Biopsychosocial Paradigm Research Articles

Musculoskeletal surgeons have implicit bias towards the biomedical paradigm of human illness.

Evidence is mounting that the biopsychosocial paradigm is more accurate and useful than the biomedical paradigm of care. Habits of thought can hinder the implementation of this knowledge into daily care strategies. To understand and lessen these potential barriers, we asked: 1) What is the relative implicit and explicit attitudes of musculoskeletal surgeons towards the biomedical or biopsychosocial paradigms of medicine? 2) What surgeon factors are associated with these attitudes? An online survey-based experiment was distributed to members of the Science of Variation Group (SOVG) with a total of 163 respondents. Implicit bias towards the biomedical or biopsychosocial paradigms was measured using an Implicit Association Test (IAT) designed by our team using open-source software; explicit preferences were measured using ordinal scales. On average, surgeons demonstrated a moderate implicit bias towards the biomedical paradigm (d-score: -0.21; Interquartile range [IQR]: -0.56 to 0.19) and a moderate explicit preference towards the biopsychosocial paradigm (mean: 14; standard deviation: 14). A greater implicit bias towards the biomedical paradigm was associated with male surgeons (d-score: -0.30; IQR: -0.57 to 0.14; P = 0.005). A greater explicit preference towards the biomedical paradigm was independently associated with a European practice location (Regression coefficient: -9.1; 95% CI: -14 to -4.4; P <0.001) and trauma subspecialty (RC: -6.2; 95% CI: -11 to -1.0; P <0.001). The observation that surgeons have an implicit bias favoring the biomedical paradigm might inform strategies for implementation of care strategies based on evidence favoring the biopsychosocial paradigm.

What can I do for my low back pain? The Work In Progress questionnaire!

There is growing evidence on Commitment Therapy for people with low back pain (LBP). A self-reported questionnaire is lacking which evaluates commitment by relying on the most recommended actions, the most important core outcome domains, and the most evidenced treatment options. To describe the development and psychometric validation of the Work In Progress (WIP) questionnaire. Development and psychometric validation of the WIP questionnaire in the context of people with LBP, as a means to evaluate Commitment. Outpatient facilities. People with LBP. The new instrument was created by item generation and selection. Face validity, appropriateness, acceptability and feasibility were investigated. Psychometric testing was carried out in a cross-sectional study and included: 1) exploratory factor analysis; 2) reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intra-class Correlation Coefficient, ICC<inf>2.1</inf>); and 3) construct validity by hypothesis testing the correlation of the WIP questionnaire with the Pain Catastrophizing Scale (PCS), the Oswestry Disability Index (ODI), and a pain intensity Numerical Rating Scale (NRS) (Pearson's r correlations). The WIP questionnaire was successfully developed based on international guidelines and the testing of face validity, appropriateness, acceptability and feasibility were satisfactory. The instrument was administered to 102 people with LBP (39 females, mean age of 49.7±14.6 years [range 20-80], pain median duration of 42.1 weeks [range 3-360]). Factor analysis revealed a two-factor 10-item solution (57% of explained variance). The internal consistency was good (α=0.70-85) and test-retest assessment was excellent (ICC<inf>2.1</inf>=0.91-94). Construct validity was good, as ≥75% of hypotheses were confirmed. The WIP questionnaire is a self-reported tool to evaluate commitment in persons with LBP showing satisfactory psychometric properties. It can be recommended for clinical and research purposes. This study adds original new data to the existing knowledge in the field of Commitment within the bio-psychosocial paradigm for disabled people. It is expected to contribute to the evaluative, clinical and rehabilitative approach of individuals with low back pain.

Social stigmas towards people living with HIV in the Sars-CoV-2 vaccination process

Introduction: Social stigmas in people living with Human Immunodeficiency Virus (HIV) have been part of their history and can still be identified in today's care environments. Objective: To analyze the social stigmas in relation to the care of people living with HIV by those who provide the anti Sars-CoV-2 vaccination service. Materials and methods: A descriptive quantitative research were developed that included a census sample of 126 people. The scale of social stigma in the care of people with HIV/AIDS (Acquired immunodeficiency syndrome) was applied. The information was analyzed through SPSS version 25. Results: Most of the participants reported not knowing people with HIV, but they have been treated as users (54%) and considered that they are discriminated (88.1%). Although a low level of stigma was evidenced (71.4%), these are present in 85.7%. Having had contact as a user with people with HIV was associated with the level of stigma (p=0.008). Conclusions: It is necessary to promote training in which the complexity of the phenomenon is addressed and aspects such as social stigmas are identified, incorporating the biopsychosocial paradigm together with a gender perspective in favor of the comprehensive provision of care.

