Biopsychosocial Model Of Care Research Articles

Psychopathological symptoms and their association with the quality of life and the sexual functioning in women affected by systemic scleroderma: a preliminary investigation.

This study aimed to investigate the presence of psychopathological symptoms and the relations of these dimensions with the quality of life and sexual function in a group of women affected by systemic scleroderma. Seventy-one women with systemic scleroderma were invited to participate in the study; 65 agreed to participate, while 6 declined. Four questionnaires were administered to the patients: a specific socio-demographic questionnaire, the Symptom Checklist-90-Revised (SCL-90-R), the Female Sexual Function Index (FSFI), and the Quality-of-Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41). Of all the participants in this study, 48% of patients showed a clinical score on SCL-90-R Somatization, 45% on depression, and 37% on obsessive-compulsive. As hypothesized, psychopathological symptoms were related to lower quality of life since somatization and depression predicted the total score of health-related quality of life and lower sexual functions, showing a specific effect of depression on sexuality. Our findings highlighted the presence of an association between psychopathological symptoms and reduced sexual functioning and the associations between somatization and the health-related quality of life dimensions in scleroderma patients. Furthermore, our results sustain the importance of also considering the mental health of patients with systemic sclerosis, within an integrated biopsychosocial care model.

Engagement with emotional concerns in general practice: a thematic analysis of GP consultations.

Emotional concerns (defined as any expression of low mood, anxiety, or psychosocial stress) are an important part of the biopsychosocial care model used in modern medical practice. Previous work has demonstrated variable engagement with emotional concerns and that improved communication has been associated with reductions in emotional distress. To examine how emotional concerns are engaged with during routine GP consultations. Secondary study using the Harnessing Resources from the Internet (HaRI) database. The available dataset contains 231 recordings from 10 GPs across eight urban and suburban practices recorded in 2017 and 2018. The dataset was reviewed to identify any consultations containing emotional concerns (as defined as any expression of low mood, anxiety, or psychosocial stress) before being imported into NVivo (version 12) to facilitate thematic analysis and coding. Reflexive inductive thematic analysis resulted in two major themes. The two main themes were as follows: engagement with emotional concerns as dynamic throughout consultations; and GPs engage with emotional concerns both diagnostically and therapeutically. In theme 1, this dynamism relates to competing areas of focus, immediate versus delayed engagement and reiteration of concerns throughout consultations. Emotional concerns can be engaged with in a similar way to physical concerns (theme 2) using a diagnostic and treatment-based approach; however, in addition to this, therapeutic listening and conversation is utilised. Awareness of the dynamic nature of emotional concerns within consultations and encouraging engagement with concerns in a flexible and patient-oriented manner may help improve doctor-patient communication. In addition, investigating how GPs and patients build shared understanding around emotional concerns may identify methods to reduce patients' emotional distress.

Social prescribing as a community health-promoting tool: lessons from a country exchange visit

Abstract Issue Social Prescribing (SP) describes evidence-based interventions designed to improve health and wellbeing by referring individuals with non-medical, health-related social needs to health-promoting community-based support and services. Differences in national health systems, sociopolitical infrastructures and terminology, has however created a heterogeneity on SP practice and limited its implementation. Description of the problem On may 2022 the Portuguese National Institute of Health Dr Ricardo Jorge in partnership with EurohealthNet, organised a Country Exchange Visit to Lisbon. The purpose was to discuss SP and other health promoting primary care strategies in practice at European level and explore the political, financial and practical enablers that connect community and primary health care and social services, in order to build up knowledge-base to foster further SP policy and practice. Results Participants from ten European health authorities visit on site several community-based initiatives and shared information about relevant activities in their countries. In particular, brainstorming sessions between participants and the twelve key SP partners from the voluntary and community sector, were continuously facilitated by organizers. A summary report was published, providing an overview of the knowledge exchange. Lessons Overall, the importance to strengthen the collaboration between health and social sectors was recorrently highlighted. Co-funding between the governmental bodies and development of intersectorial partnership projets were pointed out as key innovative approaches to launch and scale up sustainable SP implementation. It was noted that despite the evidence showing the health benefits of a SP model, quality of individual interventions should be ensured and supported by common evaluation frameworks. The development of new training and competence modules adapted to contextual needs was considered particularly relevant to foster SP implementation. Key messages • Social prescribing represents an innovative tool that enables health systems to meet in a better way the new societal challenges by a complete paradigm shift to a biopsychosocial model of care. • Implementation of social prescribing and its integration into national health systems is crucial to develop new models of care and health to face 21st century health problems.

Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders?

Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS). A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed. Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs. There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.

Psychiatry for all: enhancing medical practice and patient outcomes through psychiatric education for all doctors

This article emphasizes the importance of studying psychiatry for all medical professionals. Psychiatry deals with mental, emotional, and behavioural disorders, and a strong understanding of the field leads to more holistic, effective, and empathetic patient care. Key reasons for doctors to study psychiatry include adapting a biopsychosocial model of care, early identification and intervention for psychiatric disorders, improved health outcomes, better communication skills, combating stigma surrounding mental health, multidisciplinary collaboration, personal growth and self-care, and a more comprehensive approach to chronic illness management. Integrating psychiatry into medical education prepares doctors for the challenges they will face in their careers, ultimately improving the quality of patient care. The practice of offering internships in psychiatry, as seen in countries like UK and Australia, should be encouraged globally to create a cohort of doctors knowledgeable in the basics of psychiatry, ultimately reducing the impact of a shortage of psychiatrists and improving overall healthcare.

Medically unexplained somatic complaints: management in real life

Medically unexplained somatic complaints (MUSC) are a common phenomenon in primary care settings, and they pose a challenge to clinicians in terms of diagnosis and management. MUSC refers to the presence of physical symptoms that are not attributed to any known medical or organic cause. These symptoms can significantly affect patients’ quality of life and impose a substantial burden on healthcare systems. In real-life clinical practice, managing MUSC requires a multifaceted approach that includes a thorough clinical evaluation, psychoeducation, and collaborative care. The management of MUSC should start with establishing a good rapport with the patient and understanding their concerns and beliefs about their symptoms. Clinicians should also rule out any underlying medical conditions that may contribute to the symptoms. Once medical causes are excluded, the focus should shift to addressing the psychosocial factors that may be contributing to the symptoms. This can include educating patients about the nature of MUSC and the role of stress and anxiety in exacerbating their symptoms. Collaborative care involving primary care clinicians, mental health professionals, and other specialists is an effective approach for managing MUSC. It is essential to tailor the treatment to the individual needs of the patient and to ensure that they are engaged and motivated to participate in their care. In conclusion, managing MUSC in real-life clinical practice requires a collaborative, patient-centered approach that addresses the physical, psychological, and social factors contributing to the symptoms. Clinicians should adopt a biopsychosocial model of care and that maximizes patient engagement and improves their quality of life. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 184

Pain specialist management of sexual pain—I: foundations

Abstract Introduction The biopsychosocial model of care for women with sexual pain is a widely endorsed approach melding the expertise of multiple professional disciplines. Interventional pain management provides specialized diagnosis and treatment of chronic pain as part of the interdisciplinary care team. Diagnosis and treatment strategies are built on the foundational knowledge of the causes of female sexual pain, appreciation of the intrapersonal, interpersonal, and sociocultural contexts which shape pain, and the psychological and neurophysiological effect of chronic pain. This first paper in a series of four lays the groundwork for applying the perspectives, approaches, and therapeutic treatment options inherent in the specialty of pain management. Objectives To provide a current summary of the neurobiology, intrapersonal and interpersonal aspects of female sexual pain within a chronic pain paradigm. Describe the role of an interventional pain specialist as part of an interdisciplinary sexual pain team. Methods Internet search engines, PubMed and Cochrane Library were searched for relevant articles on female sexual pain within the scope of practice of pain management. Results A thorough review of the literature was conducted to include basic science studies, clinical trials, systematic reviews, consensus statements, and case-reports. The neurobiological and psychological aspects of sexual pain were described within a chronic pain paradigm. The perspective of a pain specialist on female sexual pain was presented. Conclusion The care of women with sexual pain is highly complex and must be individualized based on the characteristics of the pain, its chronicity, and all the ways the condition impacts each woman. Physiological changes seen in chronic pain are likely to be present in most women with sexual pain. Awareness of the replete biopsychosocial dimensions of sexual pain promotes the goals of interdisciplinary care and provides a foundation for each specialty in the team. The way pain management specialists employ that knowledge for women with sexual pain will be examined in subsequent papers.

