Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: a qualitative study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Physiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents.
Objective
To explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients.
Method
Qualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.
Results
Three main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective.
Conclusion
Although employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.
Physiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents.
Objective
To explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients.
Method
Qualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes.
Results
Three main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective.
Conclusion
Although employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.
Date Issued
2018-12-01
Date Acceptance
2018-08-15
Citation
Musculoskeletal Science and Practice, 2018, 38, pp.113-119
ISSN
2468-8630
Publisher
Elsevier
Start Page
113
End Page
119
Journal / Book Title
Musculoskeletal Science and Practice
Volume
38
Copyright Statement
Crown Copyright © 2018 Published by Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Private Physiotherapy Educational Foundation
Grant Number
N/A
Subjects
Science & Technology
Life Sciences & Biomedicine
Rehabilitation
Non-specific chronic low back pain
Biopsychosocial model
Physiotherapy
PATIENT-CENTERED CARE
PSYCHOSOCIAL FACTORS
PHYSICAL-THERAPISTS
HEALTH-CARE
BELIEFS
KNOWLEDGE
ATTITUDES
ENGAGEMENT
PRINCIPLES
GUIDELINES
Publication Status
Published
Date Publish Online
2018-11-01