Holopainen Riikka, Simpson Phoebe, Piirainen Arja, Karppinen Jaro, Schütze Rob, Smith Anne, O'Sullivan Peter, Kent Peter
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
Pain. 2020 Jun;161(6):1150-1168. doi: 10.1097/j.pain.0000000000001809.
Clinical practice guidelines recommend a biopsychosocial approach for the management of musculoskeletal pain conditions, but physiotherapists have reported feeling inadequately trained and lacking in confidence to deal with psychosocial issues. Although a growing number of studies are exploring physiotherapists' perceptions of biopsychosocial training, the results have not been synthesized. Therefore, the aim of this systematic review and metasynthesis of qualitative studies was to explore physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions. A search of the electronic databases: MEDLINE, EMBASE, CINAHL, ERIC, PsycInfo, SportDiscus, and Sociological abstracts identified eligible studies. We included full-text qualitative and mixed-methodology studies published in English, which investigated physiotherapists' perceptions of learning and implementing biopsychosocial interventions. Twelve studies involving 113 participants met the inclusion criteria, and a thematic synthesis was conducted. The quality of the included studies was appraised using the Clinical Appraisal Screening Program. Four main themes emerged from the data: changed understanding and practice, professional benefits, clinical challenges, and learning requirements. The results of this study indicate that although the physiotherapists reported a shift towards more biopsychosocial and person-centered approaches, the training interventions did not sufficiently help them feel confident in delivering all the aspects. Planning future implementation interventions and training physiotherapists through a biopsychosocial approach should focus on adequate training and individualized mentoring related to psychosocial factors, and discussion of role boundaries, patient expectations, and organizational factors such as time constraints and referral pathways.
临床实践指南推荐采用生物心理社会方法来管理肌肉骨骼疼痛疾病，但物理治疗师报告称感觉自己在这方面的培训不足，并且在处理心理社会问题时缺乏信心。尽管越来越多的研究在探索物理治疗师对生物心理社会培训的看法，但尚未对结果进行综合分析。因此，这项对定性研究的系统评价和元综合分析的目的是探讨物理治疗师对学习和实施生物心理社会干预措施以治疗肌肉骨骼疼痛疾病的看法。通过检索电子数据库：MEDLINE、EMBASE、CINAHL、ERIC、PsycInfo、SportDiscus和Sociological abstracts确定了符合条件的研究。我们纳入了以英文发表的全文定性和混合方法研究，这些研究调查了物理治疗师对学习和实施生物心理社会干预措施的看法。12项涉及113名参与者的研究符合纳入标准，并进行了主题综合分析。使用临床评估筛查程序对纳入研究的质量进行了评估。数据中出现了四个主要主题：理解和实践的改变、职业益处、临床挑战和学习需求。这项研究的结果表明，尽管物理治疗师报告称正朝着更具生物心理社会性和以患者为中心的方法转变，但培训干预措施并未充分帮助他们在提供所有方面时感到自信。通过生物心理社会方法规划未来的实施干预措施和培训物理治疗师应侧重于与心理社会因素相关的充分培训和个性化指导，以及对角色界限、患者期望和组织因素（如时间限制和转诊途径）的讨论。
