Person-centered care for musculoskeletal pain: Putting principles into practice

Hutting, Nathan; Cañeiro, J P; Ong'wen, Otieno Martin; Miciak, Maxi; Roberts, Lisa

doi:10.1016/j.msksp.2022.102663

Cited by 29 publications

(17 citation statements)

References 50 publications

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“…Another example may include targeted interventions to address MSK practitioners misinformed or erroneous beliefs (e.g., use of imaging scans for LBP management/diagnosis) [ 63 ]. Similarly, adopting a framework to promote person-centredness in MSK practice may help to cultivate and enhance the therapeutic relationship (see [ 64 ] for applied clinical principles). Moreover, different training formats (e.g., face-to-face, and online) should be used to inform clinicians about placebo/nocebo effects [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study

et al. 2023

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Background Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs (i.e., the patient-practitioner relationship, patient’s and practitioner’s beliefs/characteristics, treatment characteristics, and environment) have not been widely evaluated by musculoskeletal practitioners. Understanding their views has the potential to improve treatment quality and effectiveness. Drawing on a panel of United Kingdom practitioners’ expertise, this study aimed to investigate their perceptions of CFs during the management of patients presenting with chronic low back pain (LBP). Methods A modified two-round online Delphi-consensus survey was conducted to measure the extent of panel agreement regarding the perceived acceptability and influence of five main types of CFs during clinical management of patients with chronic LBP. Qualified musculoskeletal practitioners in the United Kingdom providing regular treatment for patients with chronic LBP were invited to take part. Results The successive Delphi rounds included 39 and 23 panellists with an average of 19.9 and 21.3 years of clinical experience respectively. The panel demonstrated a high degree of consensus regarding approaches to enhance the patient-practitioner relationship (18/19 statements); leverage their own characteristics/beliefs (10/11 statements); modify the patient’s beliefs and consider patient’s characteristics (21/25 statements) to influence patient outcomes during chronic LBP rehabilitation. There was a lower degree of consensus regarding the influence and use of approaches related to the treatment characteristics (6/12 statements) and treatment environment (3/7 statements), and these CFs were viewed as the least important. The patient-practitioner relationship was rated as the most important CF, although the panel were not entirely confident in managing a range of patients’ cognitive and emotional needs. Conclusion This Delphi study provides initial insights regarding a panel of musculoskeletal practitioners’ attitudes towards CFs during chronic LBP rehabilitation in the United Kingdom. All five CF domains were perceived as capable of influencing patient outcomes, with the patient-practitioner relationship being perceived as the most important CF during routine clinical practice. Musculoskeletal practitioners may require further training to enhance their proficiency and confidence in applying essential psychosocial skills to address the complex needs of patients with chronic LBP.

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Section: Discussionmentioning

confidence: 99%

Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study

et al. 2023

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“…Specific to patient-centred communication, strategies such as asking open-ended questions, discussing options, encouraging questions, expressing empathy and providing reassurance, explaining and providing information ( 59 , 79 ), and validating the disclosure of patients ( 81 , 82 ) are all important. This means biopsychosocial musculoskeletal pain care involves establishing meaningful connections with patients, shared-decision making, and supportive self-management ( 64 , 83 , 84 ). This will require communication behaviours synonymous to health coaching and/or motivational interviewing to navigate and optimise the clinical consultation ( 64 , 84 ).…”

Section: Discussionmentioning

confidence: 99%

“…This means biopsychosocial musculoskeletal pain care involves establishing meaningful connections with patients, shared-decision making, and supportive self-management ( 64 , 83 , 84 ). This will require communication behaviours synonymous to health coaching and/or motivational interviewing to navigate and optimise the clinical consultation ( 64 , 84 ).…”

Section: Discussionmentioning

confidence: 99%

Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care

Beales

Gucciardi

et al. 2023

Front. Pain Res.

