Barriers and facilitators to biopsychosocial management of chronic primary pain; an exploration of Canadian athletic therapists’ perspectives
Bibliographic record
Abstract
Background and objectives. One in 5 Canadians experience pain which persists longer than 3 months. The magnitude, duration and impact of that pain is determined not only by biological factors, but psychological, sociocultural and behavioral ones as well. This concept is best understood through the lens of the biopsychosocial model of disease, which is now considered most appropriate for chronic pain management. Given that certified athletic therapists (CAT(C)) in clinical practice frequently are in contact with patients experiencing chronic pain, it is essential that they be well prepared to manage this condition. Previous research has found that other healthcare professionals struggle to address psychosocial factors which influence chronic pain outcomes; athletic therapists have not been included in these studies. In this study, I will use a knowledge translation framework to assess CAT(C)s’ knowledge of current pain physiology and influencing factors, and their attitudes and beliefs regarding the management of chronic primary pain. In addition, I will explore what barriers and facilitators CAT(C)s identify to incorporating a biopsychosocial approach in the management of chronic primary pain. Methods. Forty-four CAT(C)s from six provinces completed the Knowledge and Attitudes of Pain Questionnaire. I then conducted in-depth semi-structured interviews with 10 athletic therapists to further explore barriers and facilitators to the use of a biopsychosocial approach to chronic pain management. The transcribed interviews were analyzed using reflexive thematic analysis and the resulting themes were compared to relevant behaviour change constructs from the Theoretical Domains Framework, which was also used to create the interview guide. Results. We reported the mean scores of KNAP scales; knowledge of pain physiology and influencing factors (81.79%), treatment orientation (63.46%) and the total score (76.30%). We identified six themes and 23 subthemes; themes include therapist beliefs about pain, common approaches to chronic pain management, athletic therapy in the community, training or experience in chronic pain management, communication, and the affective side of treating chronic pain. Conclusion. Athletic therapists face numerous barriers in the management of chronic pain, including knowledge gaps, and further research, training and organizational support is recommended.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.026 | 0.009 |
| Scholarly communication | 0.007 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".