7a. Biopsychosocial functioning

Question 1

What is the biopsychosocial model?

Answer 1

This is an assessment of the functional status of the patient, not only looking at the biological component, but also the psychological, social, and environmental components, creating the mental health status of a patient. These components all interact with each other, but these interactions change over time, so it’s important to measure this frequently/periodically, instead of at 1 moment in time, to really get an insight into the health status of the patient.

Question 2

There are no guidelines to assess BPS functioning, but the ones that are used have some unset needs… (2x)

Answer 2

• Little focus on the psychological component of functioning

- Not focused on reintegration of the patient when he/she is discharged

Question 3

What are 4 principles of a home-based monitoring set?

Answer 3

• It has to be ambulant: so that it can also measure at home.
• It has to give early identification of changes in the functional stages.
• Therefore, it should be continuous, or at least dynamic monitoring.
• It should be a generic measure: not only meant for 1 patient population, but for all.

Question 4

Example innovative assessment: smart meter

Answer 4

They looked at households and detected their patterns of water, Wi-Fi, and Electra use to get an insight into the daily routines of these households. They saw that when somebody for example gets a depression, that they really get some different daily routines (less showering, not cooking anymore). So looking at these changes in daily routine can be an early detection of functional decline.

Question 5

Example innovative assessment: speech analysis

Answer 5

By using phone calls and subjects saying the same lines every week, and looking at the grade, roughness, breathiness, asthenia, and strain, they could detect changes in the voice of the patient. Also, they looked at the frequency of your voice. In this way, they could detect changes in mental health and identify depressive symptoms.

Question 6

Example innovative assessment: move sensors

Answer 6

In this study subjects had to wear hip-worn sensors for 24/7 to measure acceleration, which means a change in velocity (speed). This can measure daily movements, which not only depend on physical, but also on psychological and environmental components.

Question 7

Innovative assessment: move sensors

• Looking at the activity
• Looking at the signal itself
• Looking at different assessments of BPS functioning

Answer 7

• Looking at the activity: if someone for example walks every day, and then one day is not, this may be an indication of a change in the functional status of the subject.
• Looking at the signal itself: by using the predictability of the acceleration signal we can look at pattern recognition. This is already used in EEG and they found that when the predictability of the brain waves changed, that it was an indication for epilepsy. So, we want to perform this algorithm on the daily life signals and then we hope to see that a change in predictability is a change in BPS functioning.
• Looking at different assessments of BPS functioning: besides the daily life assessments, we assessed the Short Physical Performance Battery (SPPB) which looked at physical components, and the Cognitive Impairment Test (6-CIT) which looked at cognitive components. Then we compared these assessments with the daily life assessments, and saw that the movement assessments during cycling, stair walking, sitting, and the signal as a whole (from the whole week) were linked to the functional status measured with the SPPB and 6-CIT. We saw that limitations in physical and mental functioning was associated with more regularity in daily life movement (so more repeated patterns).