Has the COVID-19 Pandemic Worsened Health-Related Quality of Life of Patients with Inflammatory Bowel Disease? A Longitudinal Disease Activity-Controlled Study.

The present longitudinal study aimed to investigate the burden of disease activity change on health-related quality of life (HRQoL) of patients with inflammatory bowel disease (IBD) during the two different pandemic waves in 2020 and 2021. A sample of 221 IBD patients (recruited during March-May 2020 for T0 and March-May 2021 for T1) was included. The psychological impact of the COVID-19 pandemic (Impact of Event Scale-Revised (IES-R)) and HRQoL (Inflammatory Bowel Disease Questionnaire (IBDQ)) were assessed. Post-traumatic COVID-19-related symptoms (IES-R) were not significantly different across the disease activity-related groups. Conversely, IBDQ was consistently higher in patients with persistent, quiescent disease activity compared to the other groups, as expected. Even after controlling for baseline IES-R, repeated-measures ANCOVA showed a non-significant main effect of time (p = 0.60) but a significant time-per-group interaction effect with a moderate effect size (η2 = 0.08). During the two different phases of pandemic restrictions, IBD-specific HRQoL was modified by disease-related factors such as disease activity, rather than by the post-traumatic symptoms of COVID-19. This lends further weight to the need for developing an evidence-based, integrated, biopsychosocial model of care for patients with IBD to identify subjective and objective factors that affect the burden of disease.

Effectiveness assessment of the medical-social rehabilitation of adolescents with mild mental retardation

Issues of treatment and rehabilitation of adolescents with mental retardation, improvement of old and new therapies using an integrated approach to rehabilitation, which allows increasing social activity of adolescents with mild mental retardation and improving their quality of life, are remaining relevant and needing further study. The aim of the work is a comprehensive study of clinical and phenomenological structure, comorbid pathology, socio-hygienic factors and criteria for assessing the limitations of life and its quality among adolescents with mild mental retardation, and to develop recommendations for rehabilitation measures in modern conditions. Materials and methods. At the Kryvyi Rih Psychoneurological Dispensary, 154 patients born in 2003–2008 who were under the dispensary observation of a teenage psychiatrist were examined. The study consisted of two stages: the first – at the initial visit for psychiatric care of patients with mild mental retardation, and the second – follow-up, at the age of 18–23 years. Clinical and epidemiological, clinical and psychopathological, psychodiagnostic and statistical methods were used in the study. The main tool of the study was the “Map for clinical and epidemiological studies”, which included socio-demographic and anamnestic information, the clinical part with a description of existing symptoms and syndromes. Results. As a result of rehabilitation measures, there was a decrease in cases and in the severity of comorbid pathology, improved cognitive functioning (attention, memory, language and writing skills, reading, arithmetic), motility, spatial orientation. Adaptive skills of statodynamic functions were improved in 36.4 % of cases, self-care ability – in 22.7 %. At the time of the study completion, 73.38 % of all respondents could be considered socially adapted. Among adolescents with mild mental retardation and comorbid mental and other pathologies, in addition to positive dynamics, there were negative dynamics (19.04 %) or no dynamics (14.29 %), emphasizing the need for longer time and larger number of rehabilitation measures among this category of patients. Conclusions. Biopsychosocial model of care for adolescents with mental retardation with the inclusion of medical-biological, psychological-pedagogical and social aspects helps to increase the effectiveness of rehabilitation measures aimed at reducing the severity of the underlying disease and improving social adaptation.

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

ATA2022 Annual Conference & Expo May 1–3, 2022Boston, Massachusetts

Transforming the medical model- The workforce skills and competencies for implementing a biopsychosocial model of care

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

HIV serodiscordant sexual partners: social representations of health care professionals.

to understand the structure of the social representations of health professionals from HIV/AIDS Specialized Care Services about HIV-positive partners. this is a qualitative study, based on the structural aspect of Social Representations, developed in specialized services of the metropolitan area of a state in the Northeast Region. Fifty-one professionals were interviewed using the technique of free association of words, processed by the software IRaMuTeQ, by means of prototypical and similarity analysis. the central nucleus was constituted by the terms "partnership", "love" and "fear", showing appreciation of meanings inherent to their beliefs, values and experiences that bring possibilities of reflections for health practices. the findings reinforce the impacts generated in the different segments of the lives of people living with HIV and in their emotional bonds. This highlights the need for the implementation of care strategies contemplating the biopsychosocial care model rather than the biological model.