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Achieving high value, biopsychosocial pain care can be complex, involving multiple stakeholders working synergistically to support the implementation of quality care. In order to empower healthcare professionals to assess, identify and analyse biopsychosocial factors contributing to musculoskeletal pain, and describe what changes are needed in the whole-of-system to navigate this complexity, we aimed to: (1) map established barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain against behaviour change frameworks; and (2) identify behaviour change techniques to facilitate and support the adoption and improve pain education. A five-step process informed by the Behaviour Change Wheel (BCW) was undertaken: (i) from a recently published qualitative evidence synthesis, barriers and enablers were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF) using “best fit” framework synthesis; (ii) relevant stakeholder groups involved in the whole-of-health were identified as audiences for potential interventions; (iii) possible intervention functions were considered based on the Affordability, Practicability, Effectiveness and Cost-effectiveness, Acceptability, Side-effects/safety, Equity criteria; (iv) a conceptual model was synthesised to understand the behavioural determinants underpinning biopsychosocial pain care; (v) behaviour change techniques (BCTs) to improve adoption were identified. Barriers and enablers mapped onto 5/6 components of the COM-B model and 12/15 domains on the TDF. Multi-stakeholder groups including healthcare professionals, educators, workplace managers, guideline developers and policymakers were identified as target audiences for behavioural interventions, specifically education, training, environmental restructuring, modelling and enablement. A framework was derived with six BCTs identified from the Behaviour Change Technique Taxonomy (version 1). Adoption of a biopsychosocial approach to musculoskeletal pain involves a complex set of behavioural determinants, relevant across multiple audiences, reflecting the importance of a whole-of-system approach to musculoskeletal health. We proposed a worked example on how to operationalise the framework and apply the BCTs. Evidence-informed strategies are recommended to empower healthcare professionals to assess, identify and analyse biopsychosocial factors, as well as targeted interventions relevant to various stakeholders. These strategies can help to strengthen a whole-of-system adoption of a biopsychosocial approach to pain care.

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“…Wenn Patient*innen Angstvermeidungsverhalten oder niedrige schmerzbezogene Selbstwirksamkeit zeigen, sind dies Faktoren, die therapeutisch beeinflusst werden können und eine spezifische Herangehensweise erfordern ("Graded Ansätze") [88]. Physiotherapeut*innen sind in einer exzellenten Position, um Patient*innen auf diesem Weg zu begleiten, empathisch zu unterstützen, fachlich zu beraten und zu körperlicher Aktivität zu ermutigen [52,89]. Patient*innen müssen nicht schwach sein oder eine schlechte Ausdauer haben, um von körperlicher Aktivität oder einem Trainingsprogramm für die Rückenmuskulatur zu profitieren.…”

Section: Bedürfnisse Von Patient*innen Mit Vermeidungsverhaltenunclassified

Körperliche Inaktivität und Rückenschmerz

Grenier

2023

MSK – Muskuloskelettale Physiotherapie

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ZusammenfassungKörperliche Inaktivität ist ein unabhängiger Risikofaktor für erhöhte kardiovaskuläre Mortalität, begünstigt das Entstehen diverser Krebserkrankungen und gilt auch als Risikofaktor für die Entwicklung von chronischen Schmerzen. Langanhaltende körperliche Inaktivität führt zu einem Abbau der Kraft und der (Rücken-)Muskulatur. Schwache Rückenmuskulatur ist aber nur ein Faktor, der zur Entstehung von lumbalen Rückenschmerzen (Low Back Pain, LBP) beitragen kann, da viele biopsychosoziale Faktoren dabei eine Rolle spielen.Regelmäßiges Training und körperliche Aktivität reduzieren zwar das Risiko, einschränkenden LBP zu erfahren, aber ein Therapieerfolg wird bei LBP nicht vorrangig durch eine Verbesserung physischer Faktoren erreicht. Vielmehr spielen andere Einflussfaktoren, wie ein reduziertes Angstvermeidungsverhalten und bessere schmerzbezogene Selbstwirksamkeit, ebenso eine wichtige Rolle im Genesungsprozess.Das Ziel dieses Artikels ist es, den Zusammenhang von körperlicher (In-)Aktivität und Rückenschmerzen darzustellen und die Risiken eines eindimensionalen, biomedizinischen Verständnisses, unabhängig von der Profession, zu diskutieren.

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Person-centered care for musculoskeletal pain: Putting principles into practice

Cited by 29 publications

References 50 publications

Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study

Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study

Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care

Körperliche Inaktivität und Rückenschmerz

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