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Table 5 Advanced meta-integration: synthesis of quantitative, qualitative, and mixed methods data

From: Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – a mixed methods systematic review

Concept Quantitative (variable) Qualitative (sub-theme) Supporting quotes from included studies MM-Quan (Variable) MM-Qual (sub-theme) Integration
Concepts (with Themes and subthemes contributing)
Current Practice (Attitude/Belief towards BPS) PABS.PT Strong biomedical belief
Lack of knowledge about tools to measure PS factors
Fixed osteopathic belief (structural outlook)
Training covered MSK pain only
BPS is a vague concept
BPS lacks definition
“And I felt my training was very much like that [mechanically focused] …. I can’t say we weren’t taught these things [BPS model]”
“I mean, I suppose I’m a bit of a structural osteopath in that I will always look for, I hate to say it, the ‘tissue-causing symptoms’”
“I try always to identify the ‘structurality of the things’ and verify if there is something related to biological nature of pain (e.g. arthrosis) in that patient”
“My osteopathic education was based on biomechanical-tissue model, that is my reference model, even because it represents what I know better and what makes me more confident and assured”
“I believe that PS factors play a major role into patient presentation of symptoms, especially the LBP but I’m not too happy about the definition of PS factors … the term is so broad, that I really find it a bit blurred, unspecific.”
“I believe that osteopaths are aware of the existence and integration of the psycho components in chronic pain, but in many cases these factors are underestimated by them [and] we manage these problems according to our experience”
PABS.PT BPS was not structural enough Concept 1: Current practice - Rooted in BM model
Theme 1: Anchored in BM model
Trained to deal with MSK pain
Structural outlook
Theme 2: BPS-non specific approach
Vague and non-specific concept definition
Underestimating PS factors
Towards a BPS model of care HC-PAIRS Pain education
Pain neuroscience
Patient empowerment
Embrace BPS - Aligning with contemporary practice
Patient empowerment
Improve self efficacy
Understanding patient perspective
Listening to patient stories
Providing reassurance
BPS-added value
Changed practice
“so with the journey of gaining health … it is to empower people so that they can take charge and control of their bodies and their health and their life”
“It seems to be absolutely everywhere at the moment. It seems to be the way the NHS is going in this country, the way physios are going in this country so I think it’s something we need to embrace - that we need to be very aware of”
“And also trying to move away from, you know, ‘Once your right SIJ is going to move well, you are going to feel much better’, sort of thing, having a, sort of, more context, more talk around their context, rather than just their body’”
“The skill to reassure and keep patients calm is very important, and represents also a starting point in the management of chronic patients, especially if they are anxious or depressed”
“We osteopaths are very different from the allopathic doctor; we establish with the patients a more superior verbal relationship”
“We have a verbal and nonverbal conversation with the patients, especially through the touch and correct use of the words. The communication and the words have to be weighed and carefully evaluated”
“I think that the therapeutic relationship is fundamental when I approach chronic patients. In any case, there are a lot of jobs to do, especially while searching to share outcomes with patients”
“Listening, querying, questioning patients- in a way I’m questioning their beliefs, their thoughts in a way that they may think actually, ‘why am I doing that?’ I then offer them different approaches”
“I think it could affect it in terms of their pain perception, so the pain processing, so where they interfere with kind of sensitisation, or altering descending inhibition within the central nervous system, or really focusing on pain, which can change their experience of it”
“The patient’s active role is essential, because they are the main actors of this therapeutic relationship. I can help them with my treatments, but they are living in pain, and it is a partnership that we have”
“I think one of the biggest skills is being able to sync with the patient regardless of who they are and how they are and just work it out together”
  Knowledge about BPS was a transformative experience Concept 2: Towards a BPS model of care
Theme 3: Embrace the BPS approach
Futuristic model
Foundational knowledge – pain and neuroscience
Theme 4: Therapeutic alliance
patient empowerment
improve self-efficacy
understanding patient perspective
Theme 5: Evolution in practice
Communication as a key role
BPS-added value
Changed practice
  1. BM Biomedical, BPS Bio-Psycho-Social, HC-PAIRS Health Care Providers’ Pain and Impairment Relationship Scale, MM Mixed Methods, NSLBP Non-Specific Low Back Pain, PABS PT - Pain Attitudes and Beliefs Scale for Physiotherapists, PS Psychosocial, Qual Qualitative, Quan – Quantitative