Table 4.

Characteristics of included studies of implementation of a behavioral medicine approach in physiotherapists' clinical practice for patients with musculoskeletal pain.

Reference, country	Aim	Target group for implementation and context	Patient sample for intervention	Implemented intervention on patients	Implemented control intervention on patients	Results of patient outcomes
Fritz et al.,23 Sweden	To explore how an intervention to facilitate the implementation of a behavioural medicine approach in primary health care improves the health outcomes of patients with persistent musculoskeletal pain.	Physiotherapists in primary health care, n = 24.	Patients with chronic musculoskeletal pain (>4 wk), aged 18–65 y, n = 155.	Identifying and managing cognitive, emotional, social, physical, and lifestyle barriers of importance for the target behaviour change. Behaviour change techniques: patient's goal-setting, self-monitoring of behaviour, the setting of graded tasks, problem solving, feedback on the patient's behaviours, and maintenance strategies.	Standard care.	No differences between the experimental and control groups over time (pre, post, 6, 12 m) regarding pain-related disability, pain intensity, and self-rated health. Significant improvements over time in both the experimental and control groups and the effect sizes were medium to large. The percentage of patients on sick leave decreased significantly in the experimental group but not in the control group.
Overmeer et al.,42 Sweden	The aim of this study was to investigate the effects on patients' outcomes of an 8-d university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment for patients with musculoskeletal pain compared to physiotherapist on a waiting list for the same course.	Physiotherapists in an outpatient and inpatient setting, n = 42	Patients with acute or subacute musculoskeletal pain, aged 18–65 y, n = 229	Treatment according to content of the course: Identify “yellow flags”; behavioral medicine principles and cognitive–behavioral management strategies; physical examination and information to the patient from a biospsychosocial perspective; reassurance; and identify and manage fear avoidance	Standard care.	No significant differences in pain or disability between the groups were found.
Reid et al.,44 USA	Study the effectiveness of a cognitive–behavioral pain self-management (CBPSM) compared with usual care (UC) for older adults receiving home care.	17 home care rehabilitation teams each including at least 15 PTs (totally 255 PTs).	Patients with activity limiting pain, aged >55 y, n = 588	Cognitive behavioral pain self-management: Pain, activity and sleep education, goal setting, relaxation, imagery (as a relaxation technique), pleasant activity scheduling and activity pacing, managing flare-ups (specific techniques), and problem solving regarding sleep. Booklet to reinforce the CBSM, reminders to practice learned techniques between physiotherapy sessions.	Usual care: evaluation of physical and psychological functioning, home environment, need/use of assistive devices, therapy goals by a physician, individualized exercise programs aiming to improve strength, range of motion, balance, coordination, gait, activities of daily life functioning, and reduce fall risk.	CBPSM and UC significantly decreased in disability and all other reported outcomes (pain intensity, ADL limitations, gait speed, depressive symptoms, and pain self-efficacy). No between group over time differences were found in any of the outcomes at 2-mo follow-up.