The Biopsycho‐ecological Paradigm: A Foundational Theory for Medicine

Abstract

The current biomedical and psychosocial frameworks that form the conceptual basis of medicine today are insufficient to address the needs of the medically complex and environmentally challenged populations of patients often cared for by physical medicine and rehabilitation specialists. The expanded biopsycho-ecological model of health, illness, injury, and disability operating through mechanisms of Health Environmental Integration (HEI) encourages a more complete understanding of illness, injury, activity limitation, and participation restriction as arising at the interface between the person and the environment. HEI recognizes complex interacting multilevel functional hierarchies beginning at the cellular level and ending at the individual’s experience of the environment. Although the foci of illness and injury are within the body and mind, the physical and social environments contain elements that can cause or exacerbate disease and barriers that interact in ways that lead to injuries and disabilities. Furthermore, these environments hold the elements from which treating agents, facilitators, and social supports must be fashioned. The highly integrative biopsycho-ecological framework provides an expanded basis for understanding the objective causes and subjective meanings of disabilities. Disabilities are reduced through HEI by seeking to maximally integrate the body and mind (the self) with both the surrounding physical environment and other people in society. HEI offers mechanisms for interdisciplinary research, an expanded framework for education and empowerment, and a blueprint for optimizing day-to-day clinical care at both the individual patient and treatment population levels in the ever-changing scientific, political, and policy environments.

Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

“…Combinations of ADL and IADL stages reflect patterns of participation relating to the co-occurrence of difficulties with self-care, and essential interactions with home and community environments (i.e., domestic life). 19 Staging is not intended to replace descriptions of limitations across individual ADLs and IADLs or other approaches to measurement. 27 Knowledge about difficulties with individual tasks is essential when establishing detailed care plans for an individual.…”

“…17 These explanatory hypotheses 18 establish the degree to which IADL stages are associated with other observable variables that theoretically should relate to additional concepts. 16,19 Recognized as fundamental to rehabilitation practices, 20 the biopsycho-ecologic model expands on the biomedical and biopsychosocial models 21 addressing how environmental elements, along with illness and injury-related impairments, link to disability. We expect that higher stages of ADL limitation will be associated with older age and perceptions of poor health.…”

Activity Limitation Stages Empirically Derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult Community‐Dwelling Medicare Population

“…Yet, the apparent shift in relative difficulties among ADLs highlights the importance of periodically re-deriving stages and other functional measures that reflect hierarchies. It is essential to recognize that the physical and social living environments are not static, and that environmental changes in the population [33] could be associated with the evolution of self-reported abilities and disabilities.…”

ICF and ICF-CY lessons learned: Pandora’s box of personal factors

“…With reference to another element, Masala and Petretto [17] concluded that the dynamic nature of the person-environment interaction process was not appropriately captured in the ICF. Stineman and Striem [18] proposed a biopsycho-ecological paradigm as a more inclusive model of the biopsychosocial model expanding the contribution of the physical environment to the interaction of elements defining human functioning.…”