Mingels Sarah, Granitzer Marita, Luedtke Kerstin, Dankaerts Wim
Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium.
Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
Curr Pain Headache Rep. 2024 Dec;28(12):1195-1207. doi: 10.1007/s11916-024-01306-7. Epub 2024 Aug 14.
Patient-centred care (PCC) is deemed essential in the rehabilitation of musculoskeletal pain. Integrating such care within a biopsychosocial framework, enables to address all facets of the individual pain experience, and to manage the individual instead of the condition. This narrative review describes the status quo of PCC physiotherapy management of people with headache within a biopsychosocial model. PubMed, EMBASE, Web of Science, Scopus were searched (update 07.05.2024). The search-query comprised terminology relating to "headache", "patient-centred", "biopsychosocial", "physiotherapy". Additional eligibility criteria were reviews, trials, cohort, case report, case-control studies in English, Dutch, French.
Gaps are exposed in patient-centred physiotherapy management of migraine, tension-type headache, and cervicogenic headache. While a biopsychosocial approach is advised to manage migraine and tension-type headache, its use in clinical practice is not reflected by the literature. A biopsychosocial approach is not advised in cervicogenic headache. Psychosocial-lifestyle interventions are mainly delivered by health-care providers other than physiotherapists. Additionally, psychologically-informed practice is barely introduced in physiotherapy headache management. Though, managing the social context within a biopsychosocial framework is advised, the implementation by physiotherapists is unclear. Comparable conclusions apply to PCC. PCC is recommended for the physiotherapy management of primary and secondary headache. Such recommendation remains however theoretical, not reaching clinical implementation. Yet, a shift from the traditional disease-centred model of care towards PCC is ongoing and should be continued in physiotherapy management. With this implementation, clinical and economical studies are needed to evaluate its effectiveness.
以患者为中心的护理（PCC）在肌肉骨骼疼痛康复中被视为至关重要。将这种护理整合到生物心理社会框架内，能够解决个体疼痛体验的所有方面，并针对个体而非病情进行管理。本叙述性综述描述了在生物心理社会模型中，以患者为中心的头痛患者物理治疗管理的现状。检索了PubMed、EMBASE、科学网、Scopus（更新于2024年5月7日）。检索词包括与“头痛”、“以患者为中心”、“生物心理社会”、“物理治疗”相关的术语。其他纳入标准为英文、荷兰文、法文的综述、试验、队列研究、病例报告、病例对照研究。
在偏头痛、紧张型头痛和颈源性头痛的以患者为中心的物理治疗管理中存在差距。虽然建议采用生物心理社会方法来管理偏头痛和紧张型头痛，但文献并未反映其在临床实践中的应用情况。颈源性头痛不建议采用生物心理社会方法。心理社会生活方式干预主要由物理治疗师以外的医疗保健提供者提供。此外，在物理治疗头痛管理中几乎没有引入心理知情实践。虽然建议在生物心理社会框架内管理社会环境，但物理治疗师的实施情况尚不清楚。PCC的情况类似。PCC被推荐用于原发性和继发性头痛的物理治疗管理。然而，这种建议仍然停留在理论层面，尚未实现临床应用。不过，从传统的以疾病为中心的护理模式向PCC的转变正在进行中，在物理治疗管理中应继续推进。随着这种实施，需要进行临床和经济学研究来评估其有效性。
