Title: 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 (MSK) pain. However, it remains unclear how osteopaths implement a BPS framework in the management of MSK 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 MSK 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 articles (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 the BPS model, various barriers exist that stop osteopaths BPS model use in osteopathic clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.

Pain knowledge and fear-avoidance beliefs of French osteopathy students and educators towards chronic low back pain: An osteopathic educational institution-based cross-sectional survey

“…Attitudes and beliefs concerning low back pain amongst musculoskeletal practitioners including osteopaths [13][14][15][16], chiropractors [17], physiotherapists [18,19] and more broadly HCP [20] have often been studied constituting useful comparison literature for our model of education with other models. Previous studies on the attitudes and beliefs of osteopaths towards chronic low back pain (cLPB) in the UK [21] and Spain [22] have hypothesised that osteopaths would have a more biopsychosocial approach towards cLBP patients than other HCP.…”