Chronic conditions (such as COPD or diabetes) are increasing in Western countries like England and Holland. These long-term conditions need the patient to be active in managing their condition in order to achieve reduced financial healthcare burden and better quality of life for the patient.
In this way, evidence shows that a biopsychosocial model would benefit patient well-being and produce these financial improvements. However provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system.
So the biopsychosocial model is a great idea – how to implement it? Read more ›
Townsend et al (2006) write that traditional roles of psychologists are being challenged by the Multi-Disciplinary Team (MDT) treatment now required in order to treat patients with chronic pain according to the biopsychosocial model.
Treatment of chronic pain was traditionally carried out according to a biomedical model- a patient after a car accident was treated for chronic pain syndrome but not assessed for PTSD, for example. Research has shown the efficacy of a biopsychosocial model in treating pain, where social and psychological factors as well as biological are taken into account. Turk (2002) reported patient benefits of the biopsychosocial approach (with regards to chronic pain) as increase in functional ability, fewer disability claims, and less illness caused as side effects of medical treatment or examination. Where treatment ie pain reduction is not possible, the MDT will aim to maximise the patient’s functioning.
Townsend et al describe a case study about a patient Ann who underwent intensive 3 week programme with a MDT to cope with her lower leg pain and end dependency on pain medication. In the case study, the OT’s role in the MDT was to incorporate the various pain control strategies into activities of daily living (ADLs), using for example pacing techniques and appropriate body mechanics. They could possibly have been involved with the functional assessment and assisted with outcome measurement.
Activity analysis is used to evaluate the motor, sensory, cognitive,emotional, behavioural, cultural and social areas of the tasks being carried out in order to complete an activity. In this example, the Biopsychosocial approach is being used to guide the assessment of the patient.
Canelón et al analysed a patient who was experiencing pain in her right wrist following an injury in the workplace and subsequent hand surgery. The patient’s job involved processing insurance paperwork based at a desk workstation, and she was experiencing continued pain despite having an operation and prescribed medication to help with the pain.
They carried out an on-site job evaluation and analysed each motor movement she carried out in great detail at her workplace. They also evaluated her communication style and social interaction with colleagues, concentration and organisation, emotional areas such as her need for gratification, and cultural influences. Read more ›
The researchers sought to identify which tasks in meal preparation were the most demanding for elderly women, and how they overcame these to continue preparing meals as they aged. Meal preparation was meaningful to the women as it was an important part of their self-identity.
The COMP model was used to identify which tasks were important to the women. The PEOP model was then used by the researchers to carry out activity analyses for the chosen tasks.
They found that the difficulty in completing tasks as the women aged was not just due to biomedical functioning decreasing, but also environmental barriers. Often the women had carried out tasks habitually for a long time and when their physical functioning declined slightly it id not occur to them to change the environment to facilitate easier task completion. In this way the environment had become disabling since if it was altered the women would be able to carry out the tasks even with their decreased functioning.
This shows an example of the biopsychosocial (BSP) model in practice as it highlights the social/environmental factors affecting individuals (and influencing their physical functioning) as well as the traditional physical/medical factors according to the biomedical model, and highlights how other factors can influence or cause biomedical problems rather than them be the starting point.
Eckel E (2012) ‘Community Dwelling Elderly Women and Meal Preparation’ Physical & Occupational Therapy In Geriatrics 30(4) pp 344-360
According to Sackett et al’s (1997) hierarchy of evidence, grey literature such as this is shouldn’t usually be the first source you turn to for evidence since there are other sources which are more reliable, for example because they have been peer-reviewed. However sometimes there may be an absence of quality sources or you are trying to gain an understanding of public opinion on a topic.
To help me assess the website I am going to use Aveyard et al’s (2001) ‘six questions to trigger critical thinking’, which are:
Where does this information come from?
What is being said?
How did they write this?
Who is telling me this?
When was this written?
Why has this been written?
Where does this information come from? I found this by searching for “guidelines stroke recovery eating” using the search engine DuckDuckGo to avoid any tracking cookies from Google biasing the results according to my previous search history. Read more ›
I can’t use any old piece of evidence which has an abstract and a few relevant keywords to base my clinical actions on.
It could be biased (such as being funded by someone with an interest in the study’s outcome), not statistically significant, methodically flawed or irrelevant to the precise patient problem I am investigating. I could be challenged by a well-informed ‘expert patient’ who has free and easy access to information themselves via the internet, so I need to make sure I can back my decisions up.
Instead I’ll need to identify the patient’s problem, find relevant studies, critically evaluate them, and then apply them to the problem taking into account the patient’s individual needs.
Research + Clinical Expertise + Patient Preference = EBP
The process of EBP has five steps, although Melnyk (2010) later added two additional ones shown in italics below. It should also be noted that sometimes ‘Health Service Restrictions’ are included in the above formula (DiCenso et al 1998), meaning that limitations due to resource cost/access are taken into account as part of pragmatic reasoning.
0. CULTIVATE SPIRIT OF INQUIRY essential starting point
1. ASK questions that are answerable!
2. ACQUIRE search for the best evidence from the research available
3. APPRAISE critically appraise/evaluate the evidence – is it relevant, valid, reliable, applicable to you clinical question?
4. APPLY integrate the evidence with clinical expertise and patient’s preferences and values, and then implement it
5. ASSESS evaluate and reflect on the outcomes of your decision
6. DISSEMINATE EBP RESULTS share good practice and support other healthcare professionals Read more ›
Or the origins of Occupational Therapy in a socio-economical context
OT is obviously awesome so the ideas behind it have pretty much always been present throughout time in one way or another.
Below is a summary of Occupational Therapy’s position throughout the ages.
Primitive age There was an emphasis on community support within tribes, with Shamans providing ‘interventions’. Nature imposed occupations on people in order for them to survive- if you did not find occupation through making fires, hunting food or making shelters you would not survive for long.
Biblical age Jesus is described as valuing all people equally. There was an awareness of the importance of all forms of health. With mental health this could be raising self esteem and equality, such as talking face to face being preferred over letter writing in John chapter 2. Physical health is mentioned eg the use of therapeutic baths, such as in John chapter 5 where Jesus heals using the Pool of Bethesda, and of course spiritual health was a running theme since Jesus was a fairly spiritual guy and frequently took time out for meditation.
Classical age Philosophers proposed the idea of body and mind being restored or maintained in perfect harmony. A balance between physical activity/occupation and rest was encouraged. The physician Aesculapius founded treatment health centres which had gyms, spa baths, horse riding activities and theatres, providing a holistic approach to treating both physical and mental illness ahead of its time. Spiritual cures such as snake venom were also frequently used (incidentally this is where the medical symbol of a serpent on a staff originates).
However in seeking this perfection, infants with disabilities which could not be cured were killed as there was no hope of restoration, and perfect harmony was impossible. Read more ›