Evaluation of a Biopsychosocial Model of Life Satisfaction in Individuals with Spinal Cord Injuries

Effective rehabilitation services are best identified through empirically-supported interventions, in what is formally known as evidence-based practice (EBP; Bolton, 1979; Chan, Sasson, Ditchman, Kim, & Chiu. 2009; Chan, Tarvydas, Blalack, Strauser, & Atkina, 2009b). EBP has been established by scholars in rehabilitation as the standard by which professionals should choose interventions that are effective, ethical, and theory- and model-driven (Chan et al., 2009b; Chan et al., 2009; Dunn & Elliott, 2008). EBP allows professionals to determine appropriate interventions for a particular population based on the body of research literature. Law (2002) explains that rehabilitation practitioners do not always follow an EBP approach, and tend to base interventions on intuition, anecdotal experiences, and habits. This may lead to poor outcomes for consumers. Rehabilitation researchers reiterate the call to use EBP in order to provide the most effective services to clients (Chan et al., 2010; Tucker & Reed, 2008). Chan et al. (2009b) suggests that implementing EBP interventions will prevent practitioners from making uninformed or habit-driven decisions. To improve the effectiveness of rehabilitation services and outcomes, conducting theory- and model-driven research to inform best practices is vital (Chan et al., 2009b). Theory can be an instrumental component to inform EBP, providing practitioners with empirically supported interventions and techniques (Ingram, Hayes, & Scott, 2000). One important model, which is consistent with the prevailing philosophies of rehabilitation, and that continues to gain empirical support as an EBP in the rehabilitation literature is the biopsychosocial model. Biopsychosocial Model Early medical and rehabilitation practice used solely a biomedical approach, considering only the symptoms and functional limitations inherent to illness and disability. In recognizing the limits of this approach, Engel (1977) proposed the biopsychosocial model of patient care, which takes into consideration the interactions of the biological, psychological, and social dimensions of a person's life. The recognition of the benefit of an expanded understanding of medical pathology from different perspectives is consistent with the characteristics of rehabilitation. Rehabilitation, by nature, is diverse and interdisciplinary, drawing on knowledge and practice from many fields, including psychology, medicine, education, and neuroscience. These diverse perspectives suggest that the well-being and health of persons with disabilities are not exclusively determined by the physical characteristics of a disability or illness itself. As Wright (1983) explained, individuals' responses to the onset of disability should be considered in the context of individuals' lives, including the environments in which they live and the coping resources and appraisal processes inherent in their personalities. Within rehabilitation, biopsychosocial models have been proposed for various conditions, such as neurological disorders (Faby, 1998) chronic pain (Talo, Rytokowski, Hamalainen & Kallio, 1996), spinal cord injuries (Trieschmann, 1988), breast cancer (Hilton, 1989) and cardiovascular health (Waltz, Badura, Pfaff, & Schott, 1988; Wiklund, Sanne, Vedin & Wilhelmsson, 2001). More general models have been proposed as well (Post, de Witte, & Schrijvers, 1999; Scofield, Pape, McCracken, & Maki, 1980). Currently, the most prominent biopsychosocial model in rehabilitation is the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF; WHO, 2001). The ICF model recognizes the interdependent nature of biological factors (e.g., physical pathology), psychological variables (e.g., emotional states), and social influences (e.g., social support), within three interactive components: (a) body functions and structures, (b) activities and participation, and (c) the context in which the individual functions. …