Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis

Abstract

Objective: Lack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation. Methods: Ten databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes. Results: Eleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes. Conclusion: This study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research. Impact: This proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes.