December 4, 2019 | 2 Min Read
An Introduction to the Integrated Systems Model for the Complex Patient
By Maggie Bergeron
No study to date has demonstrated a direct relationship between pathology and pain for any pain related condition (Clauw, 2015). Neither the presence or absence of pain nor the intensity of pain can be accurately predicted by the presence or absence of pathology (Catley, Moseley, & Jones, 2019).
How do you know when to treat what in any individual with multiple impairments and persistent pain?
Research-supported management efficacy is still lacking for most clinical problems; therefore, skilled reasoning is the clinicians’ best tool to minimize the risk of mis-management and over-servicing (Jones & Rivett, 2019). Clinical experience and the evidence suggests that clinical reasoning and individual assessment and treatment are required for best outcomes.
The Integrated Systems Model (ISM) is an evidence-informed, clinical reasoning framework to optimize strategies for function and performance.
The Integrated Systems Model has evolved from 40 years of collaborative clinical and education experience. It is a framework to help clinicians organize their knowledge and provide the best possible treatment for the individual patient. Since every clinician has a different skill set, an ISM therapist will never be a clone of someone else nor will they only adhere to specific therapies or algorithms. Each therapist is as unique and individual as the people they seek to help, why would therapy be any different? The Integrated Systems Model umbrellas all others.
In 2010, Diane Lee and Linda-Joy Lee decided on the words the ‘Integrated Systems Model’ to identify the collaborative approach they were teaching, lecturing, and writing about. Diane invited Linda-Joy to contribute to the 4th edition of The Pelvic Girdle (first edition 1989) since their collaborative work was going to be featured throughout their version. After much deliberation and clinical reflection they settled on the word ‘integration’ as being representative of what they were trying to help clinicians understand. How do the various systems we primarily treat in the scope of physiotherapy contribute to both optimal and non-optimal strategies for function and performance? They hoped that consistent language and communication would expedite and facilitate better treatment for better outcomes for their individual patients.
After naming their approach the Integrated Systems Model for Disability and Pain, they were introduced to Dan Siegel’s work through his book Mindsight. Siegel defines integration as ‘the linkage of differentiated elements to illuminate a pathway to health’. How perfect was that! It still is.
In order to treat a whole person with a biopsychosocial model one needs to understand the relationship and contribution of various systems (differentiated elements) that are ultimately manifesting as cognitive, emotional, or sensorial dissonance. In complex situations, a clinician often wonders ‘where do i start’? Treating the underlying problem and not merely the symptom is fundamental to CAMT teaching, long established in the Canadian Orthopaedic curriculum. ‘Finding their Driver’ (ISM language) is merely another way of saying the same thing – find the best place to start treatment.
Join Diana Lee and Nicole Sullivan for a one hour complimentary webinar where they will discuss models that consider interdependence of body regions. They will present a synopsis of the current evidence on motor control, posture, movement, and the neuroscience of pain that informs the ISM approach.
When: December 10th at 12:00pm EST
What: One hour complimentary webinar
Who: Diane Lee and Nicole Sullivan
Where: On Embodia – register here
What you will learn:
• Principles of the ISM approach
• Discuss the role of clinical reasoning in ISM
• Outline the specific tests and clinical reasoning of the findings that are used to facilitate better predictions of the relationships between impaired regions to determine where to focus treatment. In ISM this is called finding the driver
• Outline the further tests of the driver that help determine the underlying system impairment(s), articulate, neural, myofascial, and/or visceral, and thus develop individualized treatment programs based on the patients’ meaningful tasks and goals
• An introduction to individualized assessments and treatment plans for the whole person
Any healthcare provider and movement specialist who is interested in learning an evidence-informed, clinical reasoning framework that they can use with their patients is welcome to join their webinar.
– Learn an evidence-informed clinical reasoning framework to use with your patients –
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