Biopsychosocial assessment

Biopsychosocial assessment

The biopsychosocial assessment differs from the physical assessment in that it incorporates psychological and social issues in more depth. This gives the physiotherapist a good overview of the patient’s circumstances, his or her overall mood state, beliefs, attributes and thoughts about the problem, about therapy and about the future.

Psychological factors

A previous history of anxiety and depression, general attitudes and expectations is noted. The patient’s perceived level of control over the pain is also assessed with particular regard to the use of active or passive coping strategies (these are often referred to as ‘internalised’ or ‘externalised’

locus of control).

Social factors

Identify social areas, including work issues, pending compensation, a history of injury, sickness benefits, and daily functioning, as these may affect the outcome.

Physical examination

A body chart and physical examination may or may not be conducted, as the physiotherapist deems necessary. However, if red flags are noted then a neurological examination is indicated. Assessments may include functional

tests such as:

• the distance that can be walked in five minutes;

• the number of times the person can stand from sitting in one minute;

• the number of times the person can step up and down in one minute. Outcome measures questionnaires

The following questionnaires and tools are validated, reliable and sensitive. They can be used prior to, and following, intervention to determine efficacy.

• The Oswestry Disability Index (Fairbank et al. 1980).

• The VAS.

• The Present Pain Index.

• The short-form McGill Pain Questionnaire (Melzack 1987).

• The Hospital Anxiety and Depression Questionnaire

(Zigmond and Snaith 1983).

• The locus of control questionnaire (FABQ).

Treatment of biopsychosocial aspects of LBP disability

Many studies have reported decreases in pain levels and disability following intensive back rehabilitation programmes combining exercise and cognitive therapy (e.g. Frost et al. 1998; Guzman et al. 2001). The aims of chronic

spinal rehabilitation programmes are to:

• reduce the patient’s pain, if possible, or enable the patient to cope more effectively with the pain;

• reduce the patient’s disability;

• encourage, when possible, a return to work and hobbies to promote better physical functioning (by challenging the unhelpful belief that pain always

equates to harm);

• encourage an active, patient-centred approach to LBP management.

Van Korff and Saunders (1996), in a survey of LBP sufferers in the USA, found that patients wanted to understand the following four things.

1. The likely course of their back problem.

2. How to manage the pain.

3. How to return to normal activities of daily living.

4. How to minimise recurrences of back pain.

Example of the content of a back rehabilitation programme

• Pre-intervention questionnaire and physical tests for outcome measures.

• Circuit training, including aerobic and strengthening regimes, with emphasis on postural control, spinal stability, back extensors and deep abdominal musculature.

• Patient-centred discussions, seminars on anatomy, pathology, medication, self help measures, posture and exercise, etc.

• Relaxation workshops.

• Post-programme questionnaire and physical tests.

• Follow-up questionnaires at 1 and 12 months to determine how they are managing their LBP.