Physiotherapists working with fibromyalgia patients experience numerous difficulties, in part because of poor communication with general practitioners and a lack of pain-targeted professional skills.
Specific training to help them better understand their role in the caring process is needed. This may also help them overcome some of their professional shortcomings and better respond to patient needs with greater competence and less ambivalence.
These findings were reported in the study, “Physiotherapists’ accounts of fibromyalgia: role-uncertainty and professional shortcomings,” published in the journal Disability and Rehabilitation.
Fibromyalgia is a widespread chronic pain disorder that mostly affects women. It is still poorly understood, but several studies have provided evidence that dysfunction of the central and peripheral nervous systems, neurotransmitter imbalance, genetics, and psychiatric disorders could all contribute to its development and severity.
Given the uncertainty about fibromyalgia’s underlying mechanisms, its treatment is mostly focused on pain management. However, there is still no consensus on the best strategies to treat these patients and no guidelines are defined.
To some extent, the success of therapies for fibromyalgia, including complementary medicine, relies on the knowledge that clinicians and other specialized medical practitioners have of the disease.
Israeli researchers evaluated the role of physiotherapy and physiotherapists’ views on the treatment of fibromyalgia.
The team interviewed 20 physiotherapists who had at least two years of professional experience and had an average of 6.5 years of experience providing physiotherapy treatment to fibromyalgia patients. They were all women and were employed in 18 public health services organizations that provided treatment only by physician referral.
Based on their answers, researchers found that “physiotherapists construct fibromyalgia as an uncertain diagnosis and ambiguous illness rooted [in] psychological factors, which challenges them as professionals.”
They reported focusing on helping their patients manage pain, but feeling incompetent if they failed to bring about pain relief. However, this negative situation can also prompt them to develop unorthodox and creative treatment strategies, such as support groups and complementary and alternative medicine (CAM) techniques.
As with many other health workers, physiotherapists also showed some skepticism toward fibromyalgia’s clinical status; some even questioned its reality. Nevertheless, they also reported that they saw fibromyalgia as a problem, given that it does not fit any classical biomedical model.
These findings highlight that physiotherapists have limited tools and experience to overcome the challenges of treating chronic pain.
Given the ambiguity surrounding fibromyalgia, the physiotherapists reported that fibromyalgia treatment was generally incompatible with their traditional professional skills. In many cases, they felt that general practitioners would recommend physiotherapy without a clear clinical rationale for the referral.
From their point of view, fibromyalgia patients often exaggerate their pain symptoms, are passive, and are not committed to following the therapists’ recommendations.
Overall, interviewees clearly believed that physiotherapy had only a minor impact, if any, on pain.
“The findings highlight the necessity to address physiotherapists’ low efficacy in the treatment of fibromyalgia by specific training as part of continuing professional development,” the researchers stated.
Also, “health providers should improve communication between physiotherapists and the general practitioners referring fibromyalgia patients,” they said. This would “enable them to set shared evidence-based treatment goals,” and reduce physiotherapists’ uncertainty and role ambiguity.
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