School of Allied Health, Curtin University, Perth, Western Australia, Australia.
Pain Options, South Perth, Western Australia, Australia.
Pain. 2021 Aug 1;162(8):2154-2185. doi: 10.1097/j.pain.0000000000002217.
A substantial evidence-practice gap exists between healthcare professionals learning about the biopsychosocial model of pain and adopting this model in clinical practice. This review aimed to explore the barriers and enablers that influence the application of a biopsychosocial approach to musculoskeletal pain in practice, from the clinicians' perspective. Qualitative evidence synthesis was used. Four electronic databases (CINAHL, EMBASE, MEDLINE, and PsycINFO) were searched. Primary qualitative studies were included if they investigated the experiences of primary healthcare professionals using a biopsychosocial model of musculoskeletal pain care in outpatient settings or their perceptions towards biopsychosocial-oriented clinical practice guidelines. After screening 6571 abstracts, 77 full-text articles were retrieved. Twenty-five studies met the eligibility criteria, reporting the experiences of 413 healthcare professionals (including general practitioners, physiotherapists, and others) spanning 11 countries. Three metathemes were identified that impact the adoption of the biopsychosocial model across the whole of health: (1) at the microlevel, healthcare professionals' personal factors, knowledge and skills, and their misconceptions of clinical practice guidelines, perception of patients' factors, and time; (2) at the mesolevel, clinical practice guideline formulation, community factors, funding models, health service provision, resourcing issues, and workforce training issues; and (3) at the macrolevel, health policy, organizational, and social factors. Synthesized data revealed multilevel (whole-of-health) barriers and enablers to health professionals adopting a biopsychosocial model of pain into practice. Awareness of these multilevel factors may help inform preimplementation preparedness and support more effective implementation of the biopsychosocial model of musculoskeletal pain into clinical practice.
医护人员在了解疼痛的生物心理社会模式与将该模式应用于临床实践之间存在着显著的证据-实践差距。本综述旨在从临床医生的角度探讨影响肌肉骨骼疼痛实践中应用生物心理社会方法的障碍和促进因素。采用定性证据综合方法。检索了四个电子数据库（CINAHL、EMBASE、MEDLINE 和 PsycINFO）。如果初级保健专业人员在门诊环境中使用肌肉骨骼疼痛护理的生物心理社会模型的经验或他们对生物心理社会导向的临床实践指南的看法进行了调查，则纳入初级定性研究。经过筛选 6571 篇摘要，共检索到 77 篇全文文章。25 项研究符合纳入标准，报告了来自 11 个国家的 413 名医护人员（包括全科医生、物理治疗师等）的经验。确定了三个影响整个健康领域采纳生物心理社会模型的主题：（1）在微观层面上，医护人员的个人因素、知识和技能以及他们对临床实践指南的误解、对患者因素的看法和时间；（2）在中观层面上，临床实践指南的制定、社区因素、资金模式、卫生服务提供、资源问题和劳动力培训问题；（3）在宏观层面上，卫生政策、组织和社会因素。综合数据揭示了健康专业人员在将疼痛的生物心理社会模型应用于实践中存在多层次（整个健康）的障碍和促进因素。了解这些多层次的因素可能有助于为实施前的准备提供信息，并支持更有效地将肌肉骨骼疼痛的生物心理社会模型应用于临床实践。
