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Abstract：
OBJECTIVE: To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy.
METHODS: We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized.
RESULTS: Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient\'s understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls.
CONCLUSIONS: Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain.
BACKGROUND: Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
METHODS: We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized.
RESULTS: Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient\'s understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls.
CONCLUSIONS: Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain.
BACKGROUND: Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
摘要：
目的：确定，并综合与患者相关的障碍和/或促进因素，以实施高价值的物理治疗（HVP）治疗慢性疼痛。Further,回顾哪些与患者相关的干预措施已被用于促进慢性疼痛HVP的实施，以及它们的功效。
方法：我们系统地搜索了APAPsycInfo，Embase,CINAHL,Medline,Scopus,和PEDro数据库，用于对成人慢性疼痛进行同行评审的研究（以英语出版）。使用行为变化的理论域框架综合了与障碍和推动者相关的确定主题。报告干预措施的研究结果也进行了定性综合。
结果：14项研究报告了障碍和推动者，八个与锻炼依从性有关。障碍和推动者常见的主题包括：感知的治疗效果，与物理治疗师的关系，锻炼负担,以及患者对运动的理解。其他障碍包括害怕运动，支离破碎的护理，和成本。十项研究探讨了干预措施，其中9项旨在提高锻炼依从性。其中,4项技术干预随机对照试验的证据表明,与对照组相比,干预组的运动依从性有所改善.
结论：慢性疼痛患者经历HVP障碍，包括：他们的信仰，他们与物理治疗师互动的性质，感知治疗功效，和成本。促成者包括:与他们的物理治疗师融洽，可实现的练习，和无缝的成本效益护理。基于技术的干预措施已证明在提高锻炼依从性方面有效。我们的发现表明，寻求加强HVP实施的干预措施需要考虑慢性疼痛患者所经历的多因素障碍。
方法：我们系统地搜索了APAPsycInfo，Embase,CINAHL,Medline,Scopus,和PEDro数据库，用于对成人慢性疼痛进行同行评审的研究（以英语出版）。使用行为变化的理论域框架综合了与障碍和推动者相关的确定主题。报告干预措施的研究结果也进行了定性综合。
结果：14项研究报告了障碍和推动者，八个与锻炼依从性有关。障碍和推动者常见的主题包括：感知的治疗效果，与物理治疗师的关系，锻炼负担,以及患者对运动的理解。其他障碍包括害怕运动，支离破碎的护理，和成本。十项研究探讨了干预措施，其中9项旨在提高锻炼依从性。其中,4项技术干预随机对照试验的证据表明,与对照组相比,干预组的运动依从性有所改善.
结论：慢性疼痛患者经历HVP障碍，包括：他们的信仰，他们与物理治疗师互动的性质，感知治疗功效，和成本。促成者包括:与他们的物理治疗师融洽，可实现的练习，和无缝的成本效益护理。基于技术的干预措施已证明在提高锻炼依从性方面有效。我们的发现表明，寻求加强HVP实施的干预措施需要考虑慢性疼痛患者所经历的多因素障碍。
