Exploring the meaning of the biopsychosocial approach in the management of musculoskeletal conditions: Patients’ and physiotherapists’ perspective

Abstract

Despite an increasing amount of treatments and health care resources being devoted to them, musculoskeletal conditions continue to be the greatest health burden globally. The biopsychosocial approach is starting to be widely accepted in the field of musculoskeletal care and the main guidelines recommend its use, but its implementation in clinical practice is not without challenges. The aim of this dissertation was to explore the meaning of the biopsychosocial approach in the management of musculoskeletal conditions from the perspectives of patients and physiotherapists. The four scientific articles of this dissertation used qualitative methods. Two of the phenomenographic studies focused on the conceptions of low back pain patients and one on those of physiotherapists, captured through individual semi-structured interviews. In addition, a systematic review and metasynthesis of qualitative studies was conducted which focused on physiotherapists’ perceptions of learning and implementing biopsychosocial interventions. The findings showed that the patients’ conceptions of health care encounters and undergoing physiotherapy in the Finnish health care system both before and after the physiotherapists received brief training in Cognitive Functional Therapy varied from non-encounters and being left empty-handed to life-changing and holistic encounters that supported their autonomic agency and self-management of low back pain. The physiotherapists' perceptions of learning and implementing the biopsychosocial approach expanded from recognizing the difference of the new approach to creatively applying their new skills. Five common themes of understanding the meaning of the biopsychosocial approach in the management of musculoskeletal conditions emerged from the patients’ and physiotherapists’ perceptions: the difference of the new approach, understanding pain, patient-centered care, gaining confidence, and support. The stepping stones identified in this dissertation can be used to create more meaningful physiotherapy for patients with musculoskeletal conditions and more meaningful training for physiotherapists in order to offer better support in learning and implementing the biopsychosocial approach in clinical practice.