Treating the Whole Person – The Integrated Systems Model for Pain & Disability: An Evidence-Based Approach to Optimize Function & Performance
Physiotherapists spend a considerable number of years gaining the knowledge necessary for their chosen career, and most continue to take post-graduate courses and attend conferences to increase their theoretical knowledge base and technical skill-set available in their ‘toolbox’. In the evidence-based era of medicine, physiotherapists are also exhorted to consume an ever-growing amount of information and scientific studies. The challenge in the midst of all this information is to incorporate and integrate the newly learned science and clinical skills into a framework that facilitates wise clinical decisions in day-to-day practice. Rivett & Jones (2004) have noted that there is a tendency in both courses and conferences to neglect an essential component of daily clinical practice – clinical reasoning. How does the clinician organize both old and new knowledge, clinical experiences and the emerging scientific findings? Without a framework to organize knowledge, clinical decision-making becomes increasingly difficult. The Integrated Systems Model (ISM) for Pain & Disability (Lee & Lee, 2007) is a framework to understand and interpret the unique picture of each individual patient in the clinical context to facilitate decision-making and treatment planning. The model provides a context to organize all the different types of knowledge needed (scientific, theoretical, professional craft, procedural, and personal) and provides for the development and testing of multiple hypotheses as the multidimensional picture of the patient emerges. It also facilitates clinical reasoning ‘on the fly’ as the patient’s story unfolds and the clinician begins to understand the significant pieces of their tapestry. A multimodal treatment plan can then be designed based on the complete picture of the person and their presenting problem(s), tailored around their meaningful task(s).
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