The importance of psychosocial factors for physical therapists treating low back pain
Physical factors often overshadow psychosocial ones
The May issue of Physical Therapy dedicated the entire edition to the importance of acknowledging and properly responding to the influence of psychosocial factors when treating low back pain (LBP), the most widely researched musculoskeletal condition. The editors open up the issue by pointing out that in clinical practice, though both physical and psychosocial symptoms present themselves in LBP and other cases, they're each treated differently. For the majority of physical therapists, physical factors are treated accordingly with standard practice care, while psychosocial factors (i.e. pain beliefs, attitudes, emotions, behaviors) are either inadequately addressed or ignored within standard practice, or they trigger a referral to a mental health practitioner. This lack of attentiveness to psychosocial factors by PTs can in effect lead to suboptimal management of LBP, creating the need for PTs to broaden their focus.
Why PTs should be concerned with psychosocial factors
In responding to how they each perceive psychosocial factors, most PTs would probably claim they acknowledge their importance, and many might even say they recognize them as part of their clinical practice. But as researchers point out, merely indentifying these factors doesn't actually have any beneficial impact on managing LBP. Persuasive evidence exists that proves a patient;s beliefs, emotional responses and pain behavior have an influence on their response to pain, treatment participation and overall outcome. In addition, ignoring or improperly managing psychosocial factors can lead to a slew of negative repercussions, including patient suffering and a waste of valuable health care resources. For these reasons, PTs should recognize that taking the "whole picture" into account and being attentive to details they might otherwise overlook could lead to major gains in effective treatment.
How to go about expanding the range of focus
Quite possibly the greatest challenge is persuading biomedically-oriented PTs that this shift in focus is necessary. Standard practice for most PTs involves approaches that target correcting physical impairments exclusively, but researchers suggest PTs further enhance their professional skills in managing LBP by addressing psychosocial factors also as worthwhile treatment targets. Since the two are many times interrelated, this sort of philosophy makes sense, and if more supportive evidence of the importance of treating psychosocial factors emerges, expanding PTs range of duties may become essential in developing evidence-based medicine. A significant and sustained shift in the clinical management of LBP will require changes in current PT education and practice, and it's suggested that in their training, PTs are introduced to the key psychosocial processes considered to influence pain perception, among a number of prospective changes that can facilitate this shift. While no major alterations should yet be undertaken as further research is conducted, the significance of psychosocial factors in the treatment of LBP has enough support to be recognized by PTs and introduced to their overall strategy.
-Summarized by Greg Gargiulo
-As reported in the May '11 edition of Physical Therapy
