Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review

Abstract

Objective To identify, and synthesize patient-related barriers and/or enablers to the implementation of high-value physiotherapy (HVP) for chronic pain. Further, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, and their efficacy. Methods We systematically searched APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) regarding adults with chronic pain. Identified themes relating to barriers and enablers were synthesized using the Theoretical Domains Framework of behavior change. Outcomes from studies reporting on interventions were also qualitatively synthesized. Results Fourteen studies reported on barriers and enablers, eight related to exercise adherence. Themes common to barriers and enablers included: perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and patient’s understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, nine of which aimed to improve exercise adherence. Of these, evidence from four randomized-controlled trials of technology-based interventions demonstrated improved exercise adherence amongst interventions groups compared to controls. Conclusion Patients with chronic pain experience barriers to HVP, including: their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include: rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain.

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Exercise Therapy for Chronic Neck Pain: Tailoring Person-Centred Approaches within Contemporary Management

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