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The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (BeMe Health)ORCID iD: 0000-0002-4616-521X
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (ICU CHILD)ORCID iD: 0000-0001-6163-9690
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-1912-3110
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-4537-030X
2018 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed) Published
Abstract [en]

Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy is challenging, and studies regarding the determinants are sparse. Thus, the aim of this study was to explore determinants of applying a BM approach in physiotherapy for patients with persistent pain across the micro-, meso-, and macro-levels. Methods: A qualitative multiple-case study design was used. Data were collected from four cases through semi-structured interviews with physiotherapists (PTs), patients, and managers; observations of video-recorded treatment sessions; and reviews of local directives and regulations. Data were analyzed with inductive content analysis and cross-case analysis, followed by mapping to the domains of determinants at the micro-, meso-, and macro-levels within the Implementation of Change Model. Results: Similar determinants were found across the cases. At the micro-level, these determinants concerned the PTs’ ambivalence toward a BM approach, a biomedical focus, embarrassment asking about psychosocial factors, BM knowledge, skills for applying the approach, and self-awareness. Others concerned the patients’ role expectations of the PT, patients as active or passive agents in the treatment process, patients’ focus on biomedical aspects, and confidence in the PT. At the meso-level, support from managers and peers, allocation of time, and expectations from the organization were identified as determinants. No determinants were identified at the macro-level. Conclusion: The complexity of integrating a BM approach into physiotherapy clinical practice arises from multiple determinants functioning as both facilitators and barriers. By selecting strategies to address these determinants, the implementation of a BM approach could be supported.

Place, publisher, year, edition, pages
2018.
Keywords [en]
Behavioral medicine,  physiotherapy,  clinical practice,  determinant,  facilitator,  barrier
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:mdh:diva-41172DOI: 10.1080/09593985.2018.1476996PubMedID: 29847287Scopus ID: 2-s2.0-85047962277OAI: oai:DiVA.org:mdh-41172DiVA, id: diva2:1255954
Funder
AFA Insurance, 12169Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2019-06-18Bibliographically approved

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Fritz, JohannaSöderbäck, MajaSandborgh, MariaSöderlund, Anne

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