Health psychology claims that illness can result from a combination of biological, psychological, and social which reflects the biopsychosocial model of health and illness (Naidoo & Wills, 2008). It was introduced by George Engel in 1977. The biological component seeks to understand how the cause of illness stems from the functioning of the individual’s body, while the psychological component looks for potential psychological causes for health problem such as lack of self-control and the social part investigates how different social factors such as socioeconomic status (Wikipedia, 2010). It is in contrast with biomedical model which focus on the physical processes such as the pathology, the biochemistry and the physiology of the disease (Wikipedia, 2010). The biomedical model only explains the biological aspect without involving the psychological and social background. Psychological and social aspects are important in determine the diseases and illness are occurring without affect on both process and outcome of the treatment. Psychological play an important role in determining the prognosis of an individual with disease regardless of the severity of their medical diagnosis (Hunt, Birmingham, Skarakis-Doyle, & Vandervooth, 2008).
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The World Health Organization (2007) states that, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Thus, the biomedical model is not suitable to use in the medical field. Biological, psychological and sociological are interconnected to each other. For example, a patient, who is unable to walk normally and need crutches to do his daily routine and he was unable to use the crutches, he can fell depress with the problem his face. This will lead to psychological problem. As a conclusion, it is proven that the biopsychosocial model is fit into the World Health Organization which emphasizes the biological, psychological and sociological factors.
The application of biopsychosocial model was witnessed in the clinical practise during first clinical placement. Mrs. A, who is 50 years old malay housewife was diagnosed with osteoarthritis of knee. Osteoarthritis (OA) is degeneration of the articular cartilage within the joints of the body typically resulting in joint pain and swelling, as well as reduced the joint range of motion of mobility (Hunt, Birmingham, Skarakis-Doyle, & Vandervooth, 2008). Mrs. A came to the physiotherapy department with her husband and son. The physiotherapist, who was Mr. R was greeting the patient and treated her in a friendly manner. This leaved a good impression to the physiotherapist and a comfortable condition to the patient. Assessment started with Mrs. A, who was complaining about her pain around the knee joint and caused her unable to walk and stand in a prolonged time. Activity limitations as a result of osteoarthritis of knee are mainly manifested through its effects on mobility (Hunt, Birmingham, Skarakis-Doyle, & Vandervooth, 2008). Mrs. A was expressed her feelings about her condition and the physiotherapist was practised active listening, maintained the eye contact with the patient and asked a few question about her social life. Information given by the patient might help Mr. R to plan the treatment for the patient. Besides that, the good communication that existed between them may initiate Mrs. A to give more information about her problems.
The physical assessment was started when Mr. R asked the patient to do some mobilization around the knee joint like moving backward and forward. This helped the physiotherapist to plan a suitable treatment for her problem. Treatment given must be suitable and not harm the patient. If the physiotherapist cannot plan it well, patient’s problem may become worst and can affect her daily activities. Mr. R noticed that the patient was so afraid to mobilize her leg and she was so depressed. Physiological factors influencing depression include characteristics negative patterns of thinking, deficits in coping skills, judgement problems and impaired emotional intelligence that depressed people tend to exhibit (Nemade, Reiss, & Dombeck, 2007). Mr. R was discussing with Mrs. A about her fear to move her leg while explaining why she needed to move her leg. He educated the patient and her family about her problem and the possibilities for her to mobilize her legs without felt anxiety. This empowered the patient and the physiotherapist can proceed to the treatment smoothly.
Before started the treatment, Mr. R explained to the patient the treatment involved. He clearly explained what are the advantages and the outcome of each of the treatment. This is important to reach the goal of the treatment want by the physiotherapist and the patient. The overall goals of pain relief and return function may be similar between patients (Hunt, Birmingham, Skarakis-Doyle, & Vandervooth, 2008). The opinion from Mrs. A also taken in providing the treatment. So that the comfortable condition between the physiotherapist and patient is present.
