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The Human Rehabilitation Framework (HRF)

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1. Introduction

There is a global recognition for the need to transition from a biomedical model to a biopsychosocial (BPS) model of clinical practice that is relevant to rehabilitation and to treatment of pain and movement problems. Specific to pain, numerous national and international organizations including the International Association of Study of Pain (IASP), the World Health Organization (WHO), the International Olympic Committee (IOC), and the United States Department of Defense Veterans Affairs have made clear in their mission statements that there is a need for unified language regarding the basic understanding of pain mechanisms and the integration of BPS approaches in healthcare for the treatment of pain.1-3

The current biomedical model and the educational frameworks which support all major professional healthcare education systems have major knowledge deficits in the mechanisms and models of pain treatment, particularly the application of the BPS model of health to pain.4-6

Beyond pain, rehabilitation professions ranging from physical therapists, occupational therapists, athletic trainers, chiropractors, psychologists, physicians, to every level of the care team, lack a coherent comprehensive clinical framework that is transdisciplinary in nature. Across the domains of orthopedics, sports medicine, neurology, oncology, pediatrics, geriatrics, cardiopulmonary, integumentary, and their numerous subdomains, no frameworks exist that are shared across disciplines or domains.

Despite recognizing these gaps in knowledge, acceptance, and integration of BPS-based models for clinical practice is virtually non-existent in both private practices and hospital-based systems.7,8 Multiple healthcare disciplines have failed to transition due to concerns of limited incentives for adoption of the BPS model with current reimbursement models, the impact of the BPS model on workload, and inadequate resource availability for developing competence in BPS care.

Due to the poor acceptance of BPS-based models, healthcare consumers and medical providers have limited options and knowledge related to finding providers who utilize the BPS model.

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