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      Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice

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          Abstract

          Background

          Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education.

          Objectives

          My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM).

          Method

          Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements.

          Results

          My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another.

          Conclusion

          Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice.

          Clinical implications

          Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

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          Most cited references33

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          Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

          Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014.
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            Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides.

            Communication skills training is now internationally accepted as an essential component of medical education. However, learners and teachers in communication skills programs continue to experience problems integrating communication with other clinical skills, ensuring that clinical faculty support and teach communication beyond the formal communication course, extending communication training coherently into clerkship and residency, and applying communication skills in medical practice at a professional level of competence. One factor contributing to these problems is that learners confront two apparently conflicting models of the medical interview: a communication model describing the process of the interview and the "traditional medical history" describing the content of the interview. The resulting confusion exacerbates the above dilemmas and interferes with learners using communication skills training to advantage in real-life practice. The authors propose a comprehensive clinical method that explicitly integrates traditional clinical method with effective communication skills. To implement this more comprehensive approach, they have modified their own Calgary-Cambridge guides to the medical interview by developing three diagrams that visually and conceptually improve the way communication skills teaching is introduced and that place communication process skills within a comprehensive clinical method; devising a content guide for medical interviewing that is more closely aligned with the structure and process skills used in communication skills training; and incorporating patient-centered medicine into both process and content aspects of the medical interview. These enhancements help resolve ongoing difficulties associated with both teaching communication skills and applying them effectively in medical practice.
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              Patient-centred communication is associated with positive therapeutic alliance: a systematic review.

              During the patient-therapist encounter, which communication factors correlate with constructs of therapeutic alliance? Systematic review. Clinicians and patients in primary, secondary or tertiary care settings. Studies had to investigate the association between communication factors (interaction styles, verbal factors or non-verbal factors) and constructs of the therapeutic alliance (collaboration, affective bond, agreement, trust, or empathy), measured during encounters between health practitioners and patients. Among the twelve studies that met the inclusion criteria, 67 communication factors were identified (36 interaction styles, 17 verbal factors and 14 non-verbal factors). The constructs of therapeutic alliance in the included studies were rapport, trust, communicative success and agreement. Interaction styles that showed positive large correlations with therapeutic alliance were those factors that help clinicians to engage more with patients by listening to what they have to say, asking questions and showing sensitivity to their emotional concerns. Studies of verbal and non-verbal factors were scarce and inconclusive. The limited evidence suggests patient-centred interaction styles related to the provision of emotional support and allowing patient involvement in the consultation process enhance the therapeutic alliance. Clinicians can use this evidence to adjust their interactions with patients to include communication strategies that strengthen the therapeutic alliance. Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.
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                Author and article information

                Journal
                S Afr J Physiother
                S Afr J Physiother
                SAJP
                The South African Journal of Physiotherapy
                AOSIS
                0379-6175
                2410-8219
                20 May 2021
                2021
                : 77
                : 1
                : 1538
                Affiliations
                [1 ]Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
                Author notes
                Corresponding author: Corlia Brandt, corlia.brandt@ 123456wits.ac.za
                Author information
                https://orcid.org/0000-0002-8445-1348
                Article
                SAJP-77-1538
                10.4102/sajp.v77i1.1538
                8182461
                50d1a0e7-c5a6-41a8-b9f8-f9dc0b4a868a
                © 2021. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 30 October 2020
                : 05 February 2021
                Categories
                State of the Art

                pelvic health,biopsychosocial model,evidence,research,women’s health,men’s health

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