559: Driving Clinical Adoption:A Systems Framework To Translate Biopsychosocial Musculoskeletal Pain Care

Topic: Education, Societal Impact, and Others
Subtopic: Education of pain care

Background and Aims: Clinical practice guidelines consistently advocate a biopsychosocial approach to musculoskeletal pain care, yet provide limited guidance on how to translate it effectively within modern healthcare systems. This research proposes a data-driven systems framework to support the sustainable adoption of biopsychosocial care for musculoskeletal pain, integrating three complementary perspectives:
1. Whole-of-health system perspective: Identifying factors influencing healthcare professionals’ biopsychosocial adoption.
2. Behavioural perspective: Identifying behavioural determinants that can potentially change practice and support implementation of high-value musculoskeletal pain care.
3. Educational perspective: Identifying the educational practices and evidence indicators of biopsychosocial clinical adoption perceived by educators to facilitate clinical translation.

Methods: A three-phased methodologic approach was applied:
1. Qualitative evidence synthesis1: Systematically investigated barriers and enablers influencing primary healthcare professionals’ adoption of a biopsychosocial approach in musculoskeletal pain care.
2. Framework synthesis informed by Behaviour Change Wheel methodology2: Mapped a priori barriers and enablers to identify key behavioural determinants for improving implementation of biopsychosocial pain care.
3. Qualitative interviews3: Conducted semi-structured interviews with 18 experienced physiotherapy pain educators (mean 17.0 (SD 5.7) years teaching experience; range 7-30 years) from across Australia to understand how the biopsychosocial model of pain was taught in undergraduate, postgraduate, and within physiotherapy health workforce training programs.

Results: Factors that influenced healthcare professionals’ adoption of a biopsychosocial approach were reported as a three-perspective framework:
1. Systems perspective: Barriers and enablers reported by healthcare professionals were identified across the micro-level (clinical-level interface); meso-level (service-delivery interface); and macro-level (system interface).
2. Behavioural perspective: A cogwheel model was conceptualised by mapping a priori barriers and enablers onto the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domains Framework, highlighting the behavioural determinants and stakeholder groups that could help facilitate the implementation of biopsychosocial pain care.
3. Educational perspective: A ‘whole-person wheel’ was conceptualised to describe the seven key evidence indicators perceived by educators of biopsychosocial adoption.

Conclusions: A systems framework is presented for translating the biopsychosocial model into musculoskeletal pain care. The framework, firstly, identifies multi-level, interdependent factors across the whole-of-health to inform workforce training. Secondly, it incorporates multi-stakeholder perspectives and behavioural science insights to strengthen pain education training. Thirdly, it defines measurable indicators of biopsychosocial adoption to standardise clinical implementation. Together, these perspectives offer a practical, testable and potentially scalable framework to identify educational leverage points, in biopsychosocial adoption for musculoskeletal pain care across health systems. Testing and validation of the framework across jurisdictions and professions is recommended.

References: 1Ng W, Slater H, Starcevich C, Wright A, Mitchell T, Beales D. Barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain: A systematic review and qualitative evidence synthesis. Pain. 2021;162:2154-85.

2Ng W, Beales D, Gucciardi DF, Slater H. Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care. Front Pain Res. 2023;4:1169178.

3Ng, W., Toh, S.H., Blundell, B., Slater, H. Musculoskeletal pain education: Australian educators’ views on teaching clinical translation of a biopsychosocial model. (Under review)

Presenting Author: Wendy Ng
Submitting Author: Wendy Ng

Senior Author: Helen Slater

IASP 2026 Global Year theme of Neuropathic Pain: No

• Darren Beales: PhD - Curtin University
• Tim Mitchell: PhD - Curtin University
• Siao Hui Toh: PhD - KK Women's and Children's Hospital, Singapore Institute of Technology
• Anthony Wright: PhD - Curtin University
• Cobie Starcevich: Master of Clinical Physiotherapy - Curtin University
• Helen Slater: PhD - Curtin University