This section of the website focuses on how a rehabilitation team should analyse a patient’s situation holistically. It is set out in as a series analyses, each concentrated a separate domain within the biopsychosocial model of illness. If you wish to have a graphic of the model open in a new tab, then click here.
This series of pages illustrates some important general points, which will become obvious as you work through the pages. In this example, we are focusing the questioning on a patient’s disabilities:
- when considering any one domain(the patient’s disabilities here), then one needs to work through all the other domains to consider a series of questions.
- is what I observe in this domain (disability) consistent with what I know about the patient in each other domain (e.g. their disease diagnosis)? If not, is the discrepancy explained by factor in another domain? If not, further investigation is required to get a full understanding.
- what factors in this other domain being considered (e.g. the physical context) are adversely affecting disability, making it worse and, most importantly, can these factors be changed to reduce their adverse effect (e.g. widening doorways to allow wheelchair access to the toilet)?
- is the domain being looked at (disability) the cause of or contributing to the situation in another domain? For example a severe (in the patient’s eyes) disability might be causing depression (which in turn will may worsen disability, an example of complexity).
- items in each domain can be influenced by, and may influence items in another domain.
The areas explored are the our clinical, patient-centred domains of the model:
This comes first for several reasons. It is part of a logical order, working from inside the body out into the whole world. Disease not only, sometimes, can be cured but it also determines (a) what problems are more or less likely and (b) the ‘prognostic field’ for the patient’s problems. To look, click here.
Impairment (symptoms and signs)
This is, perhaps, the most complex part of the analysis. There are three different concepts included within the word impairment when it is used within rehabilitation:
(a) structural loss,
(b) use of a word to represent a construct, and
(c) patient experience.
(a) an essential bridge between pathology and disability,
(b) a representation of the clinician’s interpretation of observations, and
(c) a representation of the patient’s experience.
To explore further, click here.
Disability is the focal point of the rehabilitation process, and analysing disability is a central skill – but not the only one. It is a first step on what may be a short and easy journey, or a long and complex one. If the analysis is flawed or incomplete, the journey may be a cul-de-sac and waste the patient’s time, and healthcare resources. Though, at first sight, the consequence of an incorrect ‘diagnosis’ (understanding) of disability may appear less severe that in the case of an incorrect diagnosis of disease, an incorrect disease diagnosis will rapidly become evident but an incorrect rehabilitation diagnosis may only become evident slowly. To read more, click here.
Social functioning (participation)
This area is the most difficult to specify, categorise, and measure but it is also the most important area from a patient’s perspective. Moreover, it is likely that a failure to consider social functioning during rehabilitation will not only lead to a less effective and less efficient process, but will also be associated with greater long-term societal cost (health and social services combined). Patients who have inadequate social function, with too few networks and relationships (in their eyes), are more likely to be less healthy and use more healthcare resource. To read more on analysis, click here.