Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators—A Scoping Review

Abstract

The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.

Developing a low back pain guideline implementation programme in collaboration with physiotherapists and chiropractors using the Behaviour Change Wheel: a theory-driven design study

“…Also, the barriers and facilitators to implementing a biopsychosocial approach found in the present study were in line with other studies [ 29 , 68 ]. However, whether all necessary barriers have been identified has yet to be determined.…”

Does pain intensity after total knee arthroplasty depend on somatosensory functioning in knee osteoarthritis patients? A prospective cohort study

“…Our hypothesis of no or less pain improvement or worse pain scores 1 year post-TKA in the persistent disturbed somatosensory functioning group (i.e., indicative of centrally driven central sensitization) compared to the other groups was only confirmed with the difference in pain improvement over time or pain intensity 1 year post-TKA between the normal and persistent disturbed somatosensory group classified according to four of the seven grouping variables. This aligns with the notion that, especially in the persistent disturbed somatosensory functioning group, other factors can contribute to persistent post-TKA pain [ 44 ], beyond the peripheral source of nociception (KOA), and are often overlooked factors in current rehabilitation [ 45 , 46 ].…”

Can social prescribing put the ‘social’ into the biopsychosocial management of people with long‐term musculoskeletal disorders?

“…Indeed, the role of social factors is less considered than the biological and psychological domains of the BPS model (Suls & Rothman, 2004) despite research highlighting the association between lack of social contact and ‘physical pain’ (Zhang et al., 2019). The lack of undergraduate training focusing on communication, assessment and integration of the principles of the BPS approach may contribute towards a bias for the biomedical model of care (Gervais‐Hupé et al., 2023; van Dijk et al., 2023). Best practice evidence recommends integrated care in a multidisciplinary environment where experienced personnel with appropriate skills address all facets of the BPS model.…”

“…Best practice evidence recommends integrated care in a multidisciplinary environment where experienced personnel with appropriate skills address all facets of the BPS model. Even though healthcare practitioners play a key role in patient‐centered care (Kamper et al., 2014), and understand the importance of the BPS approach in the management of MSDs (Booth et al., 2017), the implementation of the BPS model in MSD is still limited (van Dijk et al., 2023), particularly in unidisciplinary environments (Sanders et al., 2013). The current gap between best practice recommendations and implementation of the BPS model may require novel approaches such as social prescribing (SP).…”