PROCESS-BASED SPECIALIST IN MOVEMENT & PAIN

• World’s first biopsychosocial process-based approach to rehabilitation that is accessible by all disciplines for delivering care in a transdisciplinary manner.
• Addresses the most criticized shortcomings of the Biopsychosocial (BPS) Model.
• Evolutionary step forward for Evidence Based Practice (EBP) that provides a new perspective that provides a broad synthesis of scientific evidence, clinical practice, and personalized care.
• Embraces the scientific philosophy of Functional Contextualism, which is adhered to comprehensively throughout the HRF™ in order to ensure a coherent approach to clinical reasoning, decision-making, scientific research, intervention, and outcome measures.
• Replaces differential diagnosis from a clinical standpoint in most circumstances but continues to work in parallel with ICD structure from a payer perspective and historical organizational demands.
• Moves beyond general heuristics and algorithmic problem framing.
• Replaces Clinical Practice Guidelines (CPGs), Clinical Prediction Rules (CPRs), and Clinical Pathways.
• Protocols following syndromes and diagnoses are replaced by a process-based approach for evaluation and intervention.
• Reductionist clinical thinking is replaced by adaptive strategies for embracing complexity, while maximizing technologic advances (including psycho technologic advances) for improving efficiency with complexity.
• Process-based interventions provide transdiagnostic effects by way of their multi-dimensional and multi-level interactions.
• Supports advances in Personalized Precision Medicine and the Value Based Care Model.
• Designed to be ready for the future of Biomedicine and Psychological research, transitioning from analyzing inter-individual variation to non-ergodic intra-individual variation and single-subject time series analysis.

Learn more by accessing the HRF Community Website here.

The PSMP was designed to bridge the gap toward application and clinical integration of the biopsychosocial model, pain science, and contemporary movement and manual therapy science. Significant emphasis on working with uncertainty and complexity is built into the coursework. Transitioning clinicians from diagnostic/protocol interventional approach to a process-based approach is guided through the Human Rehabilitation Framework (HRF).™ The PSMP will introduce several firsts in the available movement and pain certification market. It will be the first movement, rehabilitation, manual therapy, or pain oriented certification to:

• …be process-based (see more on process-based below).
• …provide a structured biopsychosocial framework oriented around both the client/patient and the clinician for sustainable facilitative interaction toward improving quality of life, in particular for those struggling with movement and pain.
• …provide credit for courses taken from other biopsychosocially informed educators and organizations to increase clinical educational exposure to a diverse world of science-based resources for improving clinical practice.

In addition, since the PSMP will continue to evolve on an ongoing basis to keep up with the current scientific evidence and best practice, all participants and certified providers will have the opportunity to access to advances in the course work to ensure they are practicing in the most current supported scientific evidence.

Process-based therapy is most commonly recognized in psychological clinical practice, in particular Acceptance and Commitment Therapy (ACT), but the underlying premise of engaging in biopsychosocial processes during clinical practice is transdisciplinary and transdiagnostic in nature, in particular with movement and pain. Traditional clinical categorization of patient/client presentations provides a cluster of symptoms that fit a syndrome for which a protocol would be initiated. However, this approach is recognized as extremely limited when it comes to the complexity of pain, movement, increasingly convergent diagnoses, and psychological and social factors. A patient may present with multiple diagnosis for chronic low back pain, right shoulder pain, left knee pain, depression, anxiety, and headache diagnoses that would yield time and practical consideration competing interests, excessive utilization, excessive interventions, and a plan of care which would not be adherable by most patients if addressed by a protocol approach. Even a simple ankle sprain is more than the ankle for an athlete in the middle of their season. Yet, these presentations are common and often result in emphasis on a single factor, domain, or diagnosis without recognition of overlapping biopyschosocial processes in such presentations. Conversely, a process-based approach that is transdiagnostic engages in biopsychosocial processes that help facilitate change for client with multiple concordant diagnoses with lower utilization, increased patient autonomy and agency, and sustainable strategies in the long term to improve patient quality of life. The PSMP trains clinicians in a process-based approach to movement and pain with the availability of clinical mentorship during and after completion of the program. 

The biopsychosocial model provides a framework which explores the interplay of biology, psychology, and sociology in human health and illness. It was developed by George Engel in 1977 as an effort to address the shortcomings of the biomedical model for treatment of illness and addressing human health. The biomedical model exclusively identifies illness as the sum of purely biological factors with the exclusion of psychological and social factors, a stance which is incompatible with current scientific evidence for the treatment of movement and pain problems. Psychosocial factors are predominant predictors of health outcomes and disability trajectory, and human health cannot be addressed without inclusion of these factors. In recognition of this understanding, the World Health Organization (WHO) first advised that all healthcare providers adopt this model in 1987 and later developed the International Classification of Function (ICF) with the biopsychosocial model as the foundation. In recent years, the adoption of the biopsychosocial model has expanded to include sports medicine: Organizations ranging from the International Olympic Committee (IOC), the National Collegiate Athletic Association (NCAA), and US Military have made the stance that athletes in pain, should be treated by sports medicine clinicians who have a thorough understanding of the biopsychosocial model. Specific to physical therapy, the IOC recommends that physical therapists who treat athletes should be trained to “identify and address inaccurate conceptualizations of pain and injury plus psychosocial and contextual influences on pain” and be able to educate “the athlete regarding the role of the central nervous system in pain, especially in chronic pain“.

Despite world-wide and USA healthcare recognition of gaps in this knowledge, acceptance and integration of BPS-based models for clinical practice is poor and rare in both private practice and hospital-based systems. This has been consistent across multiple healthcare disciplines, often with concerns of few incentives for adoption of the BPS model with current reimbursement models, the impact of the BPS model on workload, and inadequate resource availability for developing competence in BPS care serving as significant limiters to adoption. The PSMP was developed as an effort to address these barriers and many other challenges regarding the adoption of the BPS model in the treatment of individuals struggling with movement and pain problems.

Multidisciplinary approaches have shown potential to be beneficial for individuals struggling with pain. However, stand-alone intensive multidisciplinary biopsychosocial pain programs have a number of logistic, financial, and implementation challenges. Current healthcare climate (organizational factors, reimbursement, etc.) further decrease the likelihood of scaling stand alone centers to meet the needs of  the world-wide pain epidemic. The PSMP proposes an additional model to a traditional standalone multidisciplinary approach by shifting the emphasis from multiple single disciplines exclusively working in their specific domains, to a transdisciplinary model of practice across providers. Utilizing a transdisciplinary perspective allows for individual providers to have cross training with key aspects of pain treatment traditionally provided by other disciplines. By doing so, this would permit clinics with fewer available internal clinical disciplines to work within their network and community to allow for flexible integration of other disciplines on an as-needed basis to meet both the practical clinical and patient needs. This is particularly important when it comes to determining the appropriateness of the number of disciplines needed to meet the needs of the patient. Concurrent to this increased autonomy, this model will still function within new and existing multidisciplinary environments with the potential to decrease and address inefficiencies and gaps in care.

Our certification board will assess course qualification based on the scientific rigor involved in the development of a course and the congruency presented in the course between available scientific evidence and clinical practice. Below are generic examples of courses which would likely meet portfolio review approval.

Movement (Examples: Science-based exercise prescription, Graded Motor Imagery, Graded Activity and Exposure, and Loading Capacity related coursework)

Manual Therapy (Examples: Neurodynamics, Dermoneuromodulation, and other science-based manual therapy courses)

Communication (Examples: Educational Strategies courses: Pain Neuroscience education, and narrative approaches)

Behavior (Examples: ACT/DBT/CBT/Motivation Interviewing coursework)