PEDIATRIC CHRONIC PAIN MANAGEMENT DURING COVID-19

Pediatric chronic pain affects 20% to 40% of children. Occasionally severe disability and higher prevalence of mental illness follow, further complicating treatment. Chronic pain is one of the most common fields impacted by the COVID-19 pandemic, leaving many patients’ treatment indefinitely delayed. The goal of this session is to discuss the impact of the COVID-19 pandemic on the evaluation and management of pediatric patients with chronic pain through a biopsychosocial model of care.

Personalized program of medical and psychological rehabilitation of dementia patients

Dementia affects a person’s adaptation in everyday life, social life and usually affects a professional quality. Caring for patients with dementia causes distress to their family members. In modern psychiatric practice, a multi-vector approach is used within the biopsychosocial model of care for dementia patients. The leading strategy for the treatment of this category of patients includes measures to prevent development of cognitive deficits and, of course, treatment as itself. The main components of treatment are pharmacotherapy, psychotherapy and psychoeducational interventions aimed at people who provide care for patients. A comprehensive program of medical and psychological rehabilitation developed for patients with dementia includes the following components: pharmacotherapy, psychotherapy, psychoeducation (for patients and their relatives), psychological training (training of communicative, cognitive, social skills). As shown by analysis of the effectiveness of proposed program of medical and psychological rehabilitation of patients with dementia, after 1.5 years of catamnestic observation, against the background of using the program, stabilization of the emotional state of patients with dementia and their relatives, a decrease in the level of neuropsychological tension, and an improvement in the cognitive status of patients were noted. The level of socio-psychological adaptation increased, it was possible to preserve social and household skills, and they were able to switch to the use of adaptive coping strategies in patients with dementia and their family members. Keywords: relatives, rehabilitation, maladaptive behavior, emotional disorders.

Functioning profiles of individuals with Mucopolysaccharidosis according to the International Classification of Functioning.

The classification of health problems of persons with Mucopolysaccharidosis (MPS) based on the International Classification of Functioning, Disability and Health (ICF) may contribute to better understanding the disease impacts. The ICF is a useful tool to describe disabilities and functioning, especially in diseases with multisystemic involvement. To identify and classify the health needs of persons with non-neuronopathic MPS according to the ICF. A cross-sectional study. Department of Physical Therapy (Federal University, Brazil). Persons with non-neuronopathic MPS. Semi-structured interviews covering all components of the ICF were conducted to know the patients' perspectives of their health problems (patient-reported outcomes). The speeches were transcribed verbatim and analyzed by researchers to identifying meaningful concepts. Then, the concept units were linked to ICF components and the magnitude of the problem to ICF qualifiers. Data are shown by descriptive statistics and separated into two groups: children and adolescents, and adults. A total of 60 different ICF categories were used to classify participants' functioning. A total of 28 and 51 categories was necessary to classify the health problems of children and adults, respectively. Additionally, 16 categories related to contextual factors were used, of which eight and 12 were identified as facilitators by children, adolescents, and adults, respectively. The main problems were related to supportive functioning of arms or legs (b7603), pain in the body part (b2801), respiratory functions (b440), and voice functions (b310). Limitations in the activity and participation component were related to walking (d450), fine hand use (d440), washing oneself (d510), and dressing (d540). Recreation and leisure (d920) was restricted to approximately half of the studied population. People with MPS face impairments of body structures and functions, activity limitations and restrictions to participation. Environmental factors may be act as facilitators of these problems. The ICF is a useful tool to classify the health problems of people with non-neuropathic MPS. The planning of rehabilitation programs needs to covers all components of functioning to provide a biopsychosocial model of care. The ICF categories may direct health professionals to more effective targets.

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice.

BackgroundPelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education.ObjectivesMy study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM).MethodVarious databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements.ResultsMy study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another.ConclusionBiomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice.Clinical implicationsIncorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

Changes in physiotherapy students\u2019 beliefs and attitudes about low back pain through pre-registration training

BackgroundImplementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists’ who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients’ beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students’ beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training.MethodsDuring three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students’ beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score.ResultsThe mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of − 26.95 (95%CI − 30.09 to − 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (− 7.16, 95%CI − 10.50 to − 3.81, p < 0.001).ConclusionsA spinal management learning module considerably improved physiotherapy students’ beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students’ beliefs leads to improved clinical practice in their first years of practice.

