From pain to person: Integrating the biopsychosocial model in rehabilitation

The recovery in physical therapy clinics of Pakistan is mostly measured in degree of pain, range of motion and functional independence which is a biomedical model of recovery, focuses mainly on anatomical and biomechanical components of condition. As this model is effective but ignoring psychological and social aspects from patient management protocols leads to incomplete care. George Engel in 1977 proposed biopsychosocial (BPS) model suggesting that health and illness are the outcome of biological, psychological and social factors.1 Mental health and social wellbeing are the components that mostly get overlooked by physical therapist while formulating plan of care for the patient. For instance, chronic or persistent pain in patient could be due to psychological distress, sometimes patients ignore pain due to financial crises or sometimes they need to rely on others for mobility and care. All these factors lead to incomplete patient care and suboptimal outcomes of recovery. The BPS model emphasizes a patient centered approach offering holistic way of treatment, starting from examining the context of illness, discussing the patient’s goals and adapting them according to their lifestyle. Incorporating this model into practice requires effective communication and active listening skills which are overlooked in physical therapy practices. This may be because of time constraints due to patient overload, lack of interdisciplinary collaborations and lack of health profession education.2 The Health Care Professional Competency Framework in Pakistan highlights the need for patient centered care, communication and ethical practice as learning outcomes for physical therapy students.3 Shifting from pain to person requires a shift of system starting from the curriculum of undergraduates to culminate the importance of psychological and social aspects in rehabilitation, from clinicians who could make this model as a part of their assessment protocols and the policy makers who could provide platforms for training to embed psychosocial skills and develop clinical pathways for interdisciplinary approaches in treating the patient.