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An award-winning approach to returning to work with musculoskeletal disorders (MSDs) is getting results. Occupational health physiotherapist Heather Watson explains the strategy behind this effective multi-disciplinary intervention.
The biopsychosocial (BPS) model of health was first suggested by psychiatrist George L Engel in 1977. He highlighted that the wider personal perspective of the patient and the socio-economic context can influence the outcome of a health condition.
This means that how the person responds to the situation can determine the outcome, as much as the health condition itself; and it can lead to many possible results.
Engels first paper was: "The need for a new medical model: A challenge for biomedicine", and, almost 40 years on, it remains a challenge to biomedicine, and to clinicians managing a wide variety of health conditions.
In some circles it has become widely accepted as best practice, but in others it is still an anomaly. Nationally and internationally, healthcare professionals disagree on the use of the BPS model across all health conditions and stages of the care pathway.
In the UK, there is mounting scientific evidence (Waddell, Burton, Kendall, 2008) that employing a BPS approach can be an effective alternative to the biomedical model for a number of health conditions for functional work-related outcomes.
But its application is variable, at best used in circumstances where it is widely accepted for certain types of conditions, such as longterm health conditions and persistent pain, but at worst reserved only for those conditions, and not utilised earlier in the patient journey to reduce the likelihood of future disability.
It is worth noting in relation to the term "persistent pain", that it has become commonplace to use the term "chronic pain" for anything other than acute pain related to damage in the body.
However, often people think that chronic pain means bad or severe pain, whereas it actually refers to pain that has gone on longer than expected.
This sort of pain is often no longer associated with damage (even if it may have started with an injury) and more to do with how the central nervous system has processed the injury. It can require a slightly different approach to clinical treatment and return to work rehabilitation (Tasmanian Health Organisation South, 2014).
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