Supported self-management in musculoskeletal physiotherapy: the time is now! – Guest editorial

Musculoskeletal conditions are ranked as the primary source of disability worldwide, with low back pain emerging as the predominant cause of disability in 160 countries [1]. Furthermore, the global burden of disability attributable to musculoskeletal conditions is expected to rise over the next decades [2,3]. Person-centred care, a biopsychosocial perspective, and self-management are recommended in the management and treatment of musculoskeletal conditions [4–12]. Moreover, these concepts are strongly related to each other; person-centred care underpins the humanistic aspects of the biopsychosocial model and has been described as the practical application of this model, while self-management can be seen as an empowering culmination of an enactive biopsychosocial approach [13]. Therefore, self-management can be used as a practical approach to delivering person-centred care that incorporates a biopsychosocial perspective.

Several definitions of self-management exist [14,15] that focus on the skills people need to take an active and responsible role in managing their condition so that they can manage the biopsychosocial consequences of their condition and function optimally. However, self-management is often perceived as challenging and characterised by barriers that require support for people with musculoskeletal conditions [16–24]. Therefore, self-management support should be part of routine healthcare [8,25–27]. Based on several descriptions and definitions [28–32] of self-management support/supported self-management, I propose the following definition for future use: ‘Self-management support is a person-centred, collaborative approach used by healthcare providers to support people with health conditions to acquire the necessary knowledge, skills, support and confidence to take an active and leading role in managing their condition in the context of their daily lives’.

With their expertise in musculoskeletal conditions and the length of patient contact, physiotherapists are ideally placed to support people with musculoskeletal conditions in their self-management and should use a self-management approach for people with persistent musculoskeletal conditions whenever possible [8]. I strongly believe that this is always possible, not only for people presenting with persistent conditions, but also for people with (sub)acute conditions. Therefore, a self-management approach is recommended for all people presenting with musculoskeletal conditions [6,7]. However, research suggests that physiotherapists often lack the knowledge and skills needed to fully integrate self-management support and experience barriers to implementing contemporary self-management support in musculoskeletal practice [33–36]. Physiotherapists were found to focus mainly on the physical/biomechanical factors and exercise, as well as providing education [33–35]. However, knowledge of the core principles of self-management was lacking, and important self-management skills were generally not sufficiently addressed [33–36].

It is important that all physiotherapist treating people with musculoskeletal conditions (and people with other conditions) use a self-management approach as the foundation of their person-centred treatment plan. This should include support in key self-management skills such as problem solving, decision making, goal setting, action planning, obtaining support, working together, using resources, monitoring changes and self-tailoring [6,37–39]. These skills can foster behaviour change and equip patients with the skills needed to actively manage their condition [8,15]. Moreover, it is important to provide education, resources and tools on specific topics (e.g. managing pain and emotions, cognitions and perceptions, healthy lifestyle, household activities, hobbies and exercise and work participation) based on the individual’s needs [6,40]. Increasing self-efficacy and setting people up for positive experiences is also important [37,40,41].

Physiotherapists can use a recently developed framework [6] aimed at supporting clinicians in delivering person-centred care in practice, including supported self-management. Physiotherapists can also use the Self-Management Identification Tool [6] to evaluate self-management topics with their patients. Physiotherapists can use the Self-Efficacy and Performance in Self-Management Support Instrument for Physiotherapists (SEPSS-PT) to evaluate their self-efficacy and performance in self-management support [42].

It is also important to integrate knowledge and skills training in self-management support into undergraduate physiotherapy educational programmes and to update the knowledge and skills of already graduated physiotherapists. People do not always expect a self-management approach, and patient expectations have been identified as an important barrier to integrating self-management into clinical practice [34]. Therefore, patient education and community education about contemporary musculoskeletal care, including self-management, is important. Physiotherapist can play an important role in reducing the global burden of musculoskeletal conditions by supporting people in their self-management. Let’s not wait. The time is now!

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