Dispositionalism in musculoskeletal care

Rebekah DELLA CASA, OT, CSTP® [1]

“DISPOSITINALISM IN MUSCULOSKELATAL CARE: UNDERSTANDING AND INTEGRATING UNIQUE CHARACTERISTICS OF THE CLINICAL ENCOUNTER TO OPTIMIZE PATIENT CARE”

Michael VIANIN, (MSc, DC) chiropracter with a Master’s degree in Rehabilitation Sciences, Evolve global publishing (2021)

More than just a book, this publication offers a new model and tools for the understanding and caring of the patient’s, especially those presenting MusculoSKeletal (MSK) chronic pain. The unique characteristics of the individuals and the complexity resulting from the interactions of these characteristics need to be considered as this complexity has an influence on the severity and expression of the disorders. The disposition - model is considered as a contemporary patient centered model of care which offers practitioners an evidence-based treatment for MSK conditions.

The presentation and contextualization of the dispositional model in MSK pain is organized in three distinct parts: Foundation, Discovery and Mastery

• “Foundation”: In two sections (Introduction and The Context), the book underlines the limitations of the biomedical and biopsychosocial models to truly understand the complexity around MSK pain. Clinicians need to consider, not only the sum of dispositions but also their interactions. In this part, the importance of considering the clinical encounter and the context in which care is given are underlined.

• “Discovery” is a presentation of numerous unique characteristics, differently named dispositions, belonging to the patient and the practitioners© values which can have a direct or indirect impact on the expression of MSK pain. The way the different dispositions interact can lead to the manifestation of or non manifestation of the symptoms. The different factors which are described are, for the patient: the self, culture, social determinants of health, health literacy, pain catastrophizing, depression, sleep quality, metabolic health, physical activity, self efficacy and the locus of control. For the assessment of these dispositions, one will find practical tools for daily use. Clinicians© beliefs and quality of communication are also presented as having an influence on the patient’s pain experience and healing strategies.

• “Mastery” illustrates the practical application of the dispositionalism vector model. This chapter is an illustration and explanation of the evolution of the manifestation of MSK pain in a patient’s care over time. Michael Vianin chose to end his book with an invitation to further discuss the concepts on www.mskcarethebook.com.

This disposition-model seems to be an enriching way for therapists to organize their thoughts in the taking care of neuropathic pain patient and is, in my opinion, worthy to put it into practice.

[1] Somatosensory Rehab Centre, Clinique Générale, Freiburg (Europe – Switzerland).