Stineman M G, Qu W
Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA.
Eura Medicophys. 2007 Dec;43(4):543-9.
In this commentary, we argue that the current biomedical and psychosocial models of illness that form the basis of medicine are insufficient to describe this interface. We offer a biopsycho-ecological model of illness and disability referred to as health environmental integration (HEI) as a framework intended to encourage a more complete understanding of disability as arising at the interface between the person's internal and external worlds. By this model, person-level functional abilities as well as the subjective meaning of those functions result in part from interactions created by the exchange of energy and information between the person and his environment. Three components are essential in measuring function: severity of deficit, type of deficit, and meaning. We present functional status staging as an approach to measuring severity and type of deficit, and recovery preference exploration as a way to measure meaning. Rehabilitation medicine can come closer to bridging the gap between biological and the subjectively-based aspects of human function, by measuring all three concepts.
在本评论中，我们认为，构成医学基础的当前生物医学和疾病心理社会模型不足以描述这一界面。我们提出一种疾病与残疾的生物心理生态模型，称为健康环境整合（HEI），作为一个框架，旨在促进对残疾形成的更全面理解，即残疾产生于人的内部世界与外部世界的界面。根据该模型，个人层面的功能能力以及这些功能的主观意义部分源于人与环境之间能量和信息交换所产生的相互作用。测量功能有三个关键要素：缺陷的严重程度、缺陷的类型以及意义。我们提出功能状态分期作为测量缺陷严重程度和类型的方法，以及康复偏好探索作为测量意义的方式。通过测量这三个概念，康复医学可以更接近弥合人体功能生物学方面与基于主观方面之间的差距。
