Psychologically Informed Physiotherapy - embedding psychosocial perspectives within clinical management

Edited by Stuart Porter; Published by Elsevier

This is a book I wish had been available when I was training back in the dark ages! It discusses how there should be an element of psychology in every approach to our patients.

We are all aware that a patient centred approach is required and that the medical model per se is no longer sufficient in the treatment of patients. This book goes further than the social model, addressing the BioPsychoSocial model (BPS) and how it relates to health care -  physiotherapy in particular.

When I was training, we had a few psychology lectures in the first couple of terms, but they did not seem relevant to the job I was being trained for. The emphasis of my training was much more on the practical side, with knowledge of anatomy, physiology, conditions and treatments. This has changed, as discussed by the author of the book's final chapter who states: The BPS approach argues that non-medical factors have an equal importance in the understanding, and therefore treatment, of a patient’s medical condition (Katherine E. Crook, chapter 11).

Don’t be put off by the first chapter! I still haven’t read it all the way through because, in my opinion, it added nothing to the subject. The figures are not referenced in the text, and it is difficult to see their relevance. However, this is one of very few negative observations overall.  

In chapter 3, Susan Greenhalgh and James Selfe bring balance to the subject by saying that we must not concentrate everything on the PsychoSocial and lose sight of the Bio, as there may be a risk of missing serious conditions.

In chapter 7, Alan Chamberlain, amongst other things, gives a very good explanation of the Clinical Flag System. The content is generally good, but I found Chamberlain's frequent statement  It is beyond the scope of this chapter… frustrating. Examples or signposting to further reading would have been helpful!

Chapters 1 - 7 cover the BPS approach generally, and include information on the chemistry/physiology of stress, pain and recovery, cognitive behaviour therapy, and motivation. Chapters 8 - 11 describe how to apply the BPS approach.

In chapter 8, Andrew Mitchell discusses the psychology of the athlete. A lot of the principles apply to non athletes too, therefore it is still worthwhile reading this chapter if you work in the general posture and mobility field.

In chapter 9, Louise Henstock and Helen Carruthers provide a practical guide on how to use BPS strategies in everyday treatment. They talk about power sharing and the therapeutic alliance between patient and therapist. The principles are not specific to groups of patients (e.g. MSK, athletes) and are therefore transferrable to other areas of practice. As in Chapter 1, the figures are not referenced in the text, but at least appear relevant.

In the final chapter Katherine E. Crook explains how, as a student, she moved through the stages of using psychology, and how they are similar to the competence model of learning.

Each chapter of the book is well-referenced and the order flows well. In general, it seems to be aimed at the nearly qualified and new physiotherapists, although it obviously has relevance for those long in the tooth like me! It would also be a valuable resource for all medical professions.