UTILIZING PHYSICAL THERAPY RESIDENTS' AS HEALTH PROMOTION EXPERTS TO IMPROVE QOL FOR OLDER VETERANS

Abstract Gerofit, an evidence-based supervised exercise and health promotion program for older Veterans, has demonstrated success with its best practice model through the improved health, physical function, and well-being of participants. In 2017, Cincinnati VA Medical Center (CVAMC) launched an innovative approach to address the staffing needs of this wellness program by utilizing a Physical Therapy (PT) resident model for Gerofit group supervision/functional testing. As licensed PTs, residents engage in year-long advanced training in geriatrics across a variety of settings. They encounter adults who have unhealthy behaviors (lack of physical activity, smoking, poor nutrition, inadequate sleep, and stress), and demonstrate the knowledge/skills to reduce risk factors, prevent/treat chronic disease, prescribe physical activity/exercise, perform interventions consistent with the biopsychosocial paradigm, design/deliver individualized exercise prescriptions, and lead telehealth group exercises classes for Veterans. This presentation will explore how PT residents are in an ideal position to promote health/wellness in the Gerofit Program.

Which patient and surgeon characteristics are associated with surgeon experience of stress during an office visit?

To determine clinician and patient factors associated with the surgeon feelings of stress, futility, inadequacy, and frustration during an office visit. A survey-based experiment presented clinical vignettes with randomized patient factors (such as symptom intensity, the number of prior consultations, and involvement in a legal dispute) and feeling behind schedule in order to determine which are most related to surgeon ratings of stress, futility, inadequacy, and frustration on 11-point Likert scales. Higher surgeon stress levels were independently associated with women patients, multiple prior consultations, a legal dispute, disproportionate symptom intensity, and being an hour behind in the office. The findings were similar for feelings of futility, inadequacy, and frustration. Patient factors potentially indicative of mental and social health opportunities are associated with greater surgeon-rated stress and frustration. Trainings for surgeon self-awareness and effective communication can transform stressful or adversarial interactions into an effective part of helping patients get and stay healthy by diagnosing and addressing psychosocial aspects of the illness. N/a.

Modeling Suicidality Risks and Understanding the Phenomenon of Suicidality Under the Loupe of Pandemic Context: National Findings of the COMET-G Study in the Russian Population.

Suicidality is a complex clinical phenomenon reflecting vulnerability to suicidal behavior which can be explained via the biopsychosocial paradigm and in relationship with a variety of country-specific factors. Data on suicides within the Russian population are inconsistent (from 11.7 up to 25.1 per 100.000), whereas the population's suicidality risks have not been investigated in detail. Suicidality estimates during the multifactorial influence of the COVID-19 pandemic could serve as a basis to learn more about this mental health indicator. The current study is a part of the COMET-G international project (40 countries, n=55.589), which represents an analysis of data collected from Russia's general population (n=7714, 33±12 y.o., 61% female) to estimate suicidality using the Risk Assessment Suicidality Scale (RASS) and its relationships with socio-demographic, clinical, and life-habit characteristics during the COVID-19 pandemic. The evaluation of the statistical data (descriptive statistics, ANOVA, LASSO linear regression, significant at α=0.05) was undertaken using TIBCO Statistica. According to the RASS, at least 20.68%, and up to 29.15%, of the general population in Russia demonstrated increased risk of suicidality during the pandemic. Modelling these risks pointed to the key vulnerabilities related to mental and behavioral disorders, such as (i) current severe depression and a history of mental disorders, (ii) bipolar disorder, (iii) use of illicit drugs surprisingly outranking the alcohol misuse, and psychiatric compounds (hypnotics), highlighting sleep quality deterioration, (iv) a history of suicide attempts and self-harm - though not self-reported changes in depression - in response were predictors of the risk of suicidality, which can be explained by the phenomenon of "learned suicidality", a habitual behavioral suicidality pattern completion accumulated over the background. Such (v) socio-demographic indicators as younger age (disregarding the gender factor), a marital status of single, having no children, living with fewer people in the household, a recent increase in family conflicts, increased need for emotional support, decreased need for communication, and not believing in precautionary measures against COVID-19, contributed to the increase of suicidality risk in the context of the pandemic. The findings of this study revealed new suicide risk factors that should be taken into account in suicidality risk assessments for the Russian population and in the implementation of suicide prevention programs in the region.

