Tuesday, 12 February 2019

What Role Do Physiotherapists Play In Managing Psychosocial Factors?

Over the course of the decade we’ve seen a shift in physiotherapy practice guidelines from a focus solely on tissue and biomechanics to looking at biological, psychological and social factors as part of the individuals’ pain and disease experiences. While many are slow to adopt these new guidelines the shift is encouraging.
The increasing focus on psychosocial factors begs the question; especially for those of us who aren’t trained psychologists, psychotherapists, or psychiatrists; “where does the line get drawn and what’s our role in managing psychosocial factors in our patients?”

Getting something important out of the way first

Regardless of whether you’re a medical or rehab professional working with diseased and/or pained populations, or a strength coach working with high performance athletes, psychology feeds into everything you do whether it’s motivating a client for behaviour change or helping an athlete achieve peak performance. What we do does not operate in vacuums and almost always has both physiological and psychological effects.

Where our boundaries lie in managing psychosocial factors

This is going to be controversial, but I partially disagree with the opinion of some people that I’ve seen (no names mentioned) post in threads on social media that state that we should be directly managing psychosocial factors in our patients and that our scope of practice should be expanded.

The reason is … as physiotherapists we are responsible for a ton of information and skills when it comes to assessing, diagnosing and treating musculoskeletal, cardiopulmonary, neurological and systemic conditions. I’m of the belief that you can be good at anything but you can’t be good at everything (to quote Stan Efferding). I don’t know of anyone who’s great at nutrition, strength sports, orthopedic physical therapy, pediatrics and the like all at the same time. Doing 8-10 years of post-undergraduate schooling; along with tons of post graduate courses & continuing education; to excel at both physical therapy and psychology is both expensive, unhealthy and impractical in my opinion. That’s where you network with other professionals and refer out as needed.

I think we would overstep our boundaries if we

1) Diagnose mental health conditions: Just as we can’t diagnose cancer or infections or heart issues as physios (at least in Canada) we shouldn’t try to diagnose PTSD, OCD or other mental health conditions. We just need to recognize the symptoms and refer out.

2) Try to treat psychosocial factors that aren’t related to pain, injury, movement, or activity: We aren’t trained to grief counsel a mother who’s lost her kid and we aren’t trained to treat the PTSD of someone who has been sexually assaulted. That ain’t our skillset and just as we get POed when a trainer tries to be a therapist we shouldn’t try to be a psychiatrist if it’s something outside of our ballpark.

Where can we help with managing psychosocial factors?

We can help our patients with psychosocial factors by

1) Finding ways to help get them active: Exercise can help for chronic pain and for mental health conditions

Image courtesy Focus Fitness

2) Educating our patients on the importance of sleep hygiene: Given how poor sleep can be a contributor to (and result of) pain and mental health issues we’d be remised if we didn’t discuss this (and ways to improve it) with our clients.

3) Quite simply being a good person to be with: I open any (non WSIB specialty) assessment with “tell me your story.” This allows patients to say what they need to say and helps them get whatever they need to get off their chest – which can be therapeutic in and of itself. There’s a lot to be said; especially in chronic cases where a client may have been mistreated by employers, coworkers, family members and/or friends; for being the first “good guy” they talk to and by being attentive & caring.

4) Helping to decrease anxieties and unhelpful beliefs regarding pain, injury, and activity: Educating patients on the many factors involved in pain & hurt versus harm; as well as gradually increasing your client’s tolerance to both feared & desired activities (barring any medical or orthopedic contraindications); can be helpful in improving the function & well being of your clients.

5) And obviously referring out as needed

So, in a nutshell, that’s where the role of physiotherapists is in managing the psychosocial factors of patients. Not everyone’s gonna agree with me but that’s my opinion and as always – thanks for reading.

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