Intervention challenges experienced in physiotherapy and occupational therapy with workers' pain and disability representations: a mixed methods study.

purposeThe study objectives were to (1) identify prevalent unhelpful worker-held pain and disability representations and (2) explore clinicians' intervention challenges with these representations.

methodsAn explanatory sequential mixed methods design was used (quan → QUAL). Secondary analysis of a database was performed first. The database included the scores obtained by 297 sick-listed workers with musculoskeletal disorders on the Revised Illness Perception Questionnaire for Work Disability. Descriptive statistics identified the most prevalent unhelpful worker-held representations. Quantitative results were used to develop an interview guide. Semi-structured interviews explored the physiotherapy professionals' (n = 8) and occupational therapists' (n = 6) intervention challenges with workers' pain and disability representations.

resultsThe secondary data analysis showed that perceptions of severe consequences, unpredictable symptoms, and negative emotions were the most prevalent unhelpful worker-held representations. The interviews identified clinicians' key intervention challenges as two specific pain-and-disability representation patterns. The first depicted workers' perceptions of unpredictable and uncontrollable pain, perceptions that generate negative emotions. The clinicians associated this pattern with workers' sense of helplessness. The second pattern involved workers' firm beliefs in a biomedical cause, leading to their perceptions of low levels of treatment and personal pain control. According to clinicians, this pattern led to workers' resistance to active rehabilitation. The clinicians regarded both patterns as hindering worker engagement in rehabilitation treatment.

conclusionThe clinicians' key intervention challenges were two pain-and-disability representation patterns, which included or not, prevalent unhelpful worker-held representations. The results underscore the need to develop a transdisciplinary intervention for work rehabilitation clinicians that takes pain and disability representations into account.