Physio Perspective Study

Pain is one of the most common, complex and persisting symptoms worldwide. Next to the debilitating impact on the individual, pain also has a social and economic impact. A classification of pain based on duration provides the distinction between acute and chronic pain, with chronic pain described as persistent or recurrent pain for at least 3 months. The chronic pain population consists of patients with a broad variety of medical conditions. In the literature, a discrimination based on the associated condition is often made, with the most frequent distinction between non-cancer and cancer-related pain. Cancer-related pain is a debilitating symptom with a pain prevalence of 39.3% after curative cancer treatment. Within the non-cancer related pain, spinal pain has the highest prevalence and low back pain leads the chart of the years with lived disability.

Despite the different underlying condition, physical activity and exercise are the main part of the best-evidence treatment for chronic pain, both in the population of cancer survivors with chronic pain as well as in a population of chronic low back pain patients.

It is evident that this effectiveness cannot be attained without a long-term engagement towards physical activity and exercise behavior. Unfortunately, patient' adherence towards physical activity is low, which is a problem in most exercise interventions in the population under study. So, despite the benefits of physical activity for chronic pain, low physical activity levels are still reported across the span of these two populations.

Undertaking physical activity is a complex behavior with many aspects that need to be considered. Knowledge from qualitative studies clarify the self-reported barriers and facilitators towards physical activity that patients experience. This reveals similarities between experienced barriers and facilitators in patients from both populations. At a personal level it is seen that barriers on a physical level such as pain and barriers and on a psychological level such as low self-efficacy, are similar. What is also striking is that the health care provider (HCP) also has an important role to play in physical activity and exercise behavior. Uncertainty, a lack of clear information is experienced as a barrier and subsequently the need of supervision and support from an HCP is considered to be a facilitator. Additionally, previous evidence has already shown the influence of beliefs of HCPs on the beliefs of patients .

The experience of the patient shows that the HCP is part of the key in motivating towards exercise behavior. Yet, the current research on physical activity and exercise behavior of patients with chronic pain lacks the perspective of the HCP. It is known that HCPs with a biomedical view prescribe less active treatment strategies and more advice to rest in chronic low back pain patients. However, most research on physical activity prescription behavior stays quite general and therefore, it is not known what exactly they do or don't prescribe. Next to that, it is unclear what the beliefs and attitudes are of the HCPs towards physical activity and exercise in chronic pain management and how that determines this prescription behavior. A group of HCPs who are likely to prescribe and use exercise in their treatment are physiotherapists. In line with research on other HCPs, it remains unclear how physiotherapists actually recommend and organize physical activity for their patients with chronic pain. Additionally, it is not known whether the manner wherein they prescribe physical activity might differ based on their biomedical or biopsychosocial orientation, on their beliefs of the associated condition and on the beliefs on physical activity in relation to chronic pain. This knowledge will help to understand the physical activity and exercise prescription of physiotherapists and clarify how this might influence physical activity levels in the patient population of chronic pain, more specifically chronic low back pain patients and cancer survivors with chronic pain. The inclusion of these two population-groups, both with varied challenges, offers an opportunity to increase the generalizability of these findings across chronic pain conditions and to obtain broad insights into the experiences of people with chronic pain.