Physiotherapist-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a scoping review and narrative synthesis of 37 studies.

Abstract

Chronic pain (CP) is a leading global health burden. While high-value physiotherapy (HVP) such as exercise can be effective for rehabilitation, low-value treatments such as manual therapy, remain common. We identified barriers and enablers to HVP for persons with CP, and established their alignment with the Theoretical Domains Framework (TDF) of behaviour change. Six databases were systematically searched for studies reporting quantitative and/or qualitative data on barriers and enablers experienced by physiotherapists to the delivery of HVP for individuals with CP. Data were tabulated and narratively synthesised. Thirty-seven studies were included, relating to chronic low back pain [17], osteoarthritis [15], various musculoskeletal conditions [3], rotator cuff tendinopathy [1], and patellofemoral pain [1]. Barriers to HVP for chronic low back pain and osteoarthritis mapped to eight common TDF domains: knowledge, skills, social/professional role and identity, beliefs about consequences, environmental context and resources, beliefs about capabilities, intentions, and social influences. Key barrier and enabler themes included: system-level resources, knowledge/training, and professional factors. Physiotherapists face barriers to implementing HVP for the rehabilitation of individuals with CP, spanning multiple TDF domains. Findings suggest the need for multi-faceted interventions, including changes in resourcing and capacity building within healthcare systems.