Exploring the Experiences of Physiotherapists Supporting People With Back Pain to Describe Perceived Influences on Patient-Therapist Interactions and Barriers to Bio-Psychosociocultural Approaches in Physiotherapy Practice

Abstract

Back pain related disability and the associated cost on the health care system is a significant health problem in New Zealand, and physiotherapists working in private practice play an important role in supporting people to manage their condition. However, little is known about the practises of physiotherapists, or factors that potentially influence interactions with patients and impact their practices. Supporting people with back pain from a bio-psychosociocultural perspective is also a professional competency requirement to practice physiotherapy in New Zealand. It is also required by the Accident Compensation Corporation (ACC) when providing services to ACC claimants However, little is known about the challenges or barriers physiotherapists experience when they attempt to implement these types of approaches with people with back pain in this health setting. Improving understandings of patient-therapist interactions and barriers to bio-psychosociocultural approaches in the context of this condition, may inform ways to improve patient-therapist interaction experiences, and potentially, clinical outcomes for people with back pain who consult with a physiotherapist. The aim of this research, therefore, was to explore the experiences of physiotherapists supporting people to manage their back pain in private physiotherapy practice to describe perceived influences on patient-interactions that potentially impact their practises. The secondary objective was to provide new insights into barriers to physiotherapists supporting people with back pain from a bio-psychosociocultural perspective in this health setting.

Using Interpretive Description as the research methodology, eight physiotherapists working in private practice who support people with back pain were recruited and were interviewed. Interviews were transcribed and then analysed using Braun and Clarke’s (2022) six-step Reflexive Thematic Analysis process. My interpretations revealed four interrelated influences with bio-psychosociocultural dimensions: therapist perceptions about their patient’s personal characteristics and psycho-sociocultural context; the nature of the relationship and whether it is characterised by confidence and trust; tensions between patient-therapist care preferences and expectations; and lastly, whether patients engage with their therapist and physiotherapy care. Individually, or in combination, these influences were perceived to play a key role during interactions and influence the approaches therapists take up when supporting people to manage their back pain.

My findings provide important new insights into the complexity of the context in which many, if not all, interactions between physiotherapists and people with back pain take place. Practise decisions arise in the moment of therapy out of relational dynamics that emerge when patients, with their own unique personal characteristics, psychosociocultural dimensions, condition beliefs and care preferences, interact within the context of a condition characterised by diagnostic and other condition uncertainties. Together with beliefs about the adequacies of their professional training and role responsibilities, uncertainties about how to navigate the complexity of this context are sources of professional insecurities that undermine supporting people to manage their back pain from a bio-psychosociocultural perspective in physiotherapy practice.

They also reveal that interpersonal connectedness is the foundation of physiotherapy practice. Physiotherapists need to become more accepting of themselves as interactors who are confident practicing from an interdisciplinary-within perspective. This requires occupational reimagination and transformative change to embrace a broader conceptualisation of their role, and greater self-awareness of the effects of relational dynamics on their practices. These changes require reflexivity and new skills. Unless physiotherapists develop these skills, interpersonal relational barriers to improving the outcomes of physiotherapy care and supporting people with back pain from a biopsychosocial perspective in physiotherapy practice will remain.