Improving the Effectiveness of Healthcare: Diagnosis-Centered Care Vs. Person-Centered Health Promotion, a Long Forgotten New Model.

Performance of healthcare can be measured as its ability to restore and preserve health with acceptable costs for the society. Under the current prevalence of chronic disease, medical care (the major content of healthcare) underperforms in all key indicators: clinical effectiveness, benefit/risk ratio of interventions, cost/benefit ratio, and general population health. In Russia key performance indicators (KPI) of healthcare do not allow effective decision-making; a similar situation is seen worldwide: most KPIs are either focused on the process (not results) of medical care, or depend on efforts out of control of healthcare decision-makers.The key root factors limiting clinical effectiveness and cost-effectiveness of healthcare are reactive diagnosis-centered organizational model of care and the underlying biomedical paradigm, generally inadequate in chronic diseases. They make healthcare intervene too late, use less effective prevention and treatment instruments, and be in a state of resource scarcity. In Russia there is also a lack of interdisciplinary and interagency cooperation essential for health preservation and promotion.Performance of healthcare system in overcoming the chronic disease epidemic can be improved through supplementing the current ‘reactive’ organizational model with preventive person-centered model based on the biopsychosocial paradigm. Enabling patients for early lifestyle-based interventions, the core P4 medicine approach, should prevail in managing chronic disease. Communication and information technologies should allow fast scaling up of the best person-centered practices.

The Influence of the Locus of Control Construct on the Efficacy of Physiotherapy Treatments in Patients with Chronic Pain: A Systematic Review.

The biopsychosocial paradigm contemplates the patient’s personality traits in physiotherapy treatments for chronic pain. Among these traits, the locus of control has a direct relationship with the person’s coping strategies in the face of their health problems. The objective of this systematic review was to assess the influence of locus of control on the efficacy of physiotherapy treatments in patients with chronic pain. A systematic review of the publications of the last ten years in Pubmed, Scopus, Science Direct and Web of Science databases was conducting with the terms physical therapy modalities, chronic pain, internal-external control, self-management, physical therapy and physiotherapy. The inclusion criteria were participants with chronic pain lasting at least three months who have received at least one session of physical therapy; the studies should have collected the patient’s locus of control as a prognostic factor at the beginning of physiotherapy treatment; the variables studied should include the pain intensity or clinical variables related to pain. A total of 13 articles were found, of which three were experimental studies and ten were observational studies. The included samples had chronic knee pain, nonspecific back pain, low back pain or neck pain; were people over 65 years of age or patients who had undergone hand surgery. In patients with chronic pain for more than three months, the locus of control construct participates as a predictor of the results of physiotherapy treatment. The presence of an internal locus of control favors better results. The personality traits of the subjects represent an important factor to take into account when planning physiotherapy treatments.

Health Equity and a Paradigm Shift in Occupational Safety and Health.

Despite significant improvements in occupational safety and health (OSH) over the past 50 years, there remain persistent inequities in the burden of injuries and illnesses. In this commentary, the authors assert that addressing these inequities, along with challenges associated with the fundamental reorganization of work, will require a more holistic approach that accounts for the social contexts within which occupational injuries and illnesses occur. A biopsychosocial approach explores the dynamic, multidirectional interactions between biological phenomena, psychological factors, and social contexts, and can be a tool for both deeper understanding of the social determinants of health and advancing health equity. This commentary suggests that reducing inequities will require OSH to adopt the biopsychosocial paradigm. Practices in at least three key areas will need to adopt this shift. Research that explicitly examines occupational health inequities should do more to elucidate the effects of social arrangements and the interaction of work with other social determinants on work-related risks, exposures, and outcomes. OSH studies regardless of focus should incorporate inclusive methods for recruitment, data collection, and analysis to reflect societal diversity and account for differing experiences of social conditions. OSH researchers should work across disciplines to integrate work into the broader health equity research agenda.

Editorial Comment: Papers from the International Consortium for Mental and Social Health in Musculoskeletal Care.

