Musculoskeletal conditions like back pain, arthritis, and injuries are prevalent, affecting millions of people worldwide. While treatment often focuses on physical factors like posture, movement, and anatomy, research shows that contextual factors also play a significant role in musculoskeletal health. As chiropractor and lecturer Dr. Michael Vianin discusses in his book Dispositionalism in Musculoskeletal Care, taking a holistic, patient-centered approach that considers contextual factors is critical to effective care.
What are Contextual Factors?
Contextual factors refer to the social, psychological, and environmental influences on a patient’s life and health. This includes factors like:
- Socioeconomic status – A patient’s income, education level, occupation, and access to resources.
- Relationships and social support – The patient’s personal relationships and support systems can reduce stress and promote healing.
- Stress and emotional health – Mental and emotional factors like anxiety, depression, trauma, and coping abilities.
- Health beliefs and behaviors – A patient’s perspectives, knowledge, and behaviors related to health.
- Access to healthcare – How easily can a patient obtain medical treatment, afford care, and understand health info?
- Physical environment – Aspects of a patient’s home, workplace, and community that affect health.
These factors shape a patient’s overall life experience and can impact their musculoskeletal health in various ways. For example, a stressful job or financial struggles may contribute to back pain symptoms. Limited access to care can prevent early treatment of an injury. Negative beliefs about aging can lead to worse arthritis symptoms.
Why Context Matters
Too often, musculoskeletal care focuses narrowly on physical examination findings, imaging results, and anatomical issues. However, as Dr. Vianin emphasizes in Dispositionalism in Musculoskeletal Care,
“The experts in pain are the patients.”
Understanding a patient’s full context gives critical insights into their pain and dysfunction.
Contextual factors influence critical processes like:
- Stress response and nervous system sensitization
- Development of chronic pain
- Healing and recovery
- Response to treatment
- Adherence to exercise and self-care
Patients with similar musculoskeletal issues on paper can have very different experiences depending on their life context. A biopsychosocial model considers biological, psychological, and social factors and allows for more personalized care.
Assessing Contextual Factors
Thoroughly assessing contextual factors is a vital part of patient-centered musculoskeletal care. This involves open-ended questioning and active listening to understand the patient’s:
- Health beliefs and attitudes – The patient’s perspectives on their condition, treatment options, providers, self-efficacy, etc.
- Stressors and supports – Situations or relationships causing stress vs. those providing support.
- Barriers to care – Factors preventing access to treatment like cost, transportation, language, etc.
- Lifestyle and behaviors – Diet, exercise, substance use, sleep habits, and other health behaviors.
- Emotional health – Screening for conditions like anxiety, depression, grief, trauma, etc.
- Resources and environment – Income, housing, neighborhood safety, workplace, healthcare access, etc.
Standardized questionnaires like the Patient Reported Outcomes Measurement Information System (PROMIS) can also help evaluate contextual factors like anxiety, depression, sleep, social isolation, and more.
Integrating Contextual Factors into Care
Once relevant contextual factors are identified, the care plan can be tailored to address these issues. For example:
- Incorporating stress management, meditation, or counseling for patients with high anxiety.
- Providing exercise modifications for patients with limited access to gyms or equipment.
- Working with physical and occupational therapists to address workplace ergonomics.
- Connecting patients to community services and resources.
- Collaborating with mental health providers for patients with chronic pain and depression.
A holistic, team-based approach allows for individualized care integrating both physical and contextual factors, as Dr. Vianin advocates in Dispositionalism in Musculoskeletal Care.
The Takeaway
While often overlooked, contextual factors are critical in the manifestation, treatment, and outcomes of musculoskeletal conditions. Assessing and integrating relevant social, psychological, and environmental factor into care through a patient-centered approach can improve health outcomes. Recognizing that, as Dr. Vianin puts it, “the experts in pain are the patients” ensures that care is tailored to each patient’s unique needs and context.
