Lecture 5a Flashcards
What is the biomedical approach?
- Assumes a casual relationship between disease, symptoms & disability
- Assumes clinician is the expert (may be expert in burns, but not the patients lived experience)
- Focus on the impairment
- Assumes that clinicians can:
> recognise patterns of signs and symptoms
> Understand the underlying pathology
> wait for the patient to recover - Can be difficult to explain lack of improvement in functional goals, activity and participation
What is to biopsychosocial approach?
- Treatment goals tailored to the patient’s individual needs within the injury context
- Prevention of ongoing disability and pain
- Early identification of risk and intervention
- Functional goals a priority
- Constant and dynamic reassessment over time as pathology goals change
- SOMETIMES patient and therapists goals are different
BIO aspects:
- Physical incident
- Infection
- ROM
- Pain
PSYCHO aspects:
- Previous history trauma/injury/loss
- PTSD
- Mental health history
- Coping style
SOCIAL aspects:
SES and financial security
- Culture
- Roles
- Home environment
2 types of assessments of scar
- Physical
2. Patient reported outcome measures
What are physical assessments of scars?
- Scar parameters (vascularity, pigment, height, pliability, texture) i.e VSS
- Pain, itch i.e. VAS
- Functional measures (ROM, hand function, grip strength)
- Technology measuring psychological data i.e. cutometer
- One dimensional –> symptoms
What are patient reported outcome measure assessments of scars?
- Patient needs and therapeutic progress over time
- Patient perception of scar quality, pain, itch, sensation, appearance, involvement in ADL/work/leisure
i.e. patient and observer scar assessment scale (POSAS)
Brisbane Burn Scar Impact Profile
*Multidimensional –> goal focussed
What kind of physical aspects would you look at when assessing a scar?
- Scar type (hypertrophic, keloid, linear
- Scar parameters
- Pain, itch, sensation
- Adhesion
- Functional measures
- Scar under tension
What is the POSAS
- Fill in observation
- Patient fills in scale
- Can determine how impactful the scar is on their life (e.g. of therapist rating scar low but patient high - shows that it’s impacting his life significantly)
What is Brisbane Burn Scar Impact Profile
- Looks at burden of treatment
How to apply Ax results to treatment planning and goal setting
Identify
- Internal factors that can be influenced by the person themselves (garment adherence, CBT)
- External factors outside of the peron’s control (e.g. unsupportive/unsafe workplaces, driving legislation)
- How these will affect treatment experience
Need to consider
- Degree of influence of each factor
- Degree of interaction between factors
- Variation across individuals (e.g. pain experience)
- Change of factors over time and over lifespan
*Can influence patient engagement in health promoting behaviours (e.g. garment adherence, participation in counselling)
Implementation of a biopsychosocial approach
- Words matter: people will remember how you made them feel
- Patent’s story and opinion is important
- Be a genuine listener and not a polite listener
- Compliance vs adherence (how well can they adhere)
- If not you, then who?
- Goal setting relating to functional and treatment goals
- The burden of treatment
