Biopsychosocial Versus Biomedical Model in Clinical Practice, Biopsychosocial model and the physiotherapist, and Biopsychosocial model and the patient.

Biopsychosocial Versus Biomedical Model in Clinical Practice

This guide is about biopsychosocial versus biomedical model in clinical practice. Study it to gain insights that you can use in creating excellent educational essays concerning the comparison of biopsychosocial models and biomedical models.

Introduction to Biopsychosocial Versus Biomedical Model in Clinical Practice Guide

What is pain?

Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” that “persists beyond the normal time of healing” (Merskey and Bogduk, 1995). According to a recent survey of 4,839 people, 20% of them suffer from chronic pain, with many reporting a reduction in their quality of life (Breivik et al, 2006).

What are the biomedical and biopsychosocial models?

Chronic pain treatment is changing. Many critics have criticized western biomedicine’s poor integration of social and psychological factors in the assessment and treatment of pain over the last three decades. Such criticisms often dispute the Cartesian mind-body dualism paradigm of pain (which is widely credited to Descartes), in which the body and mind are considered distinct. The Cartesian model is an early biomedical model that connects pain intensity to injury severity.

The biopsychosocial model, on the other hand, was first proposed by Engel in 1977 and views illness as a ‘dynamic and reciprocal interaction between biologic, psychological, and sociocultural variables that shape a person’s responses to pain’ (Turk and Flor, 1999). The World Health Organization’s International Classification of Functioning model, which shifts the focus from the cause of illness to the impact it has on the individual, is a current example of a biopsychosocial model.

Physiotherapy is defined by the Chartered Society of Physiotherapy as “a physical approach to promote, maintain, and restore physical, psychological, and social well-being.” Student physiotherapists must understand what the biopsychosocial model of pain has to offer physiotherapy practise because they will be critical in facilitating future change in the field. The biopsychosocial model, its benefits, and the implications of putting it into practice will now be discussed one by one.

Comparison of the Biopsychosocial and the Biomedical Model in Clinical Practice

How does the biopsychosocial model compare to the biomedical model?

The biomedical paradigm supports reductionism, assuming that sickness is caused by any departure from the norm of observable biological/somatic factors and that medical techniques are the only effective way to alleviate pain. It is applicable to a wide range of diseases and is backed up by a plethora of scientific evidence. The paradigm is useful in acute diseases with predictable results (e.g., antibiotic therapy for bacterial infections) and is therefore appropriate for healthcare practitioners (HCPs) who must concentrate on a single aspect of a patient’s health.

Despite the effectiveness of the biological paradigm in the treatment of many disease processes, certain challenging and critical medical issues have proved resistant to it. The biological paradigm, for example, can not explain why pain might persist even after tissue damage is no longer present (chronic pain) or clinical phenomena like phantom pain. It has little space for the social, psychological, or behavioural aspects of sickness within its paradigm (Engel, 1977). For reasons like these, Engel thought it was vital to broaden the approach to illness to include the psychosocial without compromising the scientific method’s many benefits.

The biopsychosocial model, according to Engel, may be utilized to get a better knowledge of the illness process. The biological paradigm examines the underlying pathophysiology in isolation and is often unable to explain why recommended therapies fail, such as persistent low back pain therapy (LBP). The biopsychosocial model, on the other hand, looks at the patient’s unique biologic, psychological, social, co-morbidities, illness beliefs, coping strategies, fear, depression, employment, and financial concerns in addition to medical care, and may provide additional insight into what has hampered recovery and patient-hood.

‘Spinal pain/disability can only be understood and handled according to a biopsychosocial paradigm,’ Waddell (2006) finds. The biopsychosocial approach provides clinicians with a set of different tools to treat patients by combining biological and psychological elements to explain why individuals persevere in pain.

The biopsychosocial model also recognizes that pain is a dynamic phenomenon that evolves over time and is influenced by a person’s internal and external surroundings. For example, a physical injury may induce discomfort at first, but fear-avoidance (a psychological variable) and work-related stress (a social variable) worsen the suffering over time, leading to physical deconditioning and a self-perpetuating loop (e.g. Al-Obaidi et al.,2000, Goubert et al.,2005). The cause and effect are difficult to separate, implying that effective therapy would need a comprehensive approach.

Because it strives to treat both the patient and the condition, the biopsychosocial model takes a comprehensive approach. Therapy for a sprained ankle, for example, is independent of the patient using the biomedical paradigm (which focuses entirely on the disease/impairment); treatment involves rest, compression, and elevation. Treatment would be tailored to the person using the biopsychosocial approach.

For example, if the patient was a working mother, therapy would be changed to reflect the reality that rest may be difficult to come by owing to societal constraints. However, there are individuals who feel the biopsychosocial model is defective, and their viewpoints must be taken into account when evaluating the biopsychosocial model’s contribution to physiotherapy practice.

