High Risk
Evidence based intervention and cognitive-behavioral approach
Patients with a High Risk of developing persistent and disabling pain are guided by the principles described in the medium risk group. They benefit from specialized Physiotherapy and are informed taking account the scientific evidence. In addition, in this group, the intervention approach should focus on psychosocial aspects through the adoption of intervention strategies based on the principles of the cognitive-behavioral approach. The central element of this approach is the identification and understanding of patient's problems and goals regarding the relationship between thoughts, emotions and behaviors. The intervention plan should target the patient problems (minimizing pain and disability, restoring normal life, including the return to work) and promoting of self-management of the patient condition. For these patients are recommended 12 sessions of Physiotherapy that can be performed in a group.
The Physiotherapists providing this intervention have additional specific training. Given the nature of this approach, the communication skills of the Physiotherapist and goal setting in a collaborative way with the patient have a fundamental role for the success of the intervention. Although in some cases it may be appropriate to select intervention strategies focused on manual therapy, it is expected that (by the characteristics of this group) the physiotherapist will often use strategies focused on education. Therefore, the key aspects of the intervention are:
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The treatment plan is informed based on the scientific evidence, with a focus on the implementation of a cognitive-behavioral approach. |
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The Physiotherapist uses advanced communication skills and motivational interview techniques to maximize the effectiveness of assessment and intervention. |
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The Physiotherapist validates the patients experience, identifies their expectations for a first session as well as for the overall intervention, and defines a treatment plan together with them. |
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Clinical evaluation is framed in the biopsychosocial model and includes the analysis of cognitive, behavioral and emotional response to pain, the impact of pain at functional level, and the identification of possible obstacles to behavioral change. This assessment is supplemented, where appropriate, by a physical examination. |
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The Physiotherapist analyzes the patient's adaptive and / or non-adaptive responses to pain and its functional impact, and identifies the pain-related problems that are modifiable by Physiotherapy. Where appropriate, it discusses (psychosocial) factors that may contribute to the development and maintenance of pain. |
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If the patient's current understanding of pain does not improve their functional levels, it should be ensured that the patient develops an adequate understanding of the nature of their pain (mechanisms, prognosis, assessment and intervention). |
