Musculoskeletal ultrasound imaging – Integration with the biopsychosocial model

Abstract

Background and Method Musculoskeletal ultrasound imaging, (MSKUSI) has become a popular imaging modality in recent years and is being utilised by a variety of professions in clinical environments beyond radiology departments. A previously published study exploring physiotherapists' interests and use of MSKUSI in practice included in-depth interviews of participants, (n=11). The data from this qualitative study was analysed thematically and five themes were identified; one was 'Application of the biopsychosocial model', the basis of this paper. Results The theme, 'Application of the biopsychosocial model' drew together three categories of analysed data: clinical reasoning, professional variance and communication opportunity. 'Clinical reasoning' reflected the participants' value on subjective assessment information and the integration of ultrasound imaging with physical examination findings. 'Professional variance' observed the scanning processes undertaken by physiotherapists tended to vary from other professionals, the physiotherapists perceived their use of dynamic imaging was greater, in particular scanning in symptom provoking positions. Another variance observed was the style of communication that physiotherapists used when scanning, this was categorised as a 'communication opportunity' as it represented an event that could be utilised to promote patient understanding of their presentation, link imaging findings to proposed management and enhance compliance with rehabilitation strategies. Participants emphasised their responsibility when communicating with patients to avoid language that could promote unhelpful behaviour, e.g. catastrophisation. Conclusion Participants placed value on integrating musculoskeletal ultrasound imaging into the biopsychosocial model, further research to explore the impact of this approach on patients' clinical outcomes and reported experiences is required.

A proposed framework for point of care musculoskeletal ultrasound and ultrasound image-guided interventions by physiotherapists: scope of practice, education and governance

“…Research related to this specific field have been considered in the development and application of the framework to MSK physiotherapy PoCUS. This includes empirical data collected from physiotherapists which supports the rationale for the categorisation of MSK PoCUS roles and the proposed quality assurance strategies [ 15 – 17 , 20 ]. Drawing upon recent publications from professional bodies [ 2 , 14 ] it addresses elements of contemporary healthcare provision (including professional body guidance [ 2 , 10 , 12 , 14 , 21 , 22 ]) and highlights key considerations that underpin the safe, effective and patient-centred application of USI for physiotherapists in the MSK specialism.…”

“…Course providers are encouraged to draw on their pedagogical expertise to ensure appropriate educational mechanisms are utilised. Educational delivery that facilitates engagement with the specific elements relevant to MSK PoCUS (most notably the integration of this modality into clinical assessment and management) are essential [ 16 , 17 ]; and several educational elements (particularly practical skills teaching and clinical supervision) necessitate face to face delivery.…”

“…Due to the necessity for high level clinical reasoning skills (required to appropriately choose to use USI and to integrate those findings into patient management [ 17 ] then a physiotherapist undertaking MSK PoCUS requires a substantial level of MSK clinical skills and experience. As such, training in MSK PoCUS should occur at post-graduate level and by someone with the appropriate level of experience in MSK care which is relevant to their subsequent MSK PoCUS ScoP.…”