'Tell me your story' - How osteopaths apply the BPS model when managing low back pain - A qualitative study. (March 2020)

• Record Type: Journal Article
• Authors: Abrosimoff, Monica; Rajendran, Dévan
• Is Part Of: International journal of osteopathic medicine. Number 35(2020)
• Page Start: 13
• Page End: 21
• Publication Date: 2020-03
• Subjects: Biopsychosocial model -- Low back pain -- Osteopathic medicine -- Patient-centred care -- Uncertainty -- Manual therapy; Osteopathic medicine -- Periodicals; Osteopathic Medicine -- Periodicals; 615.53305
• DOI: 10.1016/j.ijosm.2019.11.006
• Languages: English
• ISSNs: 1746-0689

Abstract

Abstract: Background: Low back pain (LBP) is a common reason people seek osteopathic care. The biopsychosocial (BPS) model is a clinical model encompassing complex contextual aspects that contribute to a person's pain experience. This study aimed to understand osteopaths' experiences of the practical application of the BPS model to patients with LBP, and to describe any challenges in operationalisation. Methods: We conducted a qualitative study and interviewed purposively-sampled osteopaths who self-identified as applying a BPS approach to managing LBP. A constructivist approach consistent with elements of grounded theory was used to analyse these data. Results: The following themes were constructed to describe participants' experiences of applying the BPS model; 1) collaboration 2) deriving meaning from narrative 3) coaching 4) empowerment 5) reframing 'pain' and 6) desensitising. Two further themes represent challenges; 7) deficiencies of undergraduate BPS training and clinical integration and 8) osteopathic identity and scope of practice. Two central concepts were established; A) the BPS model is used as an interactive frame; and B) challenges of integration and uncertainty exist and have the potential to lead to unintentional fragmentation of the model. Conclusions: Participants viewed the BPS model as essential in navigating a person's experience of pain; identifying emergent factors contributing to the cause or maintenance of the person's condition and informing management of these factors. However, the integration of the BPS model into clinical practice remains fraught with obstacles including the dualist nature of beliefs about pain, inadequacies of undergraduate training and uncertainty about remit. Highlights: Participants provide pragmatic strategies to operationalise the biopsychosocial model. Operationalisation requires critical knowledge of the emergent nature of pain. Challenges and uncertainty lead to unintentional fragmentation of the model. Application of the biopsychosocial model expands traditional osteopathic practice. Undergraduate training, to clinically integrate the biopsychosocial, must improve.