Physiotherapy support for self-management of persisting musculoskeletal pain disorders.
Ina Diener
PMID 34859158WHAT IT FOUND
Self-management support for chronic pain often fails because patients lack readiness and therapists reinforce unhelpful beliefs.
Success requires therapists to act as coaches using motivational interviewing and pain neuroscience education, rather than just delivering exercises.
Key findings
01Self-management programmes often show no or marginal benefit for function, partly because behavioural change is difficult and patients often lack self-efficacy.
02Therapists' own unhelpful beliefs can reinforce patient disability, so clinicians need to engage in self-reflection and upskill in pain neuroscience to effectively support self-management.
03Effective support requires assessing patient readiness for change and health locus of control, using communication skills like motivational interviewing to build a strong therapeutic alliance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so the selection of evidence may be biased towards the authors' viewpoint. It does not provide new primary data or effect sizes, but rather synthesises existing findings. The recommendations are based on general principles and specific programmes (like GLA:D) that may not be directly transferable to all clinical contexts without adaptation.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that simply providing an exercise sheet or generic advice constitutes effective self-management support. The review highlights that without addressing patient beliefs, readiness for change, and using skilled communication techniques like motivational interviewing, such interventions often fail to improve function.