Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Physiother Res Int. 2022 Jan;27(1):e1932. doi: 10.1002/pri.1932. Epub 2021 Nov 5.
Low back pain is a multidimensional disorder and a biopsychosocial management approach is recommended. However, recent data indicates that physiotherapists mainly focus on biomechanical aspects in treatment and struggle with addressing psychosocial barriers for recovery. We wanted to explore how physiotherapists express their experiences of building therapeutic alliances within a biopsychosocial perspective of low back pain.
Qualitative focus-group interviews were performed with five physiotherapists on two occasions with 6 months in between. Data were analyzed within a hermeneutical perspective with decontextualization and recontextualization, and identification of themes.
Four main themes were identified from the analyses: (1) An ideal standard: Presence, empathy and applying the biopsychosocial perspective is central for building therapeutic alliance. (2) Time-consuming: Active listening and personally adapted treatment is important and time-consuming. (3) Challenging area: Advanced clinical reasoning is needed to understand and modify complex barriers for recovery. Clinical experience is sometimes necessary to integrate the psychological and social domains into physiotherapy management. (4) The art of balancing: Important to apply sensitive communication to help patients gain new insight. Some heavy psychosocial demands on patients may be outside physiotherapists' professional competence.
The physiotherapists in this focus group study expressed a shared view that therapeutic alliance should build upon person-centering, motivational communication, and facilitation of lifestyle adjustments within a biopsychosocial perspective of low back pain. Complex clinical reasoning necessary as the optimal cause-corrective treatment strategies were often not obvious. Time and tools to uncover and modify relevant psychological obstacles for recovery were perceived challenging and partly dependent on clinical experience. Addressment of psychosocial obstacles for recovery should be included in basic as well as postgraduate curriculums for physiotherapists. Collaborative practice support strategies like peer guidance and better platforms for interprofessional collaboration and decision support could contribute to improve practice in the psychosocial domain.
下腰痛是一种多维障碍，推荐采用生物心理社会管理方法。然而，最近的数据表明，物理治疗师在治疗中主要关注生物力学方面，并且难以解决康复的心理社会障碍。我们想探讨物理治疗师如何在生物心理社会视角下表达他们在建立治疗联盟方面的经验。
对 5 名物理治疗师进行了两次定性焦点组访谈，两次访谈之间间隔 6 个月。数据分析采用解释学视角，进行去语境化和再语境化，并确定主题。
从分析中确定了四个主要主题：（1）理想标准：存在、同理心和应用生物心理社会视角是建立治疗联盟的核心。（2）耗时：积极倾听和个性化治疗很重要，而且很耗时。（3）具有挑战性的领域：需要高级临床推理来理解和修改康复的复杂障碍。临床经验有时需要将心理和社会领域纳入物理治疗管理。（4）平衡的艺术：应用敏感的沟通以帮助患者获得新的见解很重要。患者的一些沉重的心理社会需求可能超出物理治疗师的专业能力范围。
本焦点小组研究中的物理治疗师表达了一种共同的观点，即治疗联盟应建立在以人为本、动机沟通和促进生物心理社会视角下的生活方式调整的基础上。治疗中需要复杂的临床推理，因为最佳的病因纠正治疗策略并不明显。发现和修改与康复相关的心理障碍所需的时间和工具被认为具有挑战性，部分取决于临床经验。应将康复的心理社会障碍的解决纳入物理治疗师的基础和研究生课程中。协作实践支持策略，如同行指导以及更好的跨专业合作和决策支持平台，可以帮助改善心理社会领域的实践。