David Ring MD, PhD (left) and Ana-Maria Vranceanu PhD (right)The International Musculoskeletal Mental and Social Health Consortium (I-MESH) brings together clinicians and researchers with a passion for reducing the global toll of musculoskeletal disorders. United by a desire to break down the silos between those who care for people with musculoskeletal conditions, we developed I-MESH in 2020 to share knowledge and resources and develop actionable strategies to transition musculoskeletal care toward a biopsychosocial model. I-MESH includes more than 60 international clinicians and researchers who are trained as orthopaedic surgeons, social workers, psychologists, nonoperative specialists, athletic trainers, as well as physical, occupational, and hand therapists. We welcome new members who share our mission! I-MESH started with developing working definitions of mental and social health. We believe mental health includes thoughts, emotions, and behaviors that help us thrive, and that social health encompasses role, relationship, job, financial, home, and food security. Social health also is affected by educational access and quality, economic stability, healthcare access and quality, neighborhood and built environment, and social and community context including racism, discrimination, and violence. In the initial I-MESH meetings, we used a consensus-based decision-making approach to identify three key priorities for I-MESH. First, we sought common ground on the terminology and language to help foster quality patient care and research. Second, we set out to conduct qualitative and mixed-methods research to gain a nuanced understanding of the barriers and facilitators to implementation of psychosocial care at the level of patients, providers, and organizations. Third, we aimed to develop clinical and research resources to foster interdisciplinary collaborations. For example, we developed special interest groups within I-MESH focusing on research, communication, and clinical practice. Our first white paper delineates details on I-MESH’s mission, vision, and values [1]. We are proud to share the selected proceedings of the inaugural I-MESH meeting in this month’s Clinical Orthopaedics and Related Research®. These papers were presented at our virtual meeting in March 2021, which included qualitative, quantitative, and mixed-methods research. These papers not only draw attention to the notable influence of unhelpful thoughts, feelings of distress, and circumstances of insecurity on symptom intensity and the magnitude of capability (how one feels and what one can do), but they also hit on areas that have the potential to enhance overall health through collaboration and coordination of biopsychosocial strategies. Collectively, the papers in these selected proceedings add to the evidence that unhelpful thinking (such as worst-case thoughts and fear of painful worry or despair have notable associations with symptom intensity and magnitude of limitations. The I-MESH papers in these selected proceedings show that orthopaedic surgeons can identify unhelpful thinking using a number of easy-to-employ measurements and communication strategies, and that specific barriers can be lowered as we craft care strategies that take advantage of this knowledge. We hope that these selected proceedings in CORR® and I-MESH can help increase the momentum toward adoption of the biopsychosocial paradigm in musculoskeletal health and in medicine more generally. We plan to hold the second I-MESH meeting in Spring 2022 and welcome abstract submissions, which individuals can send to [email protected]. Selected proceedings from that meeting will again be published in CORR.

Surgeon Ratings of the Severity of Idiopathic Median Neuropathy at the Carpal Tunnel Are Not Influenced by Magnitude of Incapability.

Accurately distinguishing the severity of pathophysiology from the level of symptom intensity and incapability is a foundation of effective treatment strategies under the biopsychosocial paradigm of illness. With respect to idiopathic median neuropathy at the carpal tunnel (the symptoms and signs of which are referred to as carpal tunnel syndrome), surgeons who are more likely to recommend surgery based on the magnitude of symptoms and incapability rather than the severity of neuropathy may be underappreciating and undertreating mental health opportunities and overtreating mild, and on occasion unmeasurable, disease. A survey-based experiment that randomizes elements of the patient presentation can help determine the relative influence of magnitude of incapability on ratings of pathology severity. What factors are associated with severity rating of idiopathic median neuropathy at the carpal tunnel on an 11-point ordinal scale? One hundred eight hand and wrist members of the Science of Variation Group (among approximately 200 participants who complete at least one survey-experiment a year related to the upper extremity on average) reviewed seven scenarios of fictional median neuropathy with seven randomized variables: age, gender, limitations of daily activity (incapability), Tinel and Phalen test results, duration of numbness episodes, prevention of numbness with nocturnal splint immobilization, constant numbness, and weakness of palmar abduction. Participants had a mean age of 51 ± 10 years, 90% (97 of 108) were men, and 74% (80 of 108) were subspecialized in hand surgery. Surgeons were asked to rate the severity of idiopathic median neuropathy at the carpal tunnel on a on an 11-point ordinal scale. Factors associated with rated severity were sought in multilevel ordered logistic regression models. Fifteen surgeons did not complete all of their assigned randomized scenarios, resulting in a total of 675 ratings. After controlling for potentially confounding variables such as magnitude of incapability, factors associated with severity rating on the 11-point ordinal scale included palmar abduction weakness (odds ratio 11 [95% confidence interval 7.7 to 15]), longer duration of symptom episodes (OR 4.5 [95% CI 3.3 to 6.2]), nocturnal numbness in spite of splint immobilization (OR 3.2 [95% CI 2.3 to 4.3]), constant numbness (OR 2.5 [95% CI 1.9 to 3.4]), positive Tinel and positive Phalen test results (OR 2.2 [95% CI 1.6 to 2.9]), and older age (OR 1.6 [95% CI 1.2 to 2.1]). Our results suggest that surgeons rate the severity of idiopathic median neuropathy at the carpal tunnel based on evidence of worse pathophysiology and are not distracted by greater incapability. Surgeons who consider greater incapability as an indication of more severe pathology seem to be practicing outside the norm and may be underappreciating and undertreating the unhelpful thoughts and feelings of worry or despair that consistently account for a notable amount of the variation in symptom intensity and magnitude of incapability.