Integrative pediatric pain management: Impact & implications of a novel interdisciplinary curriculum

ObjectivesObjectives of this paper are to: 1) Describe a novel interdisciplinary, integrative pain curriculum for pediatric residents. 2) Describe changes in residents’ understanding of pain epidemiology, physiology, and management; application of the biopsychosocial model in pain management; and understanding and application of non-pharmacologic approaches to pain management. Design, settingThis study was done in a pediatric residency program within an urban pediatric teaching hospital. It employed both anonymous, Likert-scale surveys administered via Qualtrics, as well as open-ended, free response questions. InterventionsWe provided a multidisciplinary pain education curriculum to pediatric residents with a focus on pain neuroscience, a history of pain management, the biopsychosocial model of care, and exposure to non-pharmacologic interventions to pain management over six hours of instruction conducted in two blocks of three hours each. Outcome measuresSelf-identified changes via survey measuring resident physician knowledge, comfort, approach, and management of pediatric pain through an interdisciplinary pain curriculum. ResultsPrior to this training, many residents were not confident in their understanding of pain neuroscience, the biopsychosocial model of care, and non-pharmacologic interventions. At completion of training, residents indicated positive changes in knowledge of, and comfort with, all of the domains taught. Ninety percent of residents indicated that the curriculum changed the way they conceptualized, approached, and/or managed pain, and reported thinking more holistically about pain management. Nearly all residents indicated they would like to have more training (98 %, N = 57) in integrative modalities. ConclusionsPediatric resident physicians are receptive to training in an interdisciplinary, integrative, pediatric pain management education intervention, and subsequently show positive changes in knowledge and comfort levels. There is a need and desire for additional pain education in resident training programs.

Quality of life in patients with the first-episode psychosis

IntroductionThe use of a modern biopsychosocial model of care for patients with schizophrenia dictates the need for a dynamic assessment of the quality of life of patients at different stages of the disease to identify targets for treatment and rehabilitation measures. It is especially important to determine the available targets in the early stages of the disease in order to select effective complex therapy and improve the clinical and social prognosis.ObjectivesTo determine the socio-biological and clinical factors that have a significant impact on the quality of life of patients with first-episode psychosis.MethodsThe sample consisted of patients diagnosed with schizophrenia (n=58). The following research methods were used: 1) clinical-psychopathological; 2) quality of life assessment; 3) clinical-laboratory and functional research methods; 4) statistical. The QL-100 questionnaire was used as a tool for studying the quality of life. The PANSS scale was used to assess the severity of positive and negative syndromes.ResultsThe most significant adverse impact on the quality of life indicators are the absence of family, lack of work, low material wealth, active consumption of psychoactive substances, the predominance of negative symptoms and the presence of concomitant somatic disease in the acute phase.ConclusionsEarly identification of problematic aspects of the quality of life in patients with the first-episode psychosis allows us to conduct effective treatment and rehabilitation measures for these patients.

Epidemiology of Trauma History and Body Pain: A Retrospective Study of Community-Based Australian Women

To assess whether body pain was associated with different trauma histories (physical injury vs. interpersonal injury [IPI]) within Australian women, along with body pain and trauma history associations with biological and psychological (biopsycho) confounders. A retrospective cross-sectional analysis was conducted on the Australian Longitudinal Study on Women's Health (ALSWH) 1973-1978 birth cohort wave 6 data. Relevant life events were categorized into two types of traumatic experience and included as exposure variables in a multinomial regression model for body pain subgroups. Also, subgroup analyses considered trauma and pain effects and interactions on biopsycho burden. The unadjusted multinomial regression model revealed that a history of physical injury was found to be significantly associated with body pain severity, as was a history of IPI trauma. After the model was adjusted to include biopsycho confounders, the association between IPI and body pain was no longer significant, and post hoc analysis revealed the relationship was instead mediated by biopsycho confounders. Women with a history of IPI and body pain were also found to have the greatest biopsycho (physical functioning, stress, anxiety, and depression) burden. The relationship between IPI and body pain was found to be mediated by biopsycho burden, whereas the relationship between physical injury and body pain was not. Also, a history of IPI was associated with a greater biopsycho burden than was a history of physical injury. These results suggest there is clinical value in considering the comprehensive trauma history of patients with pain when developing their biopsychosocial model of care.