Physiotherapists’ experiences of persistent pain rehabilitation practice: a qualitative systematic review and meta-synthesis

Introduction Persistent pain is a global health concern, and physiotherapists play a central role in its rehabilitation. Understanding their perspective is essential, as it informs care quality.Objective This systematic review and meta-synthesis identified, critically appraised, and synthesized the available evidence on physiotherapists’ experiences of persistent pain rehabilitation practice.Methods A systematic literature search was conducted, following Joanna Briggs Institute guidelines, across the PubMed, CINAHL, Medic, and Cochrane databases. This review considered studies employing qualitative methods in both data collection and analysis, focused on physiotherapists working in persistent pain rehabilitation, written in English, and with full text available before June 25, 2025. Two independent reviewers screened studies for inclusion and extracted data using a standardized tool. Data synthesis followed a meta-aggregative approach, categorizing findings and synthesizing them into evidence-based conclusions.Results Three synthesized findings were derived from 252 individual findings across 20 qualitative studies: (i) Persistent pain rehabilitation was perceived as a complex process, shaped by structural constraints, emotional demands, and patient resistance to biopsychosocial approaches. (ii) Physiotherapists described navigating a paradigm shift away from a biomedical model toward a more holistic approach, often feeling unprepared and inadequately trained for this evolving role. (iii) Physiotherapists conveyed that professional meaning was found in person-centered care, emphasizing therapeutic relationships and patient empowerment through active self-management. The confidence in the three synthesized findings was rated as low according to the ConQual approach.Conclusions These synthesized findings suggest physiotherapists experience a demanding transition toward holistic pain rehabilitation. While they value therapeutic relationships and patient empowerment, limited training and systemic constraints leave them feeling ill-equipped. This tension between evolving care models and lived clinical realities highlights the need for improved education and structural support to enable physiotherapists to embrace their changing role.