How physiotherapists attend to the human aspects of care when working with people with low back pain: a thematic analysis

ABSTRACT

Pain is a multidimensional experience. Physiotherapy has attempted to enhance earlier biomedical approaches to patient care through approaches like the ‘biopsychosocial’ model. Nevertheless, physiotherapy continues to focus on biomedical and/or behavioural aspects of care. We critically investigated how physiotherapists attend to human (psychosocial, emotional, existential, and moral) aspects of low back pain care. We co-analysed ethnographic data with researchers, patients, and physiotherapists using concepts of conforming, tinkering and abandoning ‘scripts’. Data included observations of 28 physiotherapy interactions between 26 patients and 10 physiotherapists and 7 researcher-clinician dialogues. Analysis suggests when conforming to scripts, clinicians have difficulty recognising and responding to emotions; time pressure limited clinicians focus, and a biological focus often distracted from psychosocial aspects of people’s back pain experiences. In contrast, tinkering with or abandoning scripts allowed space to broaden the focus. Drawing from theorists such as Butler (1999) and Gibson et al. (2020) our analysis contributes to health sociology, arguing that ‘tinkering’ with or ‘abandoning’ scripts can foster more humanistic, flexible and reflexive approaches to care. Although health sociologists have explored tinkering, abandoning is new; within physiotherapy, it encapsulates being able to respond with agility to non-physical elements of care without constraint from traditional ways of thinking and doing.

KEYWORDS:

• Qualitative methodology
• thematic analysis
• chronic pain
• physiotherapy

Authorship statement

All authors meet the ICMJE requirements for authorship.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 We use the term patient because of its clinical connotations to receiving care and acknowledge it is a socially defined term within the healthcare setting (Setchell, Nicholls, et al., 2018).

Additional information

Funding

This work was supported by the National Health and Medical Research Council of Australia Fellowship [JS: APP1157199], and UQ Early Career Researcher Grant.