Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – a mixed methods systematic review

Abstract

Background Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. Methods The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. Results A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. Discussion Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.

Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: A Qualitative Descriptive Study among Italian Osteopaths

“…It should be noted that, to date, the osteopathic core curriculum lacks education in soft skills and hands-off approaches, not allowing the development of the management of psychosocial and contextual factors [ 48 , 76 , 77 ].…”

Incorporating Physical Activity Assessments and Behavior Change Techniques Into Geriatrics

“…Healthcare providers continue to emphasize a biomedical approach (ie, a focus on the biological aspects of the injury or diagnosis) over a biopsychosocial approach (ie, incorporate behaviors associated with the injury or diagnosis). 9 , 66 A biomedical approach may initially be appropriate, especially if significant pain is present. However, at some point within the plan of care, health care providers should incorporate the biopsychosocial approach and consider the behavioral components that led to the current problem (eg, inadequate PA).…”

“… 67 , 68 , 69 By shifting to a more holistic view, behavior change can be promoted and older adults can be empowered to adopt new PA behaviors. 66 , 70 …”

Immediate effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: A factorial randomized trial

“…Taken together, MSDs and OMT are complex health conditions and interventions, respectively. Both are underlined by mechanisms that are poorly understood [30,68] and associated with various biological, psychological, and social factors [69,70]. However, of particular interest is that both MSDs [71,72] and OMT [73][74][75][76] are reputed to be associated with changes in muscle tone.…”