Objective To identify, and synthesize patient-related barriers and/or enablers to the implementation of high-value physiotherapy (HVP) for chronic pain. Further, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, and their efficacy. Methods We systematically searched APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) regarding adults with chronic pain. Identified themes relating to barriers and enablers were synthesized using the Theoretical Domains Framework of behavior change. Outcomes from studies reporting on interventions were also qualitatively synthesized. Results Fourteen studies reported on barriers and enablers, eight related to exercise adherence. Themes common to barriers and enablers included: perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and patient’s understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, nine of which aimed to improve exercise adherence. Of these, evidence from four randomized-controlled trials of technology-based interventions demonstrated improved exercise adherence amongst interventions groups compared to controls. Conclusion 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.

中文翻译：

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实施高价值慢性疼痛物理治疗的患者相关障碍和推动因素：系统评价

目的 识别并综合对慢性疼痛实施高价值物理治疗 (HVP) 的患者相关障碍和/或促成因素。此外，回顾哪些与患者相关的干预措施被用于促进 HVP 治疗慢性疼痛及其疗效。方法 我们系统地检索了 APA PsycInfo、Embase、CINAHL、Medline、Scopus 和 PEDro 数据库，以查找有关成人慢性疼痛的同行评审研究（以英文发表）。使用行为改变的理论领域框架综合了与障碍和推动因素相关的已确定主题。报告干预措施的研究结果也得到了定性综合。结果 十四项研究报告了障碍和促进因素，其中八项与运动坚持相关。障碍和促成因素的共同主题包括：治疗效果的感知、与物理治疗师的相互关系、运动负担以及患者对运动益处的理解。其他障碍包括对行动的恐惧、分散的护理和费用。十项研究探索了干预措施，其中九项旨在提高运动依从性。其中，来自四项基于技术的干预措施的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提高。结论 慢性疼痛患者在 HVP 方面遇到障碍，包括：他们的信念、他们与物理治疗师互动的性质、感知的治疗效果和费用。促成因素包括：与物理治疗师的融洽关系、可实现的锻炼以及无缝且具有成本效益的护理。基于技术的干预措施已证明可以有效提高运动依从性。我们的研究结果表明，寻求加强 HVP 实施的干预措施需要考虑慢性疼痛患者经历的多因素障碍。