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People suffering with musculoskeletal conditions, including back pain, must play a far greater role in self-care, conclude the authors of a new commentary published in Chiropracticand Manual Therapies[1]

Julie Fritz and Alice Kongsted, recognized global experts in low back pain, state that interactions with health care systems often exacerbate rather than alleviate concerns, suggesting that a shift away from clinician-led management may be required The authors point to contextual factors in healthcare as being highly relevant, consistent with the biopsychosocial model of care and a focus on patient centeredness.

As well as the structural, biomechanical role that exercise and manual therapies have on patients, their contribution to promoting patient self-efficacy and positive expectancy are also proposed as being of importance. The manner of delivery of interventions, say Fritz and Kongsted, may be as important as the interventions themselves Communication, the setting of expectations and provision of feedback all serve to build the working alliance with patients

The paper calls for more

Adoption of a biopsychosocial model and empowering patientsto take responsibilityfor their condition can playa significant rolein modern management of spinal pain and disability evidence as to how the patient-provider alliance should be built and sustained, with future research incorporating the perspectives of both patients and providers Coping strategies and patient empowerment strategies are recognized but not currently well described in the literature The authors warn that the challenges required in such a shift should not be under-estimated.

Reference: [1] Fritz JM, Kongsted A. A new paradigm for musculoskeletal pain care: moving beyond structural impairments Conclusion of a chiropractic and manual therapies thematic series Chiropr Man Therap 2023 Jun 1;31(1):15