I10005959

THE BIOPSYCHOSOCIAL MODEL

This model represents the fusion of three core aspects that is essential for physical therapists when dealing with patients. It is a combination of the three factors that revolves around every indiciduals daily life, namely; biological, psychological and social factors. In simple terms it generally encapsules the thoughts, emotions and behaviour of the individual that is to be observed and treated. It is said that these factors play a significant role in either directly or indirectly influencing the condition which they are dealing with. The health of the patient is more comprehendable when the physical therapist tackles his or her predicament using this model rather than concentrating on only the biological aspect of the issue. The biological component of the biopsychosocial model seeks to understand how the cause of the illness stems from the functioning of the individual's body. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such lack of self-control, emotional turmoil, and negative thinking. The social part of the biopsychosocial model investigates how different social factors such as socioeconomic status, culture, poverty, technology, and religion can influence health. Hence, it is vital that this model is applied when dealing with Lolly Saberolas case.

Figure 1: Illustration of the biopsychosocial model

BPHTI (JAN 2011)

Page 1

I10005959 The International Classification of Functioning, Disability and Health (ICF) is incorporated in the Biophsycosocial Model. The ICF classifies health related components that describes bodily functions and structures as well as activities and participation. The ICF provides a structure to present this information in a meaningful, interrelated, and easily accessible way. The information is organized in a simple and reliable form; namely the Rehabilitation Problem-Solving form (RPSform). This form consists of a single data sheet based on the ICF. The RPS-Form consists of a single data sheet that is based on the ICF.

Figure 2: The RPS form based on the ICF

LOLLY SABEROLAS PREDICAMENT

BPHTI (JAN 2011) Page 2

I10005959 Lolly Saberola is a 32 year old female. She walked into your private clinic seeking relief of her Right elbow pain. Her chief complaint was I have pain carrying my briefcase especially on days that I need to attend court and it gets worst if I have 2 or more cases to attend in a day. Lolly has been experiencing this pain for the past 10days and the pain that was initially 2/10 on the pain scale has increased to 5/10 when she is carrying her briefcase for just a mere 3mins.

APPLICATION OF THE RPS FORM

Patients Point of View
As a lawyer who works from 8am to 5pm on a daily basis, she fears that this increasing pain will affect the efficiency of her working performance. Seeing as her right hand is her dominant hand, she feels that there are many movements that restrict her working capability. Her main concern is her inability to carry her suitcase during court cases as the pain increases after 3 minutes of carrying it. There are also there problems that she faces due to pain, for example, she is having problems gripping the pen while taking notes during court sessions for prolonged hours. As a mother of 3 young children with no maid to carry out household chores, she is experiencing a lot of pain during everyday errands that include utilizing her hands such as laundry, cleaning the house which includes sweeping and mopping the floors and also cooking (stirring and cutting). Her youngest child is still breastfeeding and she goes through a lot of pain while cradling the child as she breastfeeds. Since she does this 3 times a day the pain really troubles her physically. It concerns her that if this pain continues and is not overcome, she may have to hire a maid though she is financially unable to sustain having a full time maid to carry out these chores while she copes with the pain at work. She is also anxious that the law firm which she is working for will label her as unfit and she risks losing her job to a more able person. These problems are beginning to affect her working mentality and she hopes to resolve this pain soon.

Physical Therapist Point of View

BPHTI (JAN 2011)

Page 3

I10005959 Upon Lollys consultation, a few questions are asked regarding her pain. After obtaining oral information, a questionnaire will be given to Lolly for her to fill in appropriate answers related to her condition. It is then deduced that Lolly experiences pain, tenderness and soreness on the outer part of elbow on the lateral epicondyle region. Lolly is asked to perform a few movements using peripheral apparatus such as a pen, a few bags of different weights, etc. Gripping and movements of the wrist hurt, especially when performing lifting movements with the bags with heavier weights. Activities that use the muscles extension are characteristically painful. She also complains of morning stiffness. Her pain increases in magnitude as she continuously carries the bag for more than 3 minutes. She experience pain when her arm is in full extension and also when she does any carrying movements towards her body. Then, an interview is conducted to trace the reasons that may contribute to the condition she has. The weight and type of suit case she carries is noted as well as the movements performed during household chores, the weight of the child she has to carry in order to breastfeed and the time taken. She is also questioned about any form of medication or methods she has used in order to cope with the pain she is dealing with. With the data collected, a meeting is held with fellow colleagues to come up with a diagnosis and possible intervention for the problem.

