What do physiotherapists need to effectively integrate a biopsychosocial approach in treatment of patients with non-specific low back pain? A qualitative analysis

Abstract

Abstract Background Musculoskeletal disorders, particularly non-specific low back pain, are significant global health concerns with increasing prevalence and a substantial burden on healthcare systems. Physiotherapists in primary care play a critical role in managing these conditions. Although effective management requires a holistic, patient centered approach, the adoption of such approaches is limited by barriers such as a predominantly biomedical focus in training and communication challenges. While research has identified numerous barriers, few facilitators have been explored, highlighting the need for improved training strategies. This study examines the needs of Swiss outpatient physiotherapists in integrating biopsychosocial approaches for non-specific low back pain treatment. Methods Semi-structured interviews and focus groups were conducted to explore physiotherapists’ experiences and needs regarding biopsychosocial approaches. Physiotherapists from Swiss outpatient healthcare were recruited via purposive sampling. Thematic analysis, following Braun and Clarke’s methodological framework, was used to analyse the data. Results Data from 15 physiotherapists revealed four interconnected themes reflecting physiotherapists’ perceived needs and facilitators for improving biopsychosocial back pain management: a supportive systemic framework, stronger interdisciplinary collaboration, enhanced educational approaches, and foundational professional attributes. Together, these themes and respective recommendations were organized within an interconnected macro-, meso-, and micro-level framework to facilitate the implementation of biopsychosocial approaches in clinical practice. Conclusion This study highlights physiotherapists’ perceived needs and priorities for implementing biopsychosocial approaches to non-specific back pain and reinforces the need for a paradigm shift in physiotherapy. Macro-level interventions should address public and professional perceptions of physiotherapy and strengthen supportive healthcare systems and quality assurance measures. Meso-level strategies include fostering interdisciplinary collaboration and improving education, particularly through practical training in communication, psychological competencies and biopsychosocial care. Micro-level recommendations focus on interpersonal skills and intrinsic motivation. Addressing these interconnected factors may facilitate the competent integration of biopsychosocial approaches into back pain management, ultimately improving patient outcomes and reducing the burden of back pain on individuals and healthcare systems.