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Rethinking the Fear Avoidance Model

By |June 12, 2017|Biopsychosocial Model, Fear Avoidance|

Rethinking the Fear Avoidance Model: Toward a Multidimensional Framework of Pain-related Disability

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SOURCE:   Pain. 2013 (Nov); 154 (11): 2262–2265

Timothy H. Wideman, Gordon G. J. Asmundson,
Rob J. E. M Smeets, Alex J. Zautra,

School of Medicine,
Johns Hopkins University,
Baltimore, MD, USA.


Introduction

Nearly 20 years ago the Fear Avoidance Model (FAM) was advanced to explain the development and persistence of disabling low back pain. The model has since inspired productive research and has become the leading paradigm for understanding disability associated with musculoskeletal pain conditions. The model has also undergone recent expansion by addressing learning, motivation and self-regulation theory [10, 34]. In contrast to these extensions, however, one relatively constant aspect of the model is the recursive series of fear-related cognitive, affective, and behavioral processes shown in Figure 1 [31, 32, 34].

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The Biopsychosocial Model and Chiropractic

By |June 9, 2017|Biopsychosocial Model|

The Biopsychosocial Model and Chiropractic:
A Commentary with Recommendations for
the Chiropractic Profession

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2017 (Jun 7); 25: 16

Jordan A. Gliedt, Michael J. Schneider, Marion W. Evans,
Jeff King and James E. Eubanks Jr

College of Chiropractic,
Logan University


There is an increasing awareness, interest and acceptance of the biopsychosocial (BPS) model by all health care professionals involved with patient care. The areas of spine care and pain medicine are no exception, and in fact, these areas of health care are a major centerpiece of the movement from the traditional biomedical model to a BPS model of patient assessment and delivery of care. The chiropractic approach to health care has a history that is grounded in key aspects of the BPS model. The profession has inherently implemented certain features of the BPS model throughout its history, perhaps without a full understanding or realization. The purpose of this paper is to present an overview of the BPS model, its relationship with spine care and pain management, and to discuss the BPS model, particularly psychosocial aspects, in the context of its historical relationship with chiropractic. We will also provide recommendations for the chiropractic profession as it relates to successful adoption of a full integration of the BPS model.

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Psychological and Behavioral Differences Between Low Back Pain Populations

By |February 25, 2017|Biopsychosocial Model, Chiropractic Care|

Psychological and Behavioral Differences Between Low Back Pain Populations: A Comparative Analysis of Chiropractic, Primary and Secondary Care Patients

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2015 (Oct 19); 16: 306

Andreas Eklund, Gunnar Bergström,
Lennart Bodin and Iben Axén

Karolinska Institutet,
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research,
Nobels väg 13, S-171 77,
Stockholm, Sweden.


BACKGROUND:   Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.

METHODS:   In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared.

A: Four hundred eighty subjects from chiropractic primary care clinics.

B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity).

C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic.

D: Two hundred thirty-five subjects from secondary care clinics.

The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).

RESULTS:   The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.

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Preliminary Study Into The Components Of The
Fear-Avoidance Model Of LBP

By |October 5, 2016|Biopsychosocial Model|

Preliminary Study Into The Components Of The
Fear-Avoidance Model Of LBP: Change After An Initial Chiropractic Visit And Influence On Outcome

The Chiro.Org Blog


SOURCE:   Chiropractic & Osteopathy 2010 (Jul 30); 18: 21

Jonathan R Field, Dave Newell, and Peter W McCarthy

Back2Health,
2 Charles Street,
Petersfield, Hants, GU32 3EH, UK.
jonathanfield@me.com


BACKGROUND:   In the last decade the sub grouping of low back pain (LBP) patients according to their likely response to treatment has been identified as a research priority. As with other patient groups, researchers have found few if any factors from the case history or physical examination that are helpful in predicting the outcome of chiropractic care. However, in the wider LBP population psychosocial factors have been identified that are significantly prognostic. This study investigated changes in the components of the LBP fear-avoidance beliefs model in patients pre- and post- their initial visit with a chiropractor to determine if there was a relationship with outcomes at 1 month.

METHODS:   Seventy one new patients with lower back pain as their primary complaint presenting for chiropractic care to one of five clinics (nine chiropractors) completed questionnaires before their initial visit (pre-visit) and again just before their second appointment (post-visit). One month after the initial consultation, patient global impression of change (PGIC) scores were collected. Pre visit and post visit psychological domain scores were analysed for any association with outcomes at 1 month.

RESULTS:   Group mean scores for Fear Avoidance Beliefs (FAB), catastrophisation and self-efficacy were all improved significantly within a few days of a patient’s initial chiropractic consultation. Pre-visit catastrophisation as well as post-visit scores for catastrophisation, back beliefs (inevitability) and self-efficacy were weakly correlated with patient’s global impression of change (PGIC) at 1 month. However when the four assessed psychological variables were dichotomised about pre-visit group medians those individuals with 2 or more high variables post-visit had a substantially increased risk (OR 36.4 (95% CI 6.2-213.0) of poor recovery at 1 month. Seven percent of patients with 1 or fewer adverse psychological variables described poor benefit compared to 73% of those with 2 or more.

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