Is the biopsychosocial model in musculoskeletal physiotherapy adequate? An evolutionary concept analysis

ABSTRACT

Purpose: It is considered that implementation of the biopsychosocial model (BPSM) within physiotherapy is affected by its lack of conceptual clarity. This concept analysis explores the meaning and offers conceptual transparency to the BPSM and expands upon its current conceptual framework for practice. Method: Literature was selected through a systematic search. The studies were analyzed and the data themed following thematic analysis. Results: From the seventeen articles included, five master themes and four subthemes were constructed. The master themes were: 1) ‘Bio-medical factors’; 2) ‘Psychological factors’; 3) ‘Social factors’; 4) ‘Communication’; and 5) ‘Individualized Care’. The subthemes were: 1) ‘Education’; 2) ‘Cognitive’; 3) ‘Behavioral factors’; 4) ‘Occupational factors’; and 5) ‘Therapeutic Alliance’. Conclusion: A contemporary visual representation of the BPSM is presented which represents a holistic, humanist perspective. ‘Communication’ scaffolds the framework and supports the exploration of the person’s lifeworld through the ‘therapeutic alliance’.

KEYWORDS:

• Biopsychosocial model
• biopsychosocial approach
• physiotherapy
• conceptual
• philosophy
• concept analysis
• holistic
• humanist

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Declaration of Interest

The authors report no declarations of interest.

Notes

¹ Relating to the nature of dualism, whereby phenomena may be explained by two opposing principles.

² Values humans as the centre of the lived world, yet maintains a connection to realism and empiricism in understanding knowledge.

³ Science is the objective means of determining understanding.

⁴ Entities and their characteristics are viewed as wholes and not just as an accumulation of separate parts.

⁵ All that makes up the world of the individual in that moment.

⁶ Viewing complexity in its simplest or fundamental parts.

⁷ Where phenomena is explained and understood through more than two parts.

⁸ The nature of knowing, exploring the theory of knowledge and rationality of belief.

⁹ Entities and their characteristics are viewed as wholes and not just as an accumulation of separate parts.

¹⁰ Viewing complexity in its simplest or fundamental parts.

¹¹ Relating to the nature of dualism, whereby phenomena may be explained by two opposing principles.

¹² Where phenomena is explained and understood through more than two parts.

¹³ A view that knowledge is dependent upon objective evidence.

¹⁴ The nature of being, exploring the essence of becoming, existence and the reality of something.

¹⁵ The nature of knowing, exploring the theory of knowledge and rationality of belief.

¹⁶ Viewing complexity in its simplest or fundamental parts.

¹⁷ Entities and their characteristics are viewed as wholes and not just as an accumulation of separate parts.

¹⁸ All that makes up the world of the individual in that moment.

¹⁹ Viewing complexity in its simplest or fundamental parts.

²⁰ A view that knowledge is dependent upon objective evidence.

²¹ Entities and their characteristics are viewed as wholes and not just as an accumulation of separate parts.

²² A view that knowledge is dependent upon objective evidence.

²³ Viewing complexity in its simplest or fundamental parts.

²⁴ Where phenomena is explained and understood through more than two parts.