School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
School of Social Science, The University of Queensland, Brisbane, Australia.
Disabil Rehabil. 2022 Jun;44(13):3270-3284. doi: 10.1080/09638288.2020.1851783. Epub 2020 Dec 7.
Low back pain (LBP) is the leading cause of disability worldwide. Clinical research advocates using the biopsychosocial model (BPS) to manage LBP, however there is still no clear consensus regarding the meaning of this model in physiotherapy and how best to apply it. The aim of this study was to investigate how physiotherapy LBP literature enacts the BPS model.
We conducted a critical review using discourse analysis of 66 articles retrieved from the PubMed and Web of Science databases.
Analysis suggest that many texts conflated the BPS with the biomedical model [Discourse 1: Conflating the BPS with the biomedical model]. Psychological aspects were almost exclusively conceptualised as cognitive and behavioural [Discourse 2: Cognition, behaviour, yellow flags and rapport]. Social context was rarely mentioned [Discourse 3: Brief and occasional social underpinnings]; and other broader aspects of care such as culture and power dynamics received little attention within the texts [Discourse 4: Expanded aspects of care].
Results imply that multiple important factors such as interpersonal or institutional power relations, cultural considerations, ethical, and social aspects of health may not be incorporated into physiotherapy research and practice when working with people with LBP.IMPLICATIONS FOR REHABILITATIONWhen using the biopsychosocial model with patients with low back pain, researchers narrowly focus on biological and cognitive behavioural aspects of the model.Social and broader aspects such as cultural, interpersonal and institutional power dynamics, appear to be neglected by researchers when taking a biopsychosocial approach to the care of patients with low back pain.The biopsychosocial model may be inadequate to address complexities of people with low back pain, and a reworking of the model may be necessary.There is a lack of research conceptualising how physiotherapy applies the biopsychosocial model in research and practice.
下腰痛（LBP）是全球导致残疾的主要原因。临床研究主张使用生物心理社会模式（BPS）来管理 LBP，但对于该模式在物理治疗中的含义以及如何最好地应用它，仍没有明确的共识。本研究旨在探讨物理治疗 LBP 文献如何实施 BPS 模式。
我们使用话语分析对从 PubMed 和 Web of Science 数据库中检索到的 66 篇文章进行了批判性综述。
分析表明，许多文本将 BPS 与生物医学模型混淆[话语 1：将 BPS 与生物医学模型混淆]。心理方面几乎完全被概念化为认知和行为[话语 2：认知、行为、黄色标志和融洽关系]。社会背景很少被提及[话语 3：简短和偶尔的社会背景]；文本中很少关注其他更广泛的护理方面，如文化和权力动态[话语 4：扩展的护理方面]。
结果表明，在与 LBP 患者合作时，可能不会将人际关系或机构权力关系、文化考虑因素、伦理和社会方面等多个重要因素纳入物理治疗研究和实践中。
当与患有下腰痛的患者一起使用生物心理社会模式时，研究人员仅将重点放在该模型的生物学和认知行为方面。
社会和更广泛的方面，如文化、人际关系和机构权力动态，在研究人员采用生物心理社会方法来照顾患有下腰痛的患者时似乎被忽视了。
生物心理社会模式可能不足以解决患有下腰痛的人的复杂性，可能需要对其进行重新设计。
在研究和实践中，缺乏关于物理治疗如何应用生物心理社会模式的研究。