Mr. R then applied short wave diathermy (SWD) to the area in knee joint. It was used to reduce the pain around the knee joint and relaxed the muscle tightness in thigh and calf (Medindia, 2010). Because of the pain that Mrs. A’s faced, she was afraid to move her leg and this cause the muscle in thigh and calf become tightness. Before applied the SWD machine to the patient, the physiotherapist asked the patient to position herself in a comfortable way. Mr. R put a small towel under the patient’s knee to make her felt comfortable. It is important to make sure the patient in a comfortable position during the treatment to avoid another complication and worst the problem. The comfortable and calm situation also can relax patient’s mind from depression and anxiety. SWD machine is positioning around the patient knee about twenty minutes (Medindia, 2010). Mr. R also makes sure that all the SWD’s wires were not touching the patient to avoid an electric shock. During applying the SWD’s machine, Mr. R asked the patient whether it is too hot or she can’t fell anything. It is important to check it to avoid burning on the skin (Medindia, 2010).
In the active part of physical therapy, Mr. R was teaching the patient some exercise that can reduce the pain. The exercise introduced to Mrs. A was extension and flexion exercises. Exercise and activity classes at local community centres are an effective method of keeping individuals with osteoarthritis of knee active and it can reduce symptoms such as pain and range of motion limitations (Hunt, Birmingham, Skarakis-Doyle, & Vandervooth, 2008). The empowerment of the patient was considered when the physiotherapist explained the treatment options. Before doing the exercise, Mr. R demonstrated the exercise to Mrs. A slowly with short explanation. He also explained the important of the exercise using appropriate dialect to further ease the communication between them. It is important for a physiotherapist to know that not every patient have a higher education and better understanding on their problems, thus they may not understand the language and treatment clearly (travaline, Ruchinskas, & D’Alonzo, 2005). This will not easily depressed the patient when she doing the exercises. Mrs. A was required to repeat the exercise thirty times in three sessions with some guidance from Mr. R after the demonstration. Besides that, Mr. R always observed the patient’s body language and facial expression. The physiotherapist may know the patient’s felling when she performs the exercise. It is whether she was in depress and anxiety condition or in a good condition.
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While observing the patient did the exercises, the physiotherapist showed good communication skill with Mrs. A. He initiated a friendly and gently dialogue to know the patient’s condition. He was asking, “how are you feeling?” , “where is the pain?” , “how is your condition compare to previous treatment?”. This is important to know the patient’s felling while doing the treatment besides observing her facial expression. It was very important to the physiotherapist to help patient defused any form of anxiety because anxiousness will result in low level of concentration and patient may refused to do it. Furthermore, Mr. R gave some support and encouragement when Mrs. A already tired and depressed when the exercise did. He kept saying, “you can do it,” , “try your best” and “very good” to resolved the emotional issue of the patient. This showed that psychological and sociological aspects were well taken care.
The physiotherapist is not neglect the sociological aspect of the patient. Living with osteoarthritis of knee can result in increased levels of depression, social isolation, and a reduced sense of well being (Hunt, Birmingham, Skarakis-Doyle, & Vandervooth, 2008). Patient who is suffering with this problem cannot perform their daily activities as well as normal person. So, involving the family members into the rehabilitation programme will encourage the patient to have the treatment. Mr. R was taught the family members the exercise that Mrs. A need to do at home. He also gave a handout of the exercise in case if they forgot about the exercise. He also educated the family members about the fall prevention and safety. Family members play an important role in rehabilitation programme as they are responsible to take care of the patient at home.
Biopsychosocial model include the biological, psychological and sociological factors of an individual in clinical practise. It consider the patient’s empowerment to have the treatment. Besides that the strong relationship between the physiotherapist and the patient can be built by a good communicating skill and it is important build the biopsychosocial model during the treatment. if the patient does not participate in the treatment, the goal of the treatment will not achieve. Thus, the biopsychosocial model is important in clinical practise and there are significant improvement in patient’s health.
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