Behavioural medicine in healthcare and in physiotherapy

Physical activity is today considered by healthcare professionals an effective complement or alternative for medical treatment. A crucial problem, however, is the poor patient compliance to advice about physical activity. When considering human movement from a behavioural medicine perspective, the focus is on what people do, think and feel. An integrated physiotherapy and behavioural medicine approach therefore implies that cognitions, emotions, physical and social environment are as important as physical prerequisites for movement behaviour. During the last decade, the behavioural medicine perspective in physiotherapy has been developed in clinical intervention studies. So far, most studies concern patients with musculoskeletal pain, e.g. low-back pain (1), whiplash-associated disorders (2) and musculoskeletal pain (3). These studies, with treatment individually tailored to patients’ problems and aiming to change patients’ behaviour, show an encouraging positive outcome trend. Reduced disability, fear-avoidance as well as increased pain control and perceived ability to manage future activities, have been found. At present, studies are needed to investigate long-term cost-effectiveness of physiotherapy with a behavioural medicine approach. Interestingly, in one high-quality study, costs were compared between orthopaedic manual therapy and a rehabilitation programme with cognitive–behavioural approach mostly delivered by physiotherapists. In a 7-year follow-up, the patients in the rehabilitation programme had reduced sickness absence, whereas sickness absence had increased in the manual therapy group (4). From a health economics point of view, it is time to think carefully where to invest the decreasing economical and human resources in healthcare. A behavioural change approach to patients presupposes a behavioural change also in physiotherapists (5). By studying the physiotherapists’ adherence to a treatment protocol in a randomized controlled trial, Sandborgh and her co-workers contribute in this issue with two papers to this new area of research. The implementation process of a behavioural medicine approach in physiotherapy necessitates further studies and constitutes a challenge for both clinicians and researchers. Further contributions in this issue are studies on Body Awareness Therapy in persons suffering from eating disorders, by Thörnborg and Mattsson, and on gender perspective on physiotherapy treatment in patients with neck and back pain, by Stenberg and Ahlgren. In a qualitative study, Olofsson and coworkers illuminate athletes’ experiences of their injury, rehabilitation and recovery after anterior cruciate ligament repair, and Thelandersson and coworkers present how systemic and haemodynamic parameters react to passive exercise. Enberg and coworkers demonstrate two occupational stress models to analyse work experiences of novice occupational therapists and physiotherapists in public sector employment. A book review on Chronic pain. Pain Management Series 2, 2007, by G.W. Jay, Informa Healthcare, is presented by Björnsdóttir.