The Psychologically Informed Practice Consultation Roadmap: A Clinical Implementation Strategy

Abstract

Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the roadmap as the building blocks and style of consultation become more familiar.

What Are the Underlying Mental Health Constructs Associated With Level of Capability in People With Knee and Hip Osteoarthritis?

“…We performed a retrospective cross-sectional analysis of data collected from a consecutive series of 954 adult patients who presented with knee and hip pain secondary to OA at a comprehensive outpatient OA management program (The Joint Health Program, Duke University) [23,40]. The program is offered in a large academic health system providing orthopaedic specialty care, including care focused on lower extremity conditions, to urban and rural populations between October 2017 and December 2020.…”

“…These patients may also be good candidates for psychologically focused treatments delivered by nonpsychologists, such as physical therapists who supplement their care with cognitive behavioral-based strategies (psychologically informed care) or through effective technology-enhanced delivery modes such as applicationbased cognitive behavioral therapy or mindfulness [11,42]. There is detailed practical guidance on the implementation and integration of multidimensional psychologic screening tools in clinical practice [11,39,40,51].…”