Das biopsychosoziale Modell als Leitfaden für die Behandlung von muskuloskelettalen Schmerzen und Behinderungen durch bewegungsbasierte Therapie

Zusammenfassung

Hintergrund: Ob Schmerzpatienten aus physiotherapeutischer Sicht geeignete Kandidaten für die Rehabilitation in Form einer bewegungsbasierten Therapie sind, hängt vor allem von der zugrunde liegenden Pathologie ab.

Ziel/Methode/Ergebnisse: Sowohl für geeignete als auch ungeeignete Pathologien werden Beispiele angeführt. Selbst bei fehlender Kontraindikation sind die Erfolgschancen klinischer Entscheidungen, die auf dem mittlerweile als überholt geltenden „biomedizinischen” (strukturbasierten) Modell basieren, als recht gering einzuschätzen.

Die Evidenz der „Best Practice” zeigt, dass sich bessere klinische Ergebnisse und eine bessere Wahrnehmung der Selbstwirksamkeit durch die Therapeuten am wahrscheinlichsten durch Strategien erreichen lassen, die auch die psychologischen „Triebfedern” der muskuloskelettalen Schmerzen berücksichtigen. Anhand von Beispielen und Evidenz wird dargelegt, dass sich gut ausgebildete Physiotherapeuten in einer idealen Position befinden, um auf den Prinzipien und der Praxis der kognitiven Verhaltenstherapie basierende Strategien anzuwenden.

Schlussfolgerung:Die kognitive Verhaltenstherapie ist ein Produkt des heutzutage bevorzugten biopsychosozialen Modells von Schmerzen und schmerzbedingter Behinderung.

Abstract

Background: Whether or not pain patients presenting to physiotherapists are suited for rehabilitation using movement-based treatments depends critically on the nature of the underlying pathology.

Objective/Method/Results: Examples are given of suitable and unsuitable pathologies. However, even when not contraindicated, where clinical decisions are based on the outmoded ”biomedical” (structure-based) model, which often seems to be the case, the chances of success are seriously limited.

”Best practice” evidence indicates that better clinical outcomes, along with therapists’ improved perceptions of self efficacy, are likely to be achieved by strategies that also address psychological drivers of musculoskeletal pain. On the basis of examples and evidence it is argued, that well-trained physiotherapists are ideally positioned to utilise appropriate strategies based on the principles and practice of cognitive behavioural therapy.

Conclusion:Cognitive behavioural therapy is a product of the now preferred biopsychosocial model of pain and pain-related disability.

Schlüsselwörter

Schmerzen - Rehabilitation - Physiotherapie - biopsychosoziales Modell - kognitive Verhaltenstherapie

Key words

pain - rehabilitation - physical therapy - biopsychosocial model - cognitive behavioural therapy

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