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Abstract

Chronic musculoskeletal pain (CMP) and chronic widespread pain (CWP) are major contributors to disability worldwide, characterized by complex biopsychosocial interactions. Psychologically-informed physiotherapy (PiP) has emerged as an innovative approach integrating physical, behavioral, and psychological strategies within standard physiotherapy practice. While evidence supports PiP effectiveness for pain, function, and psychological outcomes, patient perspectives regarding these interventions remain underexplored, and no comprehensive synthesis has yet examined how individuals with CMP and CWP perceive and experience PiP interventions. This qualitative evidence synthesis (QES) aims to identify, appraise, and synthesize qualitative studies exploring patient perspectives on PiP interventions for adults living with CMP and CWP. The protocol and the QES follow the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and preferred items for reporting systematic reviews and meta-analyses for protocols (PRISMA-P) guidelines, respectively. The search will cover Medline (Ovid), CINAHL (EBSCO), Embase, PsycINFO (Ovid), and Web of Science Core Collection from March 2011 to 6 August 2025, supplemented by gray literature and citation tracking searches. Eligible studies must include adults with CMP or CWP who have received PiP interventions and report qualitative data on patient perspectives. Two reviewers will independently screen studies, extract data, and assess methodological quality using the Cochrane qualitative Methodological Limitations Tool. Thematic synthesis will be employed to analyze patient perspectives. Confidence in the findings will be assessed using the GRADE-CERQual approach. This QES is anticipated to identify key themes reflecting diverse patient perspectives on PiP implementation, providing comprehensive insights into patients’ needs and preferences regarding these interventions. The findings will inform evidence-based development and delivery of PiP interventions, supporting improvements in clinical outcomes and physiotherapists training while optimizing patient-centred chronic pain management.

Keywords

chronic musculoskeletal pain chronic widespread pain perspectives psychologically-informed physiotherapy qualitative evidence synthesis

Background

Pain is the most common reason individuals seek health care, with osteoarthritis and back pain ranking among the top ten (Mäntyselkä et al., 2001; St Sauver et al., 2013). Chronic pain, defined as pain persisting or recurring for more than 3 months, is divided by the International Classification of Diseases (ICD-11) in different categories based on the presence/absence of specific conditions (e.g., cancer-related pain), the affected tissue or body area (e.g., neuropathic, musculoskeletal), and if the underlying mechanisms may be identified (e.g. primary [not identifiable], secondary [symptoms of an identifiable cause]) (Treede et al., 2015, 2019).

Among these classifications, chronic musculoskeletal pain (CMP) conditions, including low back pain, osteoarthritis, and neck pain, are major contributors to years lived with disability (YLDs), with low back pain being the leading contributor worldwide (GBD 2021 Diseases and Injuries Collaborators, