Seeing the world differently
Ahead of her presentation at this year's Therapy Expo, Dr Hilary Abbey of the British School of Osteopathy introduces the potential benefits of bringing together biomedical and psychosocial approaches for the treatment of persistent pain.
The way that physical and manual therapists see the world through the differently coloured lenses of biomedical or biopsychosocial models of healthcare guides clinical reasoning and practice behaviour . Approaches based on technical rationality evaluate patients' problems as biomechanical deviations from normal, whereas approaches based on professional artistry explore interactions between biological, psychological and social factors and aim to understand individual experiences .
Practitioners' own beliefs and ways of communicating about pain can affect outcomes , leading to claims that psychosocial factors are more important than biomechanical interventions, with counter-arguments supporting the use of manual skills . These polarised positions pit belief systems against each other, but clinical 'praxis' is a messy synthesis of a complex raft of actions that are essential elements in clinical practice [5, p.104] that may benefit from more flexible, pragmatic approaches .
At the British School of Osteopathy (BSO), we have been researching practical ways of re-framing biomedical and biopsychosocial perspectives as complementary rather than conflicting approaches and asking the questions: How can manual therapists expand their psychosocial skills to improve patient outcomes in chronic conditions? And how can we develop effective ways of communicating about pain and using hands-on treatment to promote active self-care?
At this year's Therapy Expo, I will be presenting outcomes from a cohort study evaluating a new osteopathic pain management programme (OsteoMAP). This approach integrated manual treatment with psychological interventions based on Acceptance and Commitment Therapy (ACT); a form of 3rd wave CBT that is effective for chronic musculoskeletal pain . Preliminary OsteoMAP findings provide insights into the feasibility of this approach for practitioners, impact on patients' pain experiences, and effects in improving pain, mood and coping . Also speaking will be Dr Oliver Thomson, who will be presenting qualitative research exploring how patients interpret the language used by student osteopaths to explain low back pain, and the impact of these interpretations on patients' back pain beliefs and attitudes . Finally, Dr Jerry Draper-Rodi will be discussing the different factors that influence patients' low back pain experiences, how these impact on prognosis , and their implications for practice and continuing professional development .
We look forward to meeting the mixed audiences attending this year's Therapy Expo, as it is a great opportunity to explore the similarities and differences in our approaches. We hope to share experiences about evolving models of care and professional education with practitioners who are interested in developing solutions within, and between, different manual therapy disciplines. Details of current research and CPD courses at the BSO can be accessed at http://www.bso.ac.uk/postgraduate-cpd/bso-research-centre