THINKING AND ACTING BEYOND THE BIOPSYCHOSOCIAL MODEL IN PHYSIOTHERAPY
K. Mescouto1, P. Stilwell2, H. Devan3, J. Setchell1
All authors, affiliations and abstracts have been published as submitted.
1The University of Queensland, Brisbane, Australia, 2McGill University, Quebec, Canada, 3University of Otago, Wellington, New Zealand
Learning objective 1: Inspire physiotherapists to critically reflect on the assumptions and values of the biopsychosocial model
Learning objective 2: Reimagine theoretical and practical advancements to consider social, cultural, and political aspects in physiotherapy clinical practice, research, education, and policy
Learning objective 3: Empower physiotherapists to foster more ethical and equitable healthcare practices
Description: The biopsychosocial model has been widely advocated in physiotherapy as an optimal approach to account for the multidimensionality of health. The model influences clinical practice, research, education, and policy. However, the model has faced important critiques such as a lack of theoretical clarity[1]and the under consideration of social, cultural, and political aspects of health[2]. Moreover, its lack of theoretical clarity leads to an over-focus on biological and psychological dimensions of health[3]and the maintenance of assumptions about knowledge, reality, science, and the world[4]. That is, physiotherapy clinical practice, research, education, and policy rely on standardised, generalisable, and objective ideas of health, which prevents more effective and equitable practices that fully appreciate each individual within their unique context. In addition, conceptualisations and applications of the biopsychosocial model usually do not attend to culturally safe[5]nor socially just initiatives. Therefore, the hidden assumptions and values that are commonly tethered to the biopsychosocial model may hinder ethical and equitable physiotherapy practices.
This symposium will facilitate physiotherapists to critically reflect on how biopsychosocial model approaches in research and clinical practice often unintentionally lie within a biomedical paradigm[2], and how it leads to narrow individualistic assumptions of the body and the world. The symposium Chair - Karime Mescouto will provide an insight into the biopsychosocial model to introduce the topic and examine how physiotherapists draw from this model in fairly limited ways[2]and will introduce the three speakers. Peter Stilwell will propose an enactive approach as an extension of the biopsychosocial model, which considers subjective health conditions as sense-making patterns through a lived body that is inseparable from the world that we shape and that shapes us[3]. Hemakumar Devan will discuss the importance of meaningful engagement with Indigenous communities and how we might draw from Indigenous and culturally and linguistically diverse views[5]of health and wellbeing to extend our thinking as physiotherapists. Finally, Jenny Setchell will draw all this together to suggest how social, cultural, and political considerations of health can be enfolded into physiotherapy practice, with a focus on embracing flexibility, situatedness, relationality, and subjectivity in healthcare practices[6]. The chair will facilitate audience participation throughout the symposium and finish with a Q&A session.
Our work demonstrates that there are other ways to conceptualise physiotherapy that either extend [3] and/or rework [2] the biopsychosocial model, which better attends to important factors usually neglected in our current practices. Our intention with this symposium is to connect with physiotherapists around the world to continue and extend this thinking and inspire physiotherapists to enact a more ethical approach in practice - be it in clinical, research, policy, or educational contexts. Physiotherapists should leave this symposium feeling better equipped to tackle the shortcomings of the biopsychosocial model and provide ethical healthcare practices.
Implications/Conclusions: Critically reflecting on the impact of assumptions and values connected to the biopsychosocial model, and moving beyond this model, will help physiotherapists to employ broader and equitable approaches to health.
