Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery, 2015, Synnott

Full title: Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review

Abstract:
Question: What are physiotherapists’ perceptions about identifying and managing the cognitive, psychological and social factors that may act as barriers to recovery for people with low back pain (LBP)?

Design: Systematic review and qualitative metasynthesis of qualitative studies in which physiotherapists were questioned, using focus groups or semi-structured interviews, about identifying and managing cognitive, psychological and social factors in people with LBP. Participants: Qualified physiotherapists with experience in treating patients with LBP.

Outcome measures: Studies were synthesised in narrative format and thematic analysis was used to provide a collective insight into the physiotherapists’ perceptions.

Results: Three main themes emerged: physiotherapists only partially recognised cognitive, psychological and social factors in LBP, with most discussion around factors such as family, work and unhelpful patient expectations; some physiotherapists stigmatised patients with LBP as demanding, attention-seeking and poorly motivated when they presented with behaviours suggestive of these factors; and physiotherapists questioned the relevance of screening for these factors because they were perceived to extend beyond their scope of practice, with many feeling under-skilled in addressing them.

Conclusion: Physiotherapists partially recognised cognitive, psychological and social factors in people with LBP. Physiotherapists expressed a preference for dealing with the more mechanical aspects of LBP, and some stigmatised the behaviours suggestive of cognitive, psychological and social contributions to LBP. Physiotherapists perceived that neither their initial training, nor currently available professional development training, instilled them with the requisite skills and confidence to successfully address and treat the multidimensional pain presentations seen in LBP.

https://www.sciencedirect.com/science/article/pii/S183695531500017X

 

Came across this while looking for patient experiences of how health care workers talk about behavior modifications. I found it interesting since at least in my country low back pain is often used as an example of a symptom where the biopsychosocial model is beneficial.

 

See this study:
Trials we cannot trust: investigating their impact on systematic reviews and clinical guidelines in spinal pain, 2023, O'connell et al
It's pretty clear there is virtually no evidence to support the use of CBT for back pain.

 

One Norwegian comedian that have "only been asking questions" about why pwME are against the recommendations for CBT/GET use his experience with lower back pain and being told it was perpetuated by his thoughts as a starting point:

Quote from a TV programs transcribed by @Kalliope in this post. This comedian is also part of the Norwegian Woman's health group, that recently published their evaluation of women's health in Norway that had a subchapter on Lightning Process when discussing ME/CFS (other members in this group is Leif Kennair, who is head of the Lightning Process study at NTNU).