The Psychologically Informed Practice Consultation Roadmap: A Clinical Implementation Strategy

Author:

Main Chris J1,Simon Corey B2,Beneciuk Jason M34,Greco Carol M56,George Steven Z27,Ballengee Lindsay A28

Affiliation:

1. School of Medicine, Keele University , Newcastle , UK

2. Department of Orthopaedic Surgery, Duke University School of Medicine , Durham, North Carolina , USA

3. Department of Physical Therapy, University of Florida , Gainesville, Florida , USA

4. Brooks Rehabilitation , Jacksonville, Florida , USA

5. Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA

6. Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences Pittsburgh , Pennsylvania , USA

7. Duke Clinical Research Institute, Duke University , Durham, North Carolina , USA

8. Department of Population Health Sciences, Duke University School of Medicine , Durham, North Carolina , USA

Abstract

Abstract Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the Roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the Roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the Roadmap as the building blocks and style of consultation become more familiar.

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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