DIAGNOSIS
BPHTI (JAN 2011) Page 4

I10005959 After detailed interpretation of the symptoms presented, it is concluded that Lollys diagnosis is a clear case of Tennis Elbow on her right elbow. Also known as Lateral Epicondylitis, this condition can take place in anyone, especially those who do a lot of work involving arm movements. Tennis elbow is an overuse injury occurring in the lateral side of the elbow region, but more specifically, occurs at common extensor tendon that originates from the lateral epicondyle. Specifically, the extensor carpi radialis brevis has been implicated in causing the symptoms of tennis elbow. It is an inflammation of the extensor tendon that ultimately results in pain.

INTERVENTION
BPHTI (JAN 2011) Page 5

I10005959 Seeing as the main complaint that Lolly voiced out was the difficulty in carrying her suitcase during work, the problem is related to relevant and modifiable factors. In this case the modifiable factor would be the suitcase. Seeing as she rarely shifts weight while carrying the suitcase, she is asked to alternately switch hands when handling the suitcase and not to just carry it with her right arm. It is highly recommended that she uses another type of bag that does not strain her elbow such a sling bag that is slung across the shoulders or a backpack that has 2 straps around the shoulder that distributes the weight equally without outweighing and applying too much weight on either arm. She is also asked to apply ice compression or a cold pack upon the area with pain to reduce its inflammation. She is also advised to go for a rehabilitation programme over a reasonable period required for healing and strengthening of the tendon. This programme should be scheduled at a time which is suitable for both the physical therapist and Lolly. She will be taught ways to manage her pain during work and also at home. After her intervention programme is completed, she should be given an epicondylitis clasp which is basically a brace that is attached on the forearm to protect the inflamed tendon throughout the healing process. After completion of this treatment, as a physical therapist, the effects of the intervention carried out should be thoroughly assessed to see if the goal of the intervention is met with the outcome. If there are complications, then adjustments in intervention should be made accordingly. However if the intervention is successful, then Lolly can be officially discharged from the treatment.

CONCLUSION

BPHTI (JAN 2011)

Page 6

I10005959 In conclusion, the biopsychosocial method is an effective way of treating a patient and producing holistic outcome that satisfies the need of the patient as it complements their way of living. It is a simple method that produces effective intervention treatment and should be used by every physical therapist to ensure the efficiency of their practice.

BIBLIOGRAPHY
BPHTI (JAN 2011) Page 7

I10005959
1. Wikipedia.org (2011) Biopsychosocial Model. Retrieved from:

http://en.wikipedia.org/wiki/Biopsychosocial_model
2. Behavioral Medicine Associates Inc. (2009) The General Model: Biological -

Psychological Social. Retrieved from: http://www.qeeg.com/Biopsychosocial.html

3. Sports Injury Clinic.net (2011) Tennis Elbow/Lateral Epicondylitis. Retrieved from:

http://www.sportsinjuryclinic.net/cybertherapist/front/elbow/tenniselbow.htm
4. About.com (2011) Tennis Elbow: Information about Tennis Elbow Pain. Retrieved from:

http://orthopedics.about.com/od/tenniselbow/tp/Tennis-Elbow.htm
5. Wikipedia.org (2011) Tennis Elbow. Retrieved from:

http://en.wikipedia.org/wiki/Tennis_elbow
6. Steiner, A. W., Ryser, L., Huber, E., Uebelhart, D., Aeshlimann, A., Stucki, G. (2002) Use

of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine, Volume 82(Number 11), 1098-1107.

BPHTI (JAN 2011)

Page 8