Barriers and enablers to providing biopsychosocial management to patients with chronic low back pain in a multidisciplinary rehabilitation setting

PURPOSE: To identify barriers and enablers for allied health professionals to provide biopsychosocial (BPS) management to patients with chronic low back pain (cLBP) within a multidisciplinary rehabilitation setting. MATERIALS AND METHODS: This qualitative study conducted 18 semi-structured interviews, guided by the Theoretical Domains Framework, within an Australian metropolitan rehabilitation hospital. Physiotherapists, exercise physiologists, occupational therapists, and assistants were recruited via purposive and snowball sampling. Interviews were audio-recorded, transcribed, and analysed using a content analysis (deductive and inductive) approach. RESULTS: Four themes emerged: (1) allied health professionals' knowledge, confidence, and role in the BPS approach, (2) how the multidisciplinary rehabilitation team impacts BPS delivery, (3) workplace environment and system-level factors impact on BPS practice, and (4) patient and social influences are central to BPS success. Enablers included professionals' knowledge, team collaboration, and the rehabilitation environment. Barriers included low confidence managing psychosocial factors, limited time, and a busy environment. Enhancing education, providing more consultation time and a reduced-stimulation environment were suggested to improve BPS management. CONCLUSIONS: Effective BPS management of cLBP is shaped by professional, team, system, and social factors. The multidisciplinary team, patient expectations and environment-often reported as barriers in primary care, were perceived as enablers within multidisciplinary rehabilitation.Implications for rehabilitationThe study was conducted in a large, multidisciplinary rehabilitation hospital where patients with chronic low back pain (cLBP) were treated by allied health professionals within multiple open gymnasium and treatment environments.The presence of a multidisciplinary team and open treatment environments facilitated communication and informal learning which were seen as enablers of providing biopsychosocial (BPS) management.The treatment environments supported patient socialisation and helped align expectations towards active management but were also barriers when busy and overstimulating.Professionals can have appropriate knowledge of the BPS approach but need support to build their confidence in implementation with patients with cLBP.Addressing barriers such as time and busy environments may improve the management of patients with cLBP in a multidisciplinary rehabilitation setting.