To assess physiotherapist-related barriers and/or enablers to implementation of HVP for adults with chronic pain. Further, to determine the efficacy of physiotherapist-related interventions which have sought to facilitate successful implementation of HVP for chronic pain.
A systematic search of five databases was completed for peer-reviewed English language studies related to: 1) physiotherapists as the service provider, 2) chronic pain conditions experienced by adults, and 3) physiotherapist-related barriers and enablers to, and/or interventions to enhance, the implementation of HVP for chronic pain. An a-priori framework synthesis methodology incorporating the Theoretical Domains Framework (TDF) of behavior change was used to qualitatively synthesize data from the included studies.
Forty-seven studies met the criteria (24 reported on barriers and enablers; 25 reported on interventions; 2 reported on both). Twelve barrier and enabler studies related to chronic low back pain (CLBP), eight related to osteoarthritis, two related to chronic pain (from various musculoskeletal conditions), and rotator cuff tendinopathy and patellofemoral pain were reported on in one study, respectively.
Physiotherapists experience a range of barriers to the delivery of HVP related to multiple domains of the TDF. Barriers relating to CLBP and osteoarthritis aligned with six common TDF domains. These domains included: knowledge, skills, social/professional role and identity, beliefs about consequences, environmental context and resources, and social influences. Specific barrier themes relating to both CLBP and osteoarthritis aligned with the environmental context and resources domain; and included: time constraints, systemic financial pressures, organizational resources, and waiting lists. Similarly, organizational resourcing was a prominent theme from studies reporting on enablers.
Eleven intervention studies related to CLBP, and twelve related to osteoarthritis. All but five of the intervention studies focused primarily on education and training of physiotherapists, and have demonstrated efficacy.
Physiotherapists face various barriers to implementing HVP for chronic pain conditions, primarily related to environmental context and resources. While education-focused interventions have shown some effectiveness, our findings highlight a crucial need for policymakers and industry stakeholders to address organizational and systemic barriers that hinder optimal care for chronic pain patients. Advocating for investment in resources and capacity building within healthcare systems could facilitate the necessary changes to support HVP provision.
The review has established multi-factorial barriers to successful implementation of HVP for persons with chronic pain, and critically, highlights a need for future interventions to focus on organizational and system-level influences. These findings can directly inform related policy and practice, and underpin initiatives to optimize care for persons with chronic pain.
High-value care
Musculoskeletal