Diagnostic Challenges and Management of Fibromyalgia.

The World Health Organization regards chronic pain to be a public health concern. In clinical medicine, fibromyalgia (FM) is the most prevalent chronic widespread pain disease. In terms of impairment, consumption of health and social resources, and impact on primary and speciality care systems, it has reached worrisome proportions. This disease is frequently managed by primary care providers. Because of its intricacy, fibromyalgia diagnosis and treatment can be difficult.Fibromyalgia is a controversial condition. It might appear ill-defined in comparison to other pain conditions, with no clear knowledge of pathophysiology and hence no particular targeted therapy. This invariably sparks debates and challenges. There is no obvious cut-off point that distinguishes FM from non-FM. The diagnosis of fibromyalgia has been complicated by several factors, including patients' health-seeking behaviour, symptom identification, and physician labelling of the disease.Fibromyalgia is currently considered a centralized pain condition, according to research that has improved our understanding of its etiopathology. A multidisciplinary strategy combining pharmacological and non-pharmacological therapies based on a biopsychosocial paradigm can result in effective therapy. Cultural and psychosocial variables appear to be a recent development in fibromyalgia, and they appear to have a larger influence on physician diagnosis than severe symptom levels in FM patients. Although physicians rely on FM criteria as the only way to classify FM patients in research and clinical settings, some crucial elements of the diagnostic challenge of fibromyalgia remain unsolved - invalidation, psychosocial variables, and diverse illness manifestation are some examples.Beyond the existing constructional scores, physicians' judgment gained in real communicative contexts with patients, appears to be the only dependable route for a more accurate diagnosis for fibromyalgia. We have performed an exhaustive review of the literature using the keywords "Fibromyalgia", "challenges" and "diagnosis" in PubMed and Google Scholar indexes up to September 2021. This article aims to examine the causes, diagnosis, and current treatment protocols of FM, as well as discuss some continuing debates and diagnostic challenges which physicians face in accurately diagnosing fibromyalgia.

Social frustratedness as a psychogenesis factor of adjustment disorders

Summary. The current biopsychosocial paradigm in medicine and medical psychology ensures the development of the theory and methodology of medical psychodiagnostics as a comprehensive study of psychological and psychosocial factors underlying mental adaptation. The diagnostic of prenosological and initial manifestations of borderline spectrum disorders designated as adjustment disorders in ICD-10 (F43.2), requires the criteria qualification of real or potential stressogenic social functioning conditions, thus, an arsenal of adequate methods of clinical and medical-psychosocial psychodiagnostics is required. The questionnaire «Social Frustration Level» represents one of such methods. The study of social frustration phenomenon as a predictor of emotional tension and stress resistance allows to characterize personality traits in relation to environmental influence and assess the specificity and pathogenic significance of socially frustrating factors. The article substantiates theoretical and methodological foundations of the questionnaire, its attributive characteristics — the phenomena of external and internal social frustration identified in medical psychodiagnostics for the first time. Socio-diagnostic criteria are illustrated by examples of the practical use in medical psychodiagnostics of social frustration in teachers of mass schools, the military and in patients with focal epilepsy. The specified research contingent is united by the problem of stress resistance in crisis situations (including a disease situation and the attitude to the disease). The questionnaire «Social Frustration Level» can be considered as a necessary form of psychosocial diagnostics of stress genesis, a source of information in screening psychoprophylactic studies, as well as in the forming of indications for psycho- and sociotherapy.

