From biopsychosocial to biopsychosocial-existential? Rethinking physiotherapy practice

Purpose Physiotherapy has increasingly adopted a biopsychosocial framework to address the multidimensional nature of health and disability. However, this model may insufficiently capture how patients experience illness, recovery, and rehabilitation through questions of meaning, purpose, identity, and connectedness. This target article examines the integration of spiritual and existential dimensions as a pragmatic extension of person-centred physiotherapy.Methods Drawing on emerging rehabilitation literature, spiritually integrated healthcare research, and person-centred physiotherapy frameworks, we synthesise conceptual and clinical arguments supporting the relevance of spiritual and existential dimensions in rehabilitation and propose a pragmatic framework for implementation in routine practice.Results Spiritual and existential dimensions may influence motivation, coping, adherence, engagement, and adjustment to illness and disability. Physiotherapists are well positioned to address these dimensions because rehabilitation often involves identity reconstruction, restoration of meaningful roles, and adaptation to functional change. A clinically feasible framework is proposed based on five interrelated processes: recognition of existential concerns, brief inquiry during routine assessment, integration of meaning and values into rehabilitation goals, concise documentation, and referral when concerns exceed professional scope. Importantly, this framework does not position physiotherapists as providers of specialist spiritual care, but rather emphasises attentive listening, meaningful goal setting, and interdisciplinary collaboration.Conclusions Integrating spiritual and existential dimensions into physiotherapy represents a pragmatic evolution of the biopsychosocial model. When approached in a patient-led, ethically sensitive, and professionally bounded manner, this approach may strengthen whole-person rehabilitation by supporting patients in restoring both function and meaningful participation in life.