title: Physical therapists' assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care.
abstract: Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs' assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain.
  
  
  
  A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs' assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs' clinical practice.
  
  
  
  Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs' clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings.
  
  
  
  Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy.
authors.affiliation: Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden. christina.emilson@neuro.uu.se.
authors.forename: C
authors.initials: C
authors.lastname: Emilson
authors.affiliation: Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Åsenlöf
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.|Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Pettersson
authors.affiliation: Research and Development Center Spenshult, Halmstad, Sweden.|Department of Public Health, and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Bergman
authors.affiliation: School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Sandborgh
authors.affiliation: Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.affiliation: Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Demmelmaier
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001521:Behavior Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D059825:Physical Therapists / Q000193:education* / Q000523:psychology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D012017:Referral and Consultation / Q000592:standards*; D013548:Sweden; D063189:Symptom Assessment / Q000592:standards*