Spine Course Introduction Flashcards
(50 cards)
As a PT, your job is to address the “bio” aspect of the biopsychosocial model. Artus et al investigated general prognostic factors for musculoskeletal pain. What are 4 factors that are associated with a negative prognosis & which physiotherapy can affect?
- widespread pain
- a high pain severity
- high disability
- movement restriction
Give 5 examples of biologic factors in the biopsychosocial model for musculoskeletal pathology.
- mobility
- strength
- coordination
- anatomy
- anatomic adaptations
Give 6 examples of social factors in the biopsychosocial model for musculoskeletal pathology.
- socioeconomic (class?) status
- social support network
- family dynamics
- cultural beliefs
- social isolation / stigma
- workplace dynamics
Give 5 examples of negative psychological prognostic factors in the biopsychosocial model for musculoskeletal pathology.
- depression
- pain-related fear
- false beliefs
- castastrophic thinking
- passive coping strategies
How should our assessment of someone’s biopsychosocial factors weigh on our treatment approach
If someone shows signs that there are biologic factors that play a significant role (e.g. patellar tendinopathy), the treatment approach will be more tissue-based. If someone shows more dominant psychsocial factors (e.g. central sensitization), then the treatment might be more about generalized movement, coupled with other healthcare professionals.
How do you evaluate social and psychological factors?
You have to ask specific questions & use questionnaires.
List two reliable questionnaires that assess for pain-related fear or anxiety about movement.
- Fear-Avoidance Beliefs Questionnaire (FABQ)
- Tampa Scale of Kinesiophobia
Which biopsychosocial domain & factor is assessed with the Tampa Scale of Kinesiophobia?
Doman: psychological
Factor: fear, fear-avoidance, beliefs
Give an example of a questionnaire that assesses for clinically relevant depression.
Four-Dimensional Symptom Questionnaire (4DSQ)
Which biopsychosocial domain & factor is assessed with the Four-Dimensional Symptom Questionnaire?
Domain: psychological
Factor: depression
Give an example of a questionnaire that assesses catastrophic thinking & beliefs about illness.
Brief Illness Perception Questionnaire (IPQ-B)
Which biopsychosocial domain & which 2 factors are assessed with the Brief Illness Perception Questionnaire?
Domain: psychological
Factors: catastrophic thinking & false beliefs about illness
Give an example of a questionnaire that assesses for a passive coping style (for someone in pain, specifically).
Pain Coping Inventory (PCI)
Which biopsychosocial domain & negative prognostic factor is assessed with the Pain Coping Inventory?
Domain: Psychological
Factors: passive coping strategies
What are 2 questions that you can ask someone to assess for the presence of social factors that may impact their prognosis?
- “How do [your symptoms] affect work?”
- “How do [your symptoms] affect your ability to spend time with friends and family?”
What acronym can be used to assess for lifestyle factors that have the highest potential to impact someone’s prognosis?
SNAPS(S)
1. Smoking
2. Nutrition
3. Alcohol
4. Physical Activity
5. Stress
6. Sleep
When assessing someone’s lifestyle factors, what are 5 questions that you might ask a patient about smoking?
- “Do you smoke?”
- “What do you smoke?”
- “How much do you smoke?”
- “Do you want to stop?”
- “Do you want any help/support?”
When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about nutrition?
- “Do you eat well?”
- “Do you know your calorie intake?”
- “Do you eat fruits and vegetables every day?”
- “How much protein do you eat?”
- “How much sugar do you eat?”
- “Do you want any help/support?”
When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about alcohol?
- “Do you drink alcohol?”
- “How often?”
- “How much?”
- “Do you know the guidelines?”
- “Do you want to stop or drink less?”
- “Do you want any help/support?”
When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about physical activity?
- “Do you exercise?”
- “How much?”
- “Do you do any strengthening exercise?”
- “Do you enjoy exercise?”
- “What stops you from exercising?”
- “Do you need any help/support?”
When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about stress?
- “Do you find time to relax?”
- “What do you do to relax?”
- “Do you feel stress often?”
- “What triggers your stress?”
- “How do you manage stress? / Do you have strategies to manage stress?”
- “Do you want any help/support?”
When assessing someone’s lifestyle factors, what are 6 questions that you might ask a patient about sleep?
- “Do you sleep well?”
- “How many hours do you get?”
- “Do you feel refreshed on waking?”
- “What stops you from sleeping?”
- “What helps you sleep?”
- “Do you want any help/support?”
What is the nocebo effect?
A clinical situation in which a person’s negative expectations of a treatment cause the treatment to be ineffective or have a more negative effect than it otherwise would have.
In a notable example of the nocebo effect, Mondaini et al performed a study in which they essentially “gave” men sexual dysfunction. Describe the study and how it demonstrates how beliefs and expectations affect outcomes.
120 males with benign prostate hyperplasia were given Finasteride (Propecia), but only half were told that they could experience side effects like erectile dysfunction, reduced libido, and/or problems with ejaculation. ~44% of those who were told about the side effects reported one or more of those symptoms, compared to only ~15% of the control group.
