师，限制了其对类似人群和环境的普遍性。
在本研究中物理治疗师对红色和黄色警示信号进行了评估，但他们在分析和治疗中对结果的解释和整合并不完整，这表明在瑞典初级医疗保健物理治疗中实施行为医学需要进一步的策略。
