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.
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