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Biopsychosocial model was introduced by American Psychiatrist, George Engel in year 1977. The biopsychosocial model generally accounts of biological, psychological and sociological which are interrelated spectrums (Lakhan, 2006). Today, this model was widely used as a solving problem in clinician practice. The biological referred to the aetiology of diseased from functioning of individual's body. The psychological and sociological will also affected and cause illness in human body. Psychological in the component of biopsychosocial that causes health problem is due to the distress of mental, whereas the sociological that causes the health problems is due to the social factors (Santrock.J.W,2007). Indeed, it is important for a physiotherapist to take note on the psychology and social context of a patient as a part of treatment for the patient. For this reason, patient is also encouraged to give as much information not only about physical symptoms, but also the psychological and sociological aspect for a better treatment.
The biopsychosocial model contains two different elements, yet inter-related. For first element of the model, 'Functioning and Disability will be affected when the impairment of the body structures have influenced the daily performance that affect the psychological level thinking of the patient due to the current disability. In contrast, for the second element of the model, 'Contextual Factors' is more to the psychosocial model which include personal factors such as age, general and beliefs as well as environment which is the external factors * (WHO,2002). The biopsychosocial model has fit into the World Health Organization (WHO) health context, which biomedical and psychosocial are interconnected that enables health care providers to view the level on health condition of a patient.
Implementation of biopsychosocial model was witnessed during the first clinical placement, Mr. L, a 64 years old Chinese man who was accompanied by his daughter's enter to physiotherapy department in his wheelchair. The physiotherapist who in charged, Miss T, greeted and introduced herself as she approach the patient. Based on the physician's report, Mr. L was diagnosed with cerebrovascular accident (CVA) that caused hemiplegic on his left side. The physiotherapist starts by conducting the subjective and objective assessment.
Miss T starts her conversation in a simple language that easily understands by the patient. Using a short, simple and clear explanation is important for patients to acknowledge health problems and their treatments (M.Travaline, Ruchinskas, D'Alonzo, 2005). Miss T was enthusiastically questioned patient about how did he starts off with the diseased, his working life and social activities. These enable Miss T to identify and provide a suitable treatment for the patient within the context of working environment and social surroundings (Nicola J. Petty, 2006, p.21).
Mr. L seems to build a very good relationship with his therapist through their conversation. Every anxieties and depression that Mr. L faces after he was diagnosed with CVA was shared with Miss T. Miss T give her an attentive listening and maintained eye contact with Mr. L. Good communication and attentive listening will help to be more comfortable in revealing their problems (O'Sullivan,Percin,2007,p.54). Miss T comforted and explained to Mr. L on what treatment to be given to him to regain and improve his muscle movement that enable him to get back to his normal life. Empowerment was given to Mr. L by setting a short-term goal for his treatment to regain his confidence. Empowerment is important as it motivates the patient on decision making regarding to their treatment and ability on self-managing their disease through patient education on the topic (Santurri,E.L.,2006). As Sally Davis (2006, p.11), states that giving choices of treatment and involvement of patient in setting their rehabilitation goal is through empowering the patient.
The first rehabilitation that was given to Mr. L was to train body balancing. Mr. L was transferred from the wheel chair to the bed in sitting position. Training in sitting position is to achieve a balance posture spine and pelvic alignment. Generally, patients with stroke have poor sitting balancing. The weight borne will tend to move in the less affected side, pelvis in a posterior tilt with flexing in the upper trunk (O'Sullivan,S.B.,Schmitz,J.T.,2005,p.748). Mr. L was asked to stabilize himself by holding the bed with his both hands and focus at a point in front of him, he was then asked whether his posture is upright or not. Miss T instruct the patient to "lean over to me" whereby she will sit on the patient's less involved side. Questions like Miss T asked, "Which directions are you tilted?" whereby the patient will be fully involved in problem solving and to be aware of it. Miss T initiates her dialogue by asking, "How do you feel?", "Are you okay?" was important for the patient whereby it helps to defuse any anxiety that will result in low concentration. According to O'Sullivan and Percin (2007,p.40), patient may be refused and hesitate on their treatment due to their fearfulness and anxiousness.
In the physical therapy part, Miss T introduced the Sit-to-Stand (STS) training on symmetrical weight bearing by focusing, muscular coordinate responses and sufficient timing (O, Sullivan p.789). The patient was asked to clasp the hands together in a prayer position and swing the hands forward as he moved from sit to stand position. Before the training is start, Miss T demonstrates the movement slowly and clearly with simple instructions and explanations to Mr. L. This will help to minimize any emotional distress and obtain a better understanding by the patient (O'Sullivan and Percin,2007,p56). Mr. L was required to repeat the exercises after Miss T demonstrated. Throughout the exercises, Miss T will always observe the facial expression and the patient's body language by it is a good indicator for the psychological thinking and emotion of the patient (M.Travaline, Ruchinskas, D'Alonzo, 2005). Miss T will immediately talk to her and gave her some encouragement and support whenever there is some facial expression changes, for instant ,"You can do it", Very good", "Don't worry, I'm here". This was to build the confident in the patient's where to further their practice in the given exercises for a better and faster improvement of rehabilitation. Besides, her daughter's who accompanied him, sat beside him to gave him moral support and encouragement whenever he was depress and unable to perform exercises that taught by Miss T. A greater mobilization effort by the given activities can be master whenever they are persuaded by their capabilities through surrounding peoples (Albert Bandura, 1998).
The second physical therapy that was given by Miss T was the gait training. Gait training was to improve the muscle strength and recover their ability in walking with the assistive devices such as walking frame, crutches and parallel bar. During the treatment, Mr. L was encouraged to use more frequent on his weaker leg where it will trained for muscle endurance. Increasing in walking distance and natural rhythm of walking speed with the assisted ambulation and assistance of physiotherapist is to train for the adaptation on the natural walking steps. According to O'Sullivan (2005,p.758), monitoring on patients performance and recognized by correction on the walking steps is a crucial goal during the treatment for improvement. For a safety exercises precaution, Miss T frequent ask a questions like, "Are you dizzy?'', "Do you feel any chest pain?", "Are you having short breathing?", "Are u still able to continue?". These were to prevent hypotension and hypertension when doing the exercise by recent stroke patient and with unstable blood pressure (O'Sullivan,2005,p743).
On the sociological aspect, Mr. L daughter was also encouraged by the physiotherapist by the involving in the rehabilitation programmed. Some simple home exercises such as strengthening and stretching muscle was taught by the physiotherapist by simple explanation on what is the aims of the exercises. Through the explanations, the family member's was educated on dealing with the patient in a proper manner. Besides, the physiotherapist also taught safety measure, fall prevention and precaution to the daughter of Mr. L. After the treatment, the schedule for the next appointment for Mr. L was arranged by his daughter for the following treatment.Through this, it was clearly show that the psychological and sociological part was implemented in approaching the patient.
Biopsychosocial is important as the model was not only emphasizes the biomedical part but also the psychosocial part. Without the attention on the psychosocial, it will be a barrier in treatments and improvement in patients health. In philosophical sense, biopsychosocial states that the working of mind and body will affect one another (Halligan,P.W., Aylward,M., 2006). As a conclusion,the biopsychosocial plays an important role in clinical practice as well as the improvement of the patient health.