Article

In this perspective article, a number of conclusions and recommendations are
offered based on the articles in this special issue of PTJ. In this special
issue, a new approach to physical therapy, termed "psychologically informed
practice," is offered as a "middle way" between narrowly focused standard
physical therapist practice based on biomedical principles and the more
cognitive-behavioral approaches developed originally for the treatment of mental
illness. This new approach uses the "flags" framework, with psychologically
informed practice requiring routine and specific consideration of "yellow flags"
and "blue flags" (depending on clinical setting) for determining risk of poor
outcome and identifying the potential for treatment modification-but with
cognizance of the overall environment or context in which the clinician must
operate. This context includes professional culture, health care policy, and
insurance reimbursement (potential "black flags"). The primary goal of this
approach is to prevent the development of unnecessary pain-associated activity
limitations. The approach is based on the identification of normal psychological
processes that affect the perception of pain and the response to it as an
expected and normal part of the musculoskeletal pain experience and that are
potentially modifiable. The potential for linking risk identification with
targeted treatment has been discussed, this article focuses on the potential
implications for training and implementation, drawing on experience in developing
training programs in which the trainees have welcomed this new approach, viewing
it as a helpful extension of their basic professional training. Indeed, this new
approach can be viewed as evolutionary rather than revolutionary, in that it
builds upon the established professional expertise of physical therapists, but
incorporates systematic attention to the psychosocial factors that are associated
with outcome of treatment.

Langue : ANGLAIS