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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Max Zusman
Adjunct Associate Professor, Curtin University of Technology
Perth, WA 6845
Australia
eMail: M.Zusman@curtin.edu.au
