title: Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review.
abstract: OBJECTIVE
  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)?
  
  
  METHODS
  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.
  
  
  METHODS
  Qualified physiotherapists with experience in treating patients with LBP.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  CRD 42014009964. [Synnott A, O'Keeffe M, Bunzli S, Dankaerts W, O'Sullivan P, O'Sullivan K (2015) Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review.Journal of Physiotherapy61: 68-76].
authors: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors: Aoife
authors: A
authors: Synnott
authors: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors: Mary
authors: M
authors: O'Keeffe
authors: School of Physiotherapy, Curtin University, Perth, Australia.
authors: Samantha
authors: S
authors: Bunzli
authors: Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
authors: Wim
authors: W
authors: Dankaerts
authors: School of Physiotherapy, Curtin University, Perth, Australia.
authors: Peter
authors: P
authors: O'Sullivan
authors: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors: Kieran
authors: K
authors: O'Sullivan
mesh_terms: D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation*; D059825:Physical Therapists / Q000523:psychology*; D026741:Physical Therapy Modalities; D011369:Professional-Patient Relations; D020127:Recovery of Function / Q000502:physiology*; D057545:Social Stigma
keywords: Low back pain; Metasynthesis; Physiotherapy; Qualitative; Systematic review