281: Identifying physiotherapists positioned to support work retention in musculoskeletal pain

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Physiotherapy (e.g. exercise, rehab)

Background and Aims: Musculoskeletal pain is a leading cause of work disability and early labour market exit. Evidence supports work retention as net-beneficial[3], yet primary care practitioners tend to address this passively, awaiting patient initiation[5]. Physiotherapists have comparatively longer consultation windows than other healthcare professionals and are well-placed to adopt a proactive role[7]. This study aimed to identify competency-relevant physiotherapist profiles and explore conditions supporting proactive work retention practice.

Methods: A sequential mixed-methods design was used. Expert interviews (n=3; clinic owners/managers with >35 physiotherapists) identified key practitioner qualities associated with a work retention-oriented practice. These qualities informed a cross-sectional survey of physiotherapists (n=247), including validated instruments (PPOS[1], Back-PAQ[8], WAI-SRT[4], RIPLS-derived patient-centredness items[6]) as well as consultation time, scheduling flexibility, and communication training. Then, latent class analysis (LCA) was applied to identify practitioner profiles. A Future Workshop with physiotherapists (forthcoming) will evaluate cluster interpretability and co-develop implementation strategies[2].

Results: Participants report focussing on work(90%) and recommended RTW (72%), and rated their own competence high or very high (81%).
Experts considered the following qualities essential: adopting a person-centred and evidence-based approach, focussing on establishing a therapeutic alliance and active use of communication as a therapeutic tool. The experts also agreed on structural factors that could facilitate a work-focused practice.
The LCA, using seven pre-identified predictors, yielded a best-fitting 3-class solution (Bootstrapped p = .60, class independence BVR = 1.57; entropy R²=0.67). Class 1 (52%) was characterised by high patient-centredness, strong working alliance, positive back pain beliefs, long initial consultation times, high scheduling flexibility, and communication training indicative of a structurally supported, proactive profile. Class 2 (27%) shared comparable attitudinal features but was distinguished by short consultation times and low flexibility, suggesting structural constraints on proactive practice. Class 3 (22%) showed low patient-centredness, weaker working alliance, and less helpful back pain beliefs.

Conclusions: Physiotherapists self-report a high degree of attention towards work-related topics. Three distinct physiotherapist profiles were identified, differentiated by both attitudinal orientation and structural working conditions. Supporting proactive work retention in community physiotherapy likely requires interventions targeting both individual attitudes and organisational structures. Future workshop findings will further inform targeted implementation strategies.

References: [1] Bejarano G, Csiernik B, Young JJ, Stuber K, Zadro JR. Healthcare students’ attitudes towards patient centred care: a systematic review with meta-analysis. BMC Med Educ 2022;22:324.
[2] Djurtoft C, Sørensen K, Odgaard C, Hoegh M, Rathleff MS, Johansen SK. Supporting Self-management Through eHealth - Exploring the Needs, Challenges and Solutions in General Practice: A Qualitative and Participatory Design Study. 2024. doi:10.1101/2024.05.17.24307464.
[3] Gerdes R, Jackson TD, Roberts R, Lytvyak E, Deibert D, Dennett L, Burton AK, Gross DP, Els C, Doroshenko A, Hagtvedt R, Straube S. Associations Between Employment and Health Outcomes: A Systematic Review of Reviews. J Occup Rehabil 2026. doi:10.1007/s10926-025-10357-5.
[4] Hansen KE, Kesmodel US, Baldursson EB, Schultz R, Forman A. The influence of endometriosis-related symptoms on work life and work ability: a study of Danish endometriosis patients in employment. European Journal of Obstetrics & Gynecology and Reproductive Biology 2013;169:331–339.
[5] Møller A, Bond CB, Andersen LN, Hartvigsen J, Stochkendahl MJ. General practitioners’ stay-at-work practices in patients with musculoskeletal disorders: using Intervention Mapping to develop a training program. Scandinavian Journal of Primary Health Care 2023;41:445–456.
[6] Nørgaard B, Draborg E, Sørensen J. Adaptation and reliability of the Readiness for Inter professional Learning Scale in a Danish student and health professional setting. BMC Med Educ 2016;16:60.
[7] Pedersen, SK, Platzer, OJ, Rathleff, MS, Hoegh M. ‘What scientific evidence supports this?’ how do physiotherapists in private practice use evidence-based practice and what are the main challenges? A convergent parallel mixed-methods study. European Journal of Physiotherapy 2024;26:201–210.
[8] Scott Nicolaysen M, Boye Larsen D, Skuli Palsson T. The Danish version for the Back Pain Attitudes Questionnaire - Translation and cross-cultural adaptation. Musculoskeletal Science and Practice 2021;52:102348.

Presenting Author: Morten Hoegh
Submitting Author: Morten Hoegh

Senior Author: Morten Hoegh

IASP 2026 Global Year theme of Neuropathic Pain: No

• Stephen Gunaratnam Klavsen: MSc - Aalborg University
• Roland Reezigt: PhD - Hanze University of Applied Sciences
• Rikke Baekgaard Nielsen: MSc - Aalborg Unversity