Critics say that the biopsychosocial paradigm has flaws, citing the dependence on subjective outcome measurements as an example (Weiner, 2008). The SF-36, the Pain Disability Questionnaire, and the VAS are examples of subjective outcome measures that have attained “validity” and widespread usage. Some contend that standard biomedical objective outcome measurements that examine pathoanatomic/pathophysiologic outcomes are undervalued (Weiner, 2008). Many chronic pain outcomes, such as stress and discomfort, are subjective and cannot be quantified scientifically.

Furthermore, utilizing objective outcome measures does not ensure validity; for example, some use sophisticated performance-based equipment that demands the subject to perform at the highest level possible for best validity. Motivation, fear, knowledge of instructions, and physical ability will all impact functional performance (Gatchel and Turk, 2008), hence the metric will still be subjective.

Critics also claim that the biopsychosocial approach has resulted in a lack of attention to pathophysiology or underdiagnosis of musculoskeletal problems in chronic LBP (Weiner, 2008), as well as allowing medically unexplained pain to be moved too easily to the psychiatric realm (Duncan, 2000). Those who support the biopsychosocial paradigm say that the biological approach is insufficient, not erroneous (Gatchel and Turk, 2008).

Reviews of the literature, on the other hand, typically support the efficacy of a biopsychosocial approach (Ostelo et al.,2005, George,2008, Scascighini et al.,2008) and commonly find that multidisciplinary, multi-modal therapies are successful in the treatment of chronic pain. Others say that interdisciplinary biopsychosocial rehabilitation requires a significant investment of time and money.

Karjalainen(2003) discovered that there was insufficient evidence to support comprehensive therapy in individuals with neck/shoulder pain. This research, however, was a methodologically poor randomised controlled trial (RCT) that failed to randomize patients, apply a power calculation, or conduct an intention-to-treat analysis. High-quality research (Mosely et al., 2002; Smeets, 2006) examined biopsychosocial methods to personalized physiotherapy treatment (which need less financial resources) and found substantial evidence of their efficacy.

They had a demographic match to the target population (primary care) and were properly specified enough to be implemented by a single physiotherapist. It’s worth noting that such studies are conducted in the manner of biomedically oriented RCTs, while qualitative research focuses on people’s perceptions, beliefs, attitudes, and experiences.

Evidence shows, however, that the shift from the biological to the biopsychosocial model is incomplete (Bishop et al., 2008) and that its integration into medical practice is taking longer than expected (Alonso, 2003). Furthermore, although Cote(2009) questioned the biomedical model’s viability, he discovered that it is still widely employed by physiotherapists.

Biopsychosocial model and the physiotherapist

Has the application of the biopsychosocial model been successful in physiotherapy?

Biopsychosocial Versus Biomedical Model in Clinical Practice
Biopsychosocial model and the physiotherapist

The biopsychosocial model in physiotherapy recognizes the patient as a whole, their social, cultural, and environmental context that determines an individual’s reaction to sickness. Integration of developing pain science findings (advocating biopsychosocial methods) into the clinical reasoning process is one example of the physiotherapy profession moving toward a more evidence-based approach to clinical treatment. Physiotherapists should have altered their practice appropriately, however, data shows that HCPs are continuing to manage chronic pain using biological techniques (Bishop and Foster, 2005, Cote, 2009) and failing to adopt collaborative goal-setting and patient-centred treatment (Edwards et al, 2004).

The biopsychosocial model’s practical use in physiotherapy has proven difficult since it requires doctors to broaden the breadth of parameters considered as part of complete patient treatment. Because psychological aspects are thought to be more difficult to treat, many physiotherapists do not feel confident or equipped to handle them (Daykin and Richardson, 2004, Cote,2009). At this stage, it’s also worth considering if physiotherapists are allowed to treat psychological problems within their scope of practice.

Physiotherapist education has hitherto been centred on a biological basis, which failed to teach skills essential for psychosocial evaluation. As a result, physiotherapists who are now working in clinical practice are dissatisfied with their education (Parsons et al.2007). Moseley (2003) discovered that physiotherapists had a poor understanding of the neurophysiology of pain. As a result, physiotherapist attitudes and beliefs regarding chronic pain have been proven to influence the advice and treatment given to patients (Daykin and Richardson, 2004, Bishop,2007).

Physiotherapists who felt ill-equipped to handle psychological issues had a propensity to ascribe patient suffering to structural reasons, according to Daykin and Richardson (2004), and this was reflected in the therapy they offered. The physiotherapists preferred the therapist-centred biological approach, even though they believed in a mutually collaborative model. Similarly, Linton (2002) discovered that one-third of physiotherapists surveyed believed that pain reduction is a requirement for return to work, two-thirds would advise patients to avoid painful movements, and 25% thought sick leave was a good treatment for LBP, all of which are contrary to current guidelines and reflect biomedically oriented treatment.

