My final post and conclusion

Thank-you for following my blog. Here is my final instalment. Please feel free to post any comments related to any experiences you have had within your practice or training experiences you have felt useful.

Initially, I discussed what is meant by biopyschosocial risk factors and how they are categorised. I then looked at how pain is perceived and how biopsychosocial factors can influence this. This was because based on my clinical experience I found patients that often presented with biopsychosocial factors were harder to treat and seemed to have a slower rate of recovery and occasionally there were times that I was unable to successfully manage their presentation. After gaining an understanding of how pain is perceived and how it can be shaped by an array of biopsychosocial factors I chose to look at what attitudes and beliefs that we as clinicians hold on biopsychosocial risk factors in the view of how this effects patient experience and clinical outcome.

A study by Kidd et al 2011 conducted a qualitative study evaluating what is important to patients in their encounter with their Physiotherapist. Generated from the data were 5 categories of characteristics related to patient centred physiotherapy: the ability to communicate; confidence; knowledge and professionalism; an understanding of people and an ability to relate; and transparency of progress and outcome. These categories appeared to occur in isolation, but formed a picture of patient-centred physiotherapy from the patient’s perspective.

Pinto et al 2012 conducted a literature review that aimed to ascertain which communication factors facilitate patient – therapist relationship during the patient therapist encounter. The results suggest that patient-centred interaction styles that are related to providing emotional support and allowing patient involvement in the consultation process enhances therapeutic alliance however the strength of these results were weakened by the fact that was no meta analysis. Disappointingly the review’s inclusion criteria caused there to be a limited number of studies that investigated the interaction of patients with physiotherapists although the settings that were included involved clinicians and patients within primary care and tertiary hospital facilities: areas where patients’ needs are likely to be similar to the ones seeking treatment in physiotherapy settings. Therefore it could be assumed that the findings that are related to communication factors are transferable within rehabilitation.

A paper by Fairburn and Cooper 2011 that looked at therapist competence, quality and training in psychotherapy recognised that there is a considerable demand for training in psychological treatments but highlights the difficulty in obtaining appropriate training. A variety of training methods were evaluated and even in those who have relevant background knowledge the paper scrutinises the effectiveness of training methods undertook.

Ackerman and Hilsenroth (2003) similarly conducted a literature review exploring what impact therapist characteristics and techniques have on therapeutic alliance. No physiotherapists were included the review looked solely within psychology and included psychologists, senior nursing staff and advanced assistants. Characteristics that commonly emerged were similar to the other studies that I have mentioned previously. Techniques that were thought to be influential were skilled techniques not taught within physiotherapy unless I assume post graduate.

As physiotherapists are continuously facing the challenge of practicing in an increasingly competitive marketplace understanding the needs of patients is even more paramount. As per our own personal standards as well as our governing body and employers organisational standards treating patients as equals, with respect and dignity, listening and including them in decision making processes is something that should be done routinely. My conclusion is that patients with biopsychosocial factors should be no differently treated however if their barriers to recovery are too great then a multidisciplinary approach may be most appropriate. I believe the process of this blog has taught me more about how pain can be perceived and what influence biopsychosocial factors could have in the development of chronic pain and / or poorer compliance. Initially I thought it was all about what treatment I could or should be learning in order to best treat them but know I feel it is more about r,recognising factors well and addressing them as I am able to and if I were to think about specific training such as cognitive behavioural therapy that is said to be a useful modality I perhaps would engage in training that focus’ more on communication and psychological understanding first.

Ackerman J, Hilsenroth M. A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review. 2003; 23: 1-33

Kidd M, Bond M, Bell M. Patients’ perspectives of patient centredness as important in musculoskeletal physiotherapy interactions: a qualitative study. Physiotherapy. 2011; 27: 7: 154-162

Pinto R, FErreira M, Oliveira V, Franco M, Adams R, Maher C and Ferreira P. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. Journal of Physiotherapy. 2012; 58: 77-87

Street R, Makoul, Arora N, Epstein R. How does communication heal? Pathways linking clinician – patient communication to health outcomes. Patient education and Counselling. 2009; 74: 3: 295-301





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