The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization
The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization
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DOI：
10.1080/09593985.2022.2080130
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发表时间：
2022-05-29
影响因子：
2
通讯作者：
Gibson, Jo
中科院分区：
文献类型：
--
作者：
Cormack, Ben;Stilwell, Peter;Gibson, Jo
越来越多的人建议使用生物心理社会模型（BPSM）作为肌肉骨骼研究和实践的指导。然而，对该模型的解释和应用范围很广，其中许多都偏离了乔治·恩格尔最初的BPSM。这些偏差导致了混乱和次优的病人护理。1)回顾恩格尔的原著；2)概述研究和实践中突出的BPSM解释和误用；3)提出了BPSM的“主动”现代化。方法对骨骼肌疼痛进行批判性叙事回顾。结果BPSM已被生物医学化、碎片化、简化化。BPSM的两个有用版本大部分是并行运行的，很少融合。第一个版本是基于以人为中心和以关系为中心的“人本主义”解释。第二个版本是一种“因果”解释，侧重于疾病和健康的多因素因素。最近，一些作者认为，对BPSM的现代主动方法可以容纳这两种解释。结论BPSM的概念往往是狭隘的，在临床护理中只得到部分实施。我们概述了肌肉骨骼护理的“激活- bps方法”如何与恩格尔的愿景保持一致，同时解决了理论局限性，并可能减少误用。
Introduction There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel's original BPSM. These deviations have led to confusion and suboptimal patient care. Objectives 1) To review Engel's original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an "enactive" modernization of the BPSM. Methods Critical narrative review in the context of musculoskeletal pain. Results The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a "humanistic" interpretation based on person- and relationship-centredness. The second version is a "causation" interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations. Conclusion The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an "enactive-BPS approach" to musculoskeletal care aligns with Engel's vision yet addresses theoretical limitations and may mitigate misapplications.