Biopsychosocial Factors during the Perinatal Period: Risks, Preventative Factors, and Implications for Healthcare Professionals.

Women face risks to their wellbeing during the perinatal period of pregnancy. However, there is a dearth of information on perinatal risk factors within the biopsychosocial paradigm. Emphasis is often placed on biological components associated with pregnancy and women’s health. However, psychological and social determinants of health are integral during the perinatal period, and mental wellness is often a determinant for positive maternal and neonatal health outcomes. This article reviews risk factors of perinatal wellness (e.g., physical and nutritional concerns, trauma, discrimination, adverse childhood events) and highlights protective factors for women in their perinatal period. Healthcare professionals can support perinatal health by focusing on culturally and contextually appropriate research and prevention, providing equal access to sexual and reproductive healthcare information and services, providing quality education and training for helping professionals, and supporting policies for positive sexual and reproductive women’s healthcare.

How to define today a medical disorder? Biological and psychosocial disadvantages as the paramount criteria.

The 20th century has seen great developments in the concept of disease. Marked by the biopsychosocial paradigm, several strategies for disease definition were added to previous descriptive organic views, but a final concept is still out of reach. A critical review was carried out on thorough analysis of articles and textbooks to describe the main concepts and definitions of disease. The concept 'disease' is a pragmatic construct, not a natural kind. Three main ways to define disease were identified, and characterized: Biological (disease as a lesion, disadvantage/deviation from normal and dysfunction), Psychosocial (distress and disability, existential potentials, descriptive prototype, and prototype typification), and values-based definition. All the paradigms have advantages and flaws, but progressive use of all criteria in disease definition adds validity and reliability to diagnostic constructs. Such constructs must be, above all, useful for practice and research. Biological paradigm is relevant, but fails to cover all the complexity that involves human illness and the treatment process. An emphasis on distress, dysfunction, and carefully selected value-laden characteristics might be the right direction for useful diagnostic construct conceptions.

Analysis of General Practitioners' Attitudes and Beliefs about Psychological Intervention and the Medicine-Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care.

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative-qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist’s profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization.

CORR Insights®: Can Crafted Communication Strategies Allow Musculoskeletal Specialists to Address Health Within the Biopsychosocial Paradigm?

CORR Insights®: Can Crafted Communication Strategies Allow Musculoskeletal Specialists to Address Health Within the Biopsychosocial Paradigm?

Can Crafted Communication Strategies Allow Musculoskeletal Specialists to Address Health Within the Biopsychosocial Paradigm?

Musculoskeletal specialists who attempt to discuss the connection between mental health (thoughts and emotions) and physical health (symptom intensity and activity tolerance) with patients, may fear that they risk offending those patients. In a search for language that creates comfort with difficult conversations, some specialists favor a biomedical framework, such as central sensitization, which posits abnormal central neuron activity. Without addressing the relative accuracy of mind- or brain-based conceptualizations, we addressed crafted and practiced communication strategies as conversation starters that allow specialists to operate within a biopsychosocial framework without harming the relationship with the patient. We measured (1) patient resonance with various explanations of the mind-body connection, including examples of both mind- and brain-based communication strategies, and (2) factors associated with resonance and emotional reactions to the explanations. In this cross-sectional study, all adult new and returning patients who were literate in English and who attended several musculoskeletal specialty offices were invited to complete questionnaires addressing reactions to one of seven explanations of the mind-body connection assigned using a random number generator. Acknowledging that the relative accuracy of mind-based and nerve- or brain-based strategies are speculative, we developed the following conversation starters: two explanations that were cognitively framed ("the mind is a great story teller"; one positively framed and one negatively framed), two emotionally framed explanations ("stressed or down"; one positively framed and one negatively framed), one mentioning thoughts and emotions in more neutral terms ("mind and body work together … thoughts and emotions affect the way your body experiences pain"), and two biomedical neurophysiology-based explanations ("nerves get stuck in an over-excited state" and "overstimulated nerves"), all crafted with the assistance of a communication scholar. It was unusual for people to decline (although the exact number of those who did was not tracked) and 304 of 308 patients who started the questionnaires completed them and were analyzed. In this sample, 51% (155 of 304) were men, and the mean ± SD age was 49 ± 17 years. Reactions were measured as resonance (a 1 to 5 Likert scale regarding the degree to which the stated concept aligns with their understanding of health and by inference is a comfortable topic of discussion) and self-assessment manikins using circled figurines to measure feelings of happiness (frowning to smiling figures), stimulation/excitement (a relaxed sleepy figure to an energized wide-eyed figure), and security/control (small to large figures). These are commonly used to quantify the appeal and emotive content of a given message. Patients also completed surveys of demographics and mental health. Multilevel multivariable linear regression models were constructed to assess factors associated with resonance, happiness, excitement, and control. Controlling for potential confounding variables such as demographics and mental health measures, a relatively neutral biopsychosocial explanation ("mind and body work together") had the greatest mean resonance (4.2 ± 0.8 versus 3.8 ± 0.9 for the other explanations; p < 0.01) and the largest regression coefficient for resonance (0.78 [95% confidence interval 0.41 to 1.15]). The next-most-resonant explanations were biomedical ("excitable nerves", "over-excited state"). Biopsychosocial explanations that mention stress, distress, or cognitive bias ("mind is a great storyteller") had lower resonance. People with greater unhealthy cognitive bias regarding pain (more catastrophic thinking) were less comfortable with all the explanations (lower resonance, regression coefficient -0.03 [95% CI -0.06 to -0.01]). Emotional reactions were relatively comparable with the exception that people felt less control and security with specific explanations such as "excitable nerves" and "mind is a great storyteller." Crafted communication strategies allow musculoskeletal specialists to address health within the biopsychosocial paradigm without harming their relationship with the patient. Musculoskeletal specialists may be the first clinicians to notice mental health opportunities. It may be helpful for them to develop and practice effective communication strategies that make mental health a comfortable topic of discussion.

