Feuerstein M, Beattie P
Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Md 20814.
Phys Ther. 1995 Apr;75(4):267-80. doi: 10.1093/ptj/75.4.267.
Patients with recurrent or persistent low back pain (LBP) and disability represent a formidable challenge to physical therapists. Classic models of disease and pain mechanisms do not adequately explain the commonly observed discrepancies between the extent of pathology and reported pain, or the level of pain and disability. Research over the past decade that considers the interactive role of biological, environmental, and psychological processes in pain and disability has supported the involvement of a number of biobehavioral factors in these conditions. Physical therapists and other health care providers have become more aware of these factors and their impact on the evaluation, treatment, and management of LBP. Despite this recognition, little information is available that translates the implications of this research to direct care within physical therapy practice. The purposes of this article are (1) to provide an operational definition of biobehavioral factors; (2) to review the role of these factors in the clinical presentation of LBP, functional limitation, and disability; (3) to identify commonly used approaches for their recognition and quantification; (4) to illustrate how an understanding of biobehavioral factors can assist the physical therapist in evaluation and treatment of patients with LBP; and (5) to identify certain gaps in current knowledge of the role of biobehavioral factors and their application in physical therapy. Given the central role assumed by many physical therapists in the management of LBP, acknowledging and addressing these factors in clinical practice should assist in the prevention of chronic LBP and disability, as well as potentially improve physical therapy interventions and management.
患有复发性或持续性下腰痛（LBP）及功能障碍的患者对物理治疗师来说是一项巨大的挑战。经典的疾病和疼痛机制模型无法充分解释病理程度与报告的疼痛之间、疼痛程度与功能障碍之间常见的差异。过去十年的研究考虑了生物、环境和心理过程在疼痛和功能障碍中的相互作用，支持了多种生物行为因素在这些情况中的作用。物理治疗师和其他医疗保健提供者已经更加意识到这些因素及其对LBP评估、治疗和管理的影响。尽管有这种认识，但将这项研究的意义转化为物理治疗实践中的直接护理的信息却很少。本文的目的是：（1）提供生物行为因素的操作性定义；（2）回顾这些因素在LBP临床表现、功能受限和功能障碍中的作用；（3）确定识别和量化这些因素的常用方法；（4）说明对生物行为因素的理解如何帮助物理治疗师评估和治疗LBP患者；（5）确定当前关于生物行为因素的作用及其在物理治疗中的应用的知识差距。鉴于许多物理治疗师在LBP管理中所起的核心作用，在临床实践中认识并处理这些因素应有助于预防慢性LBP和功能障碍，并可能改善物理治疗干预和管理。
