Implementation of a biopsychosocial approach into physiotherapists’ practice: a review of systematic reviews to map barriers and facilitators and identify specific behavior change techniques

Abstract

Purpose

Our first objective was to map the barriers and facilitators to the implementation of a biopsychosocial approach into physiotherapists’ practice within the Theoretical Domains Framework (TDF). Our second objective was to identify the specific behavior change techniques (BCT) that could facilitate this implementation.

Materials and methods

We conducted a review of systematic reviews to identify barriers and facilitators to the use of a biopsychosocial approach by physiotherapists and we mapped them within the TDF domains. We then analyzed these domains using the Theory and Techniques tool (TaTT) to identify the most appropriate BCTs for the implementation of a biopsychosocial approach into physiotherapists’ practice.

Results

The barriers and facilitators to the use of a biopsychosocial approach by physiotherapists were mapped to 10 domains of the TDF (Knowledge; skills; professional role; beliefs about capabilities; beliefs about consequences; intentions; memory, attention and decision processes; environmental context; social influences; emotion). The inclusion of these domains within the TaTT resulted in the identification of 33 BCTs that could foster the use of this approach by physiotherapists.

Conclusions

Investigating the implementation of a biopsychosocial approach into physiotherapists’ practice from a behavior change perspective provides new strategies that can contribute to successfully implement this approach.

Implications for Rehabilitation

• The implementation of a biopsychosocial approach into physiotherapists’ practice is a complex process which involves behavior changes influenced by several barriers and facilitators.

• Barriers and facilitators reported by physiotherapists when implementing a biopsychosocial approach can be mapped within 10 domains of the Theoretical Domain Framework.

• Thirty-three behavior change techniques (e.g., verbal persuasion about capability, problem solving, restructuring the physical environment, etc.) were identified to foster the implementation of a biopsychosocial approach and specifically target barriers and facilitators.

• By using a behavior change perspective, this study highlights new strategies and avenues that can support current efforts to successfully implement the use of a biopsychosocial approach into physiotherapists’ practice.

Keywords:

• Physiotherapy
• biopsychosocial
• theoretical domain framework
• behavior change techniques
• implementation

Acknowledgments

The authors thanks to Myriam Grondin, librarian at the Université de Montréal, for her precious help during the literature search, as well as to Mathieu-Joël Gervais, Ph.D., and Diana Zidarov, Ph.D., for their comments and suggestions during the early stages of this project. JGH received doctoral training scholarships from the Canadian Institutes of Health Research, the Faculty of Medicine and the School of Rehabilitation of the University of Montreal, from Ordre professionnel de la physiothérapie du Québec and from the Quebec Rehabilitation Research Network. AH is supported by a junior 1 salary award from Fonds de recherche du Québec – Santé (Chercheur-Boursier Junior 1). AF received funds from Société Française de Physiothérapie and Mitacs Globalink.

Disclosure statement

The authors report no declarations of interest.