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.
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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.
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BackgroundWorking alliance can possibly influence patients’ experiences of pain and physical functioning. The aim of this systematic review is to merge evidence from literature regarding the influence of patients’ perceived working alliance on pain and physical functioning in patients with chronic musculoskeletal pain.MethodsA systematic review in which randomized controlled trials and cohort studies were included that assessed the influence of working alliance on either pain or physical functioning in patients with chronic musculoskeletal pain. The methodological quality of the included studies were rated by means of the PEDro score and STROBE statement.ResultsThe first step of the search process provided 1469 studies. After screening, five studies were included in this review including one RCT and four cohort studies of patients with chronic musculoskeletal pain. One cohort study was rated as low methodological quality and the other studies as high methodological quality. There was a significant effect of working alliance on the outcome of pain severity, pain interference, and physical functioning in all studies. Physical functioning was measured by means of questionnaires and functional capacity tests. The effect on questionnaires was positive; the effect was conflicting on functional capacity.ConclusionWhen influencing pain with treatment, a patient’s perceived working alliance during treatment does predict pain reduction and improvement in physical functioning. It is recommended to inquire about a patient’s working alliance during treatment in patients with chronic musculoskeletal pain.
Het gebruik van E-Health in de gezondheidszorg neemt een steeds prominentere rol in. Zeker ook onder de COVID 19 omstandigheden blijkt E-Health een nuttige bijdrage aan het zorgproces te kunnen leveren. Voor chronische pijn patienten die behandeld zijn in diverse revalidatie centra blijkt het moeilijk om de bereikte positieve resultaten te bestendigen. Binnen het SOLACE project (RAAK 2014-02-23P) is met behulp van Co-Design de content van een zelfmanagement programma ontwikkeld om terugval na revalidatie te voorkomen of te verminderen. Dit programma kent twee uitgangspunten, gestoeld op gedragsmatige principes; “Do it Your Self” waarin positieve herinneringen en ervaringen worden geregistreerd en “Waardevolle Doelen” waarbij patienten doelen vanuit de revalidatie en of nieuwe doelen kunnen aangeven en hoe deze stapsgewijs binnen een vast tijdbestek behaald kunnen worden. In de Agrippa studie (RAAK.PUB05.002) zijn deze doelen verder ontwikkeld in een Applicatie, de Agrippa app. Daarnaast wordt gekeken in een gerandomiseerd onderzoek of deze app ook effectief is. De huidige aanvraag behelst een kwalitatieve studie naar de bruikbaarheid van de app ervaren door de patienten en ervaren door de zorgverleners. Daarnaast zal worden gekeken hoe de COVID-19 omstandigheden invloed hebben gehad op het gebruik ervan.
