Physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions: a systematic review and metasynthesis of qualitative studies

Abstract

Clinical practice guidelines recommend a biopsychosocial approach for the management of musculoskeletal pain conditions, but physiotherapists have reported feeling inadequately trained and lacking in confidence to deal with psychosocial issues. Although a growing number of studies are exploring physiotherapists' perceptions of biopsychosocial training, the results have not been synthesized. Therefore, the aim of this systematic review and metasynthesis of qualitative studies was to explore physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions. A search of the electronic databases: MEDLINE, EMBASE, CINAHL, ERIC, PsycInfo, SportDiscus, and Sociological abstracts identified eligible studies. We included full-text qualitative and mixed-methodology studies published in English, which investigated physiotherapists' perceptions of learning and implementing biopsychosocial interventions. Twelve studies involving 113 participants met the inclusion criteria, and a thematic synthesis was conducted. The quality of the included studies was appraised using the Clinical Appraisal Screening Program. Four main themes emerged from the data: changed understanding and practice, professional benefits, clinical challenges, and learning requirements. The results of this study indicate that although the physiotherapists reported a shift towards more biopsychosocial and person-centered approaches, the training interventions did not sufficiently help them feel confident in delivering all the aspects. Planning future implementation interventions and training physiotherapists through a biopsychosocial approach should focus on adequate training and individualized mentoring related to psychosocial factors, and discussion of role boundaries, patient expectations, and organizational factors such as time constraints and referral pathways.

Exploring the feasibility of a network of organizations for pain rehabilitation: what are the lessons learned?

“…This requires complex changes in clinical routines, collaboration among disciplines, and changes in the organization of care, or even in cultural beliefs and attitudes [35]. However, in the review of Holopainen et al (2020), it was found that most biopsychosocial interventions to improve health care are focused on the individual skills of HCPs instead of on collaboration [36]. An added value of our study was the multidisciplinary transmural education days and practice meetings with all HCPs from primary, secondary, and tertiary care together, which also stimulated implementation at the group and organizational levels.…”

Trust, conversations and the ‘middle space’: A qualitative exploration of the experiences of physiotherapists with clients with suicidal thoughts and behaviours

“…Alexanders [63] theorised that, as a consequence of a lack of training in psychology, physiotherapists might feel underprepared to assess and manage psychological factors. In a systematic review, Holpainen et al [64] identified that physiotherapists feel underprepared and uncomfortable dealing with psychosocial factors when implementing psychologically informed practice. Andrew et al [21] found that physiotherapists expressed little confidence in their ability to competently manage people with severe and persistent mental illness; largely due to a lack of training in mental health.…”

Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation

“…Simulation of different situations might stimulate physiotherapist's confidence in handling new situations. Furthermore, booster sessions and providing feedback during the intervention (coaching on the job) may further improve cognitivebehavioural skills and confidence of physiotherapists [25,26].…”