Furthermore, in the presence of psychosocial factors, such advice and treatment may actually exacerbate chronicity (Pincus et al.,2002). The research finds that certain practitioners have fear-avoidance attitudes, which have an impact on therapy. These studies provide light on the obstacles that come with putting research results into reality. However, practising physiotherapists must be capable of continual self-audit in order to improve their professional abilities and keep up with medical and health research breakthroughs.

This lack of formal training and the effect of experienced physiotherapists (who are familiar with biological procedures) on newly certified physiotherapists may explain why the biopsychosocial model is taking longer than expected (Casserley-Feeney et al.,2008). However, with more focus on biopsychosocial techniques in undergraduate curricula, it is more likely to become embedded in clinical practice. However, it is not just the physiotherapist’s attitudes and beliefs that must be addressed; the patient’s attitudes and beliefs are also critical in guaranteeing the success of the biopsychosocial approach.

Biopsychosocial model and the patient

How has the biopsychosocial model impacted the treatment of patients?

The patient is seen as a passive receiver of therapy and a victim of circumstance under the biological paradigm, with no responsibility for their illness. It removes the patient’s responsibility for their sickness, thus jeopardizing their autonomy. The biological method is focused on the physician, and it asks the patient to submit to the clinical “expert” who controls the interaction. Furthermore, the word “patient” strengthens the biological paradigm and fosters the patient’s passivity. Some physiotherapists may choose to retain this disparity in order to keep control over rehabilitation and therapy.

Biopsychosocial Versus Biomedical Model in Clinical Practice
Biopsychosocial model and the patient

The biopsychosocial paradigm, on the other hand, tries to encourage patients to participate in their treatment (for example, via joint decision-making) and enable them to manage their pain on their own (Edwards et al.,2004). Patients are less likely to embrace self-management (Underwood,2006) or biopsychosocial techniques if they feel their pain is entirely physiological (Stone, 2002). In order to give a successful solution, it is critical to first determine the patient’s pain beliefs.

Urquhart et al. (2008) argue that maladaptive attitudes and behaviours must be changed. Negative beliefs (e.g., fear-avoidance) are predictive of chronic, debilitating pain, and modifying these beliefs is more essential than biological aspects in pain management effectiveness, according to the research, highlighting the need for a biopsychosocial paradigm. Through strategies such as graded exposure, cognitive-behavioural treatments try to change such beliefs/behaviours.

CBT is generally shown to be an effective therapy for chronic pain in reviews of the literature (e.g. Turk, 2008, Lunde et al., 2009), despite methodological flaws, such as the fact that many studies are statistically underpowered. The effectiveness of these therapies adds to the growing body of evidence that pain is more than a physical sensation.

Conclusion

The biopsychosocial paradigm has given physiotherapy a larger range of techniques to assist treat chronic pain sufferers, much as the biological model did. The transformation from a biological to a biopsychosocial approach is far from complete. Despite the existence of psychosocial elements, many physiotherapists continue to utilize mostly physical treatments, which contributes to supporting the biological perspective of pain that many patients still hold. As a result, altering the perceptions of both HCPs and patients is a problem. Evidence-based approaches to healthcare demand that physiotherapists use procedures that have been clearly proved to be beneficial, therefore more patient education and therapist assistance is required to put the suggested improvements into practice.

Frequently Asked Questions (FAQs)

1. What exactly is pain?

Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” that “persists beyond the normal time of healing” (Merskey and Bogduk, 1995). According to a recent survey of 4,839 people, 20% of them suffer from chronic pain, with many reporting a reduction in their quality of life (Breivik et al, 2006).

2. What are the biomedical and biopsychosocial models used for?

Such criticisms often dispute the Cartesian mind-body dualism paradigm of pain (which is widely credited to Descartes), in which the body and mind are considered distinct. The Cartesian model is an early biomedical model that connects pain intensity to injury severity. The biopsychosocial model, on the other hand, was first proposed by Engel in 1977 and views illness as a ‘dynamic and reciprocal interaction between biologic, psychological, and sociocultural variables that shape a person’s responses to pain’ (Turk and Flor, 1999).

3. What is the biopsychosocial model in physiotherapy?

The biopsychosocial model in physiotherapy recognizes the patient as a whole, their social, cultural, and environmental context that determines an individual’s reaction to sickness. Integration of developing pain science findings (advocating biopsychosocial methods) into the clinical reasoning process is one example of the physiotherapy profession moving toward a more evidence-based approach to clinical treatment.

Biopsychosocial Versus Biomedical Model in Clinical Practice

 

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