The biopsychosocial model is a general theory of illness and healing and is now widely adopted by medicine educators and investigators, especially in Physiotherapy field. This model was proposed by an American Psychiatrist by the name of George Engle in the year 1977. It is a model that proves that biological, psychological and sociological factors play a significant role in human functioning in the context of disease. It is also considered as an interconnected spectrum (Lakhan, 2006). Despite the three factors, there are several principles within the field of biopsychosocial model which is also important in the health care field. Autonomy is mainly one of the principles. It is normally defined as the patient's rights to choose and decide on their choices on whether or not to undergo the treatment plan (O'Sullivan, Schmitz, 2007, p. 68). Besides that, Rodwell (1996) cited in Petty (2004, p. 333) stated that "Empowerment is the process of enabling or imparting power transfer from one individual to another; it includes the elements of power, authority, choices and permission". Other than that, beneficence is also one of the principles. It is understood that one health care practitioner should promote their well being to the patient. It also can be defined as the "moral obligation of health care practitioners" (O'Sullivan, Schmitz, 2007, p. 68).
Despite of all the advantages provided in the biopsychosocial model, Smith (2002) cited in (Weston, W. Wayne, 2005) that many health care professionals are facing problems during clinical practice. According to Stam (2000) cited in (Erskine, et al, 2003, p. 174) complains that the model is lack of definition and the model is considered as "neither a theory nor a model".
Before the biopsychosocial model is being hugely influential, the biomedical model is considered to be the dominant modern model of disease if compared to psychological and social model. It focuses mainly on the physical causes such as pathology, biochemistry and physiology of a particular disease and it does not take social or psychological aspects into account (H.Williams, 2010). Moreover, Catherine A. Sanderson (2004, p. 11) said that it works effectively in the development of immunology, surgery, pathology and public health.
However, there're many negative feedbacks regarding the concepts of biomedical model in clinical practice, especially in physiotherapy practice mainly because it does not take social or psychological aspects into considerations. This is very important as both social and psychological plays an important role in authorizing the prognosis of an individual with disease in spite of the seriousness of their medical diagnosis. This model does not clearly explain how signs, symptoms and subsequent disability may prolong, moreover when the social and psychological abnormality is excluded from considerations. ( Michael A. Hunt, Trevor B. Birmingham, Elizabeth Skarakis-Doyle and Anthony A. Vandervoort, 2008, p.55 ).
The value of biopsychosocial model can be witnessed thorugh the clinical practice during the first clinical placement whereby Mr. S, a 57-year-old man who is suffering from osteoarthritis at the left knee. According to the physician, Mr. S was an atheletics since 1966, which is 44 years ago and now he has develop into osteoarthritis at the knee region. Osteoarthritis can be defined as a degenerative disease that results in a gradual wearing of articular cartilage within the joints. Normally it will cause pain and swelling at the surrounding joint, but not to forget, the range of motion and mobility will also be reduced ( Michael A. Hunt, Trevor B. Birmingham, Elizabeth Skarakis-Doyle and Anthony A. Vandervoort, 2008, p.54 ). Basically, athletes have a higher potential in getting osteoarthritis at the knee joint. The physiotherapist, Miss J then conducts both the subjective and objective assessment by first addressing the patient with a polite and friendly manner by greeting the patient and undergoes some introduction to the Mr. S. The assessment started when the Mr. S complained about pain at his left knee especially when walking and Miss J found out that there's a little swelling around the knee region by observing and palpating the difference between sizes of knee in both legs. Miss J then performed active listening, maintains eye contact with the patient and began asking open ended question to the patient. This will allow the patient to express more about his problems to the therapist. This makes a lot easier for the therapist to gather important data about the present history, past history and medical history regarding to the patient's problem to carry out a more effective treatment plan for the patient. Reynolds (2005, p. 9) proves that medical professionals will be able to carry out a more effective treatment plan for the patient through active listening and careful questioning.
During the objective assessment, Miss J examines the level of patella, flexibility and strength of both knees. Then she compared both the knee whether or not the affected left knee is in the normal range by measuring the range of motion (ROM). The patient's expression was taken into account because this movement may result in exacerbating the pain. Based on the diagnosis from the physicians together with the information gathered from the patient, Miss J then worked out a treatment plan for Mr. S. Before carrying out the plan, the therapist first explain to Mr. S about the treatment that is going to be applied by using general terms and diagrams so that the patient will be able to understand easily. Johnston, M., Gilbert, F. (1992) stated that "The quality of communication and patient education" is very important.
The physiotherapist must respect the decision of the patient whether he accept or reject the treatment. After all, patient has the rights to make the decision as they have control over their lives (O' Sullivan and Schmitz, 2007, p. 72). The physiotherapist then applies cold gel pack with a towel wrapping around it onto the patient's knee for approximately 15 minutes. Its' purpose is to lower the metabolic rate and produces vasoconstriction; swelling will be reduced in an acute inflammatory response (William E. Prentice, 2003, p. 378). Besides that, ultrasound treatment and electrotherapy are also being applied for 5 minutes and 15 minutes respectively. Both this treatments works together effectively by increasing the blood flow to the deep tissues and triggering muscle contraction (William E. Prentice, 2003, p. 391). The physiotherapist supports both his head and knee with a pillow during the treatment. Patient's comfort is very important so that they are able to relax when they undergo the treatment without feeling any discomfort and the therapist should also respect how the patient like being treated (Petty, 2004, p. 341).
Physiotherapist then teach the patient some simple muscle strengthening exercises mainly on strengthening his quadriceps muscle and pain relief method without using any equipment from the rehabilitation department. This is to ensure that the patient can carry out those exercises independently at home without feeling any difficulty. O' Sullivan and Schmitz (2007, p.54) states that the feeling of dependency and despair can be eased when the patient experience enhanced sense of control and ability through an active role in rehabilitation process. Physiotherapist demonstrates and gives simple instructions on how to carry out the exercise by using appropriate dialect to ease the communication between them. It is very important for a physiotherapist to know many different languages so that barrier in understanding between the therapist and the patient can be eliminated (M. Travaline., Ruchinskas., D'Alonzo., 2005). To enhance more on the patient's confidence, therapist praised Mr. S by saying "very good, well done" to the patient. Offering positive feedbacks built up confidence in one patient thus decrease depression and initiate self control (Bandura, 1986 cited in Reynolds, 2005, p. 68). Through this, the psychological and sociological aspect was shown clearly.
In addition, the sociological aspect was also taken into account by involving the family members. Family members play an important role by which they have strong influence as they provide moral support to the patient. They are the one who give encouragement to the patient especially during the rehabilitation process. The family members were educated about the importance of conditioning and strengthening exercise and were assigned to help and guide the patient when undergoing these exercises.
As a conclusion, health is a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization, 2003). Thus, biopsychosocial model has the whole package which is compatible with the WHO health context which emphasizes the biological, psychological and sociological aspects in defining illness. Unlikely the biomedical model, failed to fulfill the requirement in the WHO health context. George L. Engel (1977) states that "the proposed biopsychosocial model provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care" has been really a wonder in health care history.
