Functional illness in primary care: dysfunction versus disease

<p>Abstract</p> <p>Background</p> <p>The Biopsychosocial Model aims to integrate the biological, psychological and social components of illness, but integration is difficult in practice, particularly when patients consult with medically unexplained physical symptoms or functional illness.</p> <p>Discussion</p> <p>This Biopsychosocial Model was developed from General Systems Theory, which describes nature as a dynamic order of interacting parts and processes, from molecular to societal. Despite such conceptual progress, the biological, psychological, social and spiritual components of illness are seldom managed as an integrated whole in conventional medical practice. This is because the biomedical model can be easier to use, clinicians often have difficulty relinquishing a disease-centred approach to diagnosis, and either dismiss illness when pathology has been excluded, or explain all undifferentiated illness in terms of psychosocial factors. By contrast, traditional and complementary treatment systems describe reversible functional disturbances, and appear better at integrating the different components of illness. Conventional medicine retains the advantage of scientific method and an expanding evidence base, but needs to more effectively integrate psychosocial factors into assessment and management, notably of 'functional' illness. As an aid to integration, pathology characterised by structural change in tissues and organs is contrasted with dysfunction arising from disordered physiology or psychology that may occur independent of pathological change.</p> <p>Summary</p> <p>We propose a classification of illness that includes orthogonal dimensions of pathology and dysfunction to support a broadly based clinical approach to patients; adoption of which may lead to fewer inappropriate investigations and secondary care referrals and greater use of cognitive behavioural techniques, particularly when managing functional illness.</p

Prevalence of low back pain and lumbar spine degenerative disorders. Questionnaire survey and clinical–radiological analysis of a representative Hungarian population

A cross-sectional epidemiological study via personal interviews was performed regarding low back pain and its related clinical aspects in a Hungarian sample of 10,000 people. Joining the international campaign of the “Bone and Joint Decade”, our aim was to give data on low back pain prevalence and to explore the underlying possible clinical conditions in a Central European adult and adolescent population. Ten thousand people aged 14–65, selected randomly by the Hungarian central office of statistics from three counties of the south-western Hungarian region, were surveyed using a special questionnaire focusing on low back pain and other degenerative spinal symptoms. People with low back pain complaints and written consent were asked to participate in a further clinical investigation, where radiological and clinical assessment was performed. A total of 4,389 persons (44.1%) reported low back pain in the last month at the time of the survey. Work absenteeism due to low back pain affected 2,140 persons (21.5%). A total of 292 people (2.9%) had already undergone spinal surgery. Upon request 682 people came for a clinical follow-up, where thorough physical examination and radiological analysis was performed and results were statistically interpreted. The Oswestry disability index (ODI) in the examined group of patients averaged 35.1%; radiological degenerative signs were observed in 392/682 (57.5%). Individuals with signs of radiological degeneration had a statistically significant higher ODI value, age, and a higher, yet not significantly increased BMI value than radiographically negative patients (p < 0.05). Co-existence of hip and knee osteoarthritis was also investigated. Higher osteoarthritis prevalence was found in individuals with radiographic signs of spinal degeneration. Details of the survey and clinical investigations are discussed

Estimating utility values for health states of overweight and obese individuals using the SF-36

Objective: To use health-related quality-of-life (HRQoL) data from the Australian 1995 National Health Survey to estimate the impact of obesity (as measured by body mass index or BMI) on utility and quality-adjusted life expectancy (QALE). Method: SF-36 responses from 12,661 individuals in the general population were transformed into utility values using the SF-6D algorithm developed by Brazier and colleagues.Separate regression analyses for males and females were used to examine the impact of BMI and five obesity-related medical conditions (diabetes, coronary heart disease, depression, musculoskeletal disorders, and cancer) on utility. The utility estimates were used to provide indicative estimates of the decrease in QALE associated with being overweight or obese. Results: There was a statistically significant negative relationship between BMI and utility for males and females. For males (females), the marginal effect of a one-unit increase in BMI was associated with a −0.0024 (−0.0034) decrement in utility.Based on these estimates, a non-smoking male (female) aged 40 years who is obese can expect 7.2 (8.7) years less of QALE over their remaining lifetime. Conclusions : Results suggest that BMI is negatively associated with utility. Evaluation of policies designed to prevent or treat obesity should capture HRQoL as an outcome