Keywords: Biopsychosocial, critical reflexivity, equity, ethics
This symposium will facilitate physiotherapists to critically reflect on how biopsychosocial model approaches in research and clinical practice often unintentionally lie within a biomedical paradigm[2], and how it leads to narrow individualistic assumptions of the body and the world. The symposium Chair - Karime Mescouto will provide an insight into the biopsychosocial model to introduce the topic and examine how physiotherapists draw from this model in fairly limited ways[2]and will introduce the three speakers. Peter Stilwell will propose an enactive approach as an extension of the biopsychosocial model, which considers subjective health conditions as sense-making patterns through a lived body that is inseparable from the world that we shape and that shapes us[3]. Hemakumar Devan will discuss the importance of meaningful engagement with Indigenous communities and how we might draw from Indigenous and culturally and linguistically diverse views[5]of health and wellbeing to extend our thinking as physiotherapists. Finally, Jenny Setchell will draw all this together to suggest how social, cultural, and political considerations of health can be enfolded into physiotherapy practice, with a focus on embracing flexibility, situatedness, relationality, and subjectivity in healthcare practices[6]. The chair will facilitate audience participation throughout the symposium and finish with a Q&A session.
Our work demonstrates that there are other ways to conceptualise physiotherapy that either extend [3] and/or rework [2] the biopsychosocial model, which better attends to important factors usually neglected in our current practices. Our intention with this symposium is to connect with physiotherapists around the world to continue and extend this thinking and inspire physiotherapists to enact a more ethical approach in practice - be it in clinical, research, policy, or educational contexts. Physiotherapists should leave this symposium feeling better equipped to tackle the shortcomings of the biopsychosocial model and provide ethical healthcare practices.
Implications/Conclusions: Critically reflecting on the impact of assumptions and values connected to the biopsychosocial model, and moving beyond this model, will help physiotherapists to employ broader and equitable approaches to health.
Keywords: Biopsychosocial, critical reflexivity, equity, ethics
References: 1. Bolton, D. and G. Gillett,Biopsychosocial Conditions of Health and Disease, inThe Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments. 2019, Springer International Publishing: Cham, 2019: p. 109-145.
2. Mescouto, K., R.E. Olson, P.W. Hodges and J. Setchell,A critical review of the biopsychosocial model of low back pain care: time for a new approach?Disabil Rehabil, 2020: p. 1-15.
3. Stilwell, P. and K. Harman,An enactive approach to pain: beyond the biopsychosocial model.Phenomenology and the Cognitive Sciences, 2019.184: p. 637-665.
4. Hatala, A.,The status of the "Biopsychosocial" model in health psychology: towards an integrated approach and a critique of cultural conceptions.Open Journal of Medical Psychology, 2012.14: p. 51-62.
5. Yoshikawa, K., B. Brady, M.A. Perry and H. Devan,Sociocultural factors influencing physiotherapy management in culturally and linguistically diverse people with persistent pain: a scoping review.Physiotherapy, 2020.107: p. 292-305.
6. Setchell, J., D.A. Nicholls and B.E. Gibson,Objecting: Multiplicity and the practice of physiotherapy.Health (London), 2018.222: p. 165-184.
2. Mescouto, K., R.E. Olson, P.W. Hodges and J. Setchell,A critical review of the biopsychosocial model of low back pain care: time for a new approach?Disabil Rehabil, 2020: p. 1-15.
3. Stilwell, P. and K. Harman,An enactive approach to pain: beyond the biopsychosocial model.Phenomenology and the Cognitive Sciences, 2019.184: p. 637-665.
4. Hatala, A.,The status of the "Biopsychosocial" model in health psychology: towards an integrated approach and a critique of cultural conceptions.Open Journal of Medical Psychology, 2012.14: p. 51-62.
5. Yoshikawa, K., B. Brady, M.A. Perry and H. Devan,Sociocultural factors influencing physiotherapy management in culturally and linguistically diverse people with persistent pain: a scoping review.Physiotherapy, 2020.107: p. 292-305.
6. Setchell, J., D.A. Nicholls and B.E. Gibson,Objecting: Multiplicity and the practice of physiotherapy.Health (London), 2018.222: p. 165-184.
Funding acknowledgements: Jenny Setchell is supported by an NHMRC Fellowship (#1157119). Hemakumar Devan is supported by a Health Research Council Health Delivery Career Development Award (#20/834)
All authors, affiliations and abstracts have been published as submitted.