SLEEP DISORDERS IN THE COVID-19 PANDEMIC:

Sleep is a biological need that can be affected by various factors and interferes with physical and mental well-being. Thus, the current pandemic of COVID-19 has changed the routine of a large part of the population, as well as affected the quality of sleep and has become a risk factor for the development of problems. In this context, the present study sought to highlight the importance of sleep quality for different situations. In view of this, the article understands how the current pandemic scenario has interfered with the quality of sleep and, consequently, with the population’s biopsychosocial paradigm. This is a bibliographic review with data collection from secondary sources in March and April 2021, carried out in the SciELO and PubMed databases. It has been observed that sleep deprivation makes it possible to increase cytokine activity, namely interferon (IFN), tumor necrosis factor alpha (TNF-α), interleukin-1-beta (IL-1-beta), favoring the increase in inflammatory markers such as C-reactive protein (CRP), this set of changes negatively affects immunity and is directly related to changes in sleep patterns. Therewith, from the analysis, it is possible to perceive the harm that the scenario of COVID-19 brought to the quality of sleep, causing several losses in daily activities. Therefore, it can be inferred that changes related to sleep contribute to the absence of alertness and changes in perception as well as in sensory processes, making the individual lethargic and with a reduction in the cognitive ability to perform functions of essential attributions for their quality of life.

ИССЛЕДОВАНИЕ УРОВНЯ ГОТОВНОСТИ К ЦЕЛОСТНОМУ ВОСПРИЯТИЮ ПАЦИЕНТА У СТУДЕНТОВ МЕДИЦИНСКОГО ВУЗА

The significance of the article is determined by a necessity of a professional training of physicians in accordance with the biopsychosocial paradigm of health and illness that implies the readiness of a specialist to provide a holistic perception of a patient, to take into consideration psychological and pedagogical peculiarities of the patient and psychosocial aspects of one’s life, to communicate with the patient basing upon the concept of dignity. The aim of the study is to investigate the second-year medical students’ perception of doctor-patient interaction from the viewpoint of a holistic approach and to study the level of the psychological readiness to realize this type of interaction. Results. Understanding of the essence and the meaning of doctor’s profession was romantic and immature. The results obtained also showed that the students had high levels of anxiety, negative emotions and negative inner-experience. In spite of this the majority of the students showed themselves as active persons oriented at overcoming the difficulties. Conclusions. A combination of negative emotions, deficient skills of a holistic perception of the patient and deficient skills of interaction with the patient in junior students can lead to the emergence of a crisis in the professional development of a specialist and certain risk of a further emotional burnout in senior medical students and clinical residents while practicing in clinic. Basing upon the results obtained, trends for the improvement of communication courses and means of providing adjustment and prevention of emotional burnout in students were defined.