Biopsychosocial Model In Clinical Physiotherapy

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In retrospect, many physicians and psychologists believed that our health is separated into physical and mental aspects. In other words, mind and body are distinctive human structures and provide little interaction. Bernard's and Krupat's conclusion (1994) supported Engel's view (1977) that this belief is essential in providing the foundation of the biomedical model that dominates medicine todayThe biomedical model ignores the mind-body connection such as cognitive behaviours.

On the other hand, it focuses only on the biological aspect of health. The rise of this model has encouraged worldwide research efforts of identifying the specific cause of illness and treatment without putting the patient's psychological factors into consideration. Physician does not take the patient's mind into account throughout the development of disease that affect only the physical aspect of health. This led to the emergence of aggressive specific physical treatments of disease and contributes much to the potency of the medicine field (Bernard & Krupat, 1994).Despite the advantages offered by the biomedical model of illness, the two trends that arise in the medicine field revealed the weaknesses present in the biomedical model - the changing pattern of illness and the rocketing cost of healthcare (Bernard & Krupat, 1994).

It appears that the biomedical model is incomplete as the social and psychological factors are not taken into account. This can deter further improvement of the individual's health concerning that health does not merely refer to the absence of disease and is a state of complete physical, mental and social well-being (WHO, 2003).In 1977, psychiatrist George Engel proposed the biopsychosocial model of illness (Dowling, 2005). This model proposes that biological, psychological and social processes are integrally and interactively involved in the physical health and illness (Suls & Rothman, 2004).However, there are existing barriers to overcome in the actual implementation of biopsychosocial model in clinical practice.

Herman (1989) identified three barriers to the practice of biopsychosocial model. One is that applied biopsychosocial science is not easily taught and it is difficult to apply under conditions of stress. The other factor is the lack of nosological glossary which helps define the biopsychosocial model as an existing model in the medical context. On the contrary, the biopsychosocial model is a vision suggested by ideologist and an approach to practice rather than a verifiable theory, a coherent philosophy or a clinical method (Epstein & Borrell-Carrio, 2005).The implementation of biopsychosocial model was witnessed in clinical reality during a clinical placement.

Mr. A, a 35 years old male patient presenting complaints of pain in the right ankle, walked into the physiotherapy department using wheelchair with his wife. Based on the medical report, tear in the anterior talofibular ligament, and partial tears in the posterior talofibular and medial tibiotalar ligaments were diagnosed in the right ankle. During the first encounter, the physiotherapist greeted both Mr.

A and his wife in a friendly manner before proceeding to the assessment.The physiotherapist first found out that Mr. A is a foreigner and has problems understanding English. The physiotherapist immediately sought help from his wife who has better command of English.

Consequently she had translated the physiotherapist's message to her husband effectively. Besides, the physiotherapist also avoided using difficult English so that the patient's wife, who is a foreigner as well, could comprehend well during the interview. It is stated that communication between the patient and the caregiver needs to be modified based on the patient's age, cultural backgrounds, language and educational levels so that the patient can accommodate well to the surroundings (O' Sullivan and Schmitz, 2007, p.13).The physiotherapist also made the patient feel at ease by enquiring the patient's life in the residing country. Much information was obtained throughout the casual conversation which further completed the subjective assessment as it is important to gain information directly from the patient and family members (O'Sullivan and Schmitz, 2007, p.4). Mr.

A was an active sports person and had sprained his right ankle during a football game one week ago. Mr. A was told to recall in what manner he had fallen during the football game. Mr.

A realised that he was unbalanced while passively turning his foot inwards to a great extent and fell onto the ground. The physiotherapist recorded the findings and explained to Mr. A about the mechanics of ankle sprain during excessive inversion of the foot. This showed that the physiotherapist was well aware of the importance of patient's education as well-informed and motivated patients are empowered. As a result they are better able to participate in future treatment decisions (Haugh, 2005).In an extended conversation, the physiotherapist also discovered that Mr.

A is a foreign student studying English language in a local college and has since resided in the country for two years. Mr. A was enquired about the college he attended and the transportation he took in order to attend classes before the ankle injury.

The physiotherapist was also concerned about Mr. A's daily activities in the college such as the frequency of using the staircase and elevator. It was clearly shown that the social aspects were considered thoroughly. As mentioned by Petty.

J (2006), it is important that the patient is managed within the context of the patient's social and work environment and in this case, the study environment, in order to treat the condition appropriately.Mr. A was later asked about his expected outcomes of the treatment, which was to resume walking and return to his normal life. The physiotherapist gave assurance that he would be able to start walking after conducting adequate treatment and exercises along with sufficient rest.

Consequently, the patient was confident and positive in achieving the expected results. In addition, the physiotherapist listened to the patient attentively and was able to give positive feedback ceaselessly in order to build up the patient's confidence. At the same time, Mr. A was observed for any physical manifestations that indicate emotional discomfort, such as slumped body posture, grimacing facial expression and poor eye contact (O'Sullivan and Schmitz, 2007, p.4).

Again, the psychological factors were considered. However, these signs were absent in Mr. A's case. In overall, the interview had established rapport, effective communication and mutual trust between Mr. A and the physiotherapist.

This ensures successful rehabilitation and plan of care in the future (O'Sullivan and Schmitz, 2007, p.4).In objective assessment, the physiotherapist gave explicit instructions throughout the assessment. He made sure that the patient was well-informed about the assessment procedures by repeating in a slow manner so that both the patient and his wife could fully understand the procedures. In this way, effective patient-related instructions were given to ensure optimal healthcare and successful rehabilitation (O' Sullivan and Schmitz, 2007, p.13). The physiotherapist then commenced the objective assessment by measuring the range of movement of the ankle joint.

In the beginning, Mr. A expressed fear and apprehension by restraining the right ankle movements. The physiotherapist then eliminated his anxiety by explaining the way to perform the movement without aggravating the pain. Mr. A was also asked to discuss his fear and concern as some patients find it beneficial to discuss their fear with their therapists so that they can proceed with the assessment and treatment (O'Sullivan and Schmitz, 2007, p.40).

This was another clear evidence of physiotherapist considering the psychological factors.Mr. A was then encouraged to participate in treatment decisions. The physiotherapist asked for consent to give treatments such as TENS and cold pack instead of forcing the patient into compliance.

It is stated that "patients who believe that they possess control regarding their treatment and feel respected by staff tend to have better health outcomes" (O'Sullivan and Schmitz, 2007, p.28). The physiotherapist also comforted Mr. A in treatment session. Questions such as "Is the temperature too cold?" and "Are you feeling comfortable?" were asked. This proved that the psychological factors were taken into account during treatment.The physiotherapist also taught the patients some ankle rehabilitation exercises.

First Mr. A put on several Therabands to test the maximum strength that he could tolerate. Movements such as ankle dorsiflexion, plantar flexion, inversion and eversion were demonstrated by the physiotherapist. Compliments and positive feedbacks were given to Mr.

A in order to give encouragement as well as improve the outcome of the exercises by eliminating his fear avoidance behaviours. This clearly showed that the psychological aspect was taken into consideration. Moreover, the patient's wife was educated about home exercises and safety precautions so that she could participate in the rehabilitation process. The cooperation of family members significantly improves the overall treatment outcomes as evidence shows that the family involvement in the rehabilitation process is essential in ensuring adherence to the plan of care and overall satisfaction (O'Sullivan and Schmitz, 2007, p.15).

The use of scientific jargons and labels must also be avoided as the patient-therapist communication should be simple and easy to understand according to Mr. A's cognitive and education level (O' Sullivan and Schmitz, 2007, p.40).The social factors were taken into account as the physiotherapist advised the patient not to use the staircase available in the college before the ankle fully recovers. Mr. A was asked to avoid any sports activities and change the means of transport to avoid aggravating the ankle injury.

Elbow crutches was recommended by the physiotherapist to aid in walking during daily activities. This allowed Mr. A to improve his access to social networks and socialization (O'Sullivan and Schmitz, 2007, p.52).Through observation, the biopsychosocial model has apparent results of improving the patient's health outcomes in clinical practice.

Therefore, biomedical model is not sufficient as an approach to patient because patient's health is a complex including the biological, psychological and social aspects. Biopyschosocial model is proven effective as caregivers equipped with interpersonal skills have more satisfied patients with better health outcomes who are unlikely to file malpractice suits and are more able to build trust with their respective physiotherapist (Mauksch, 2005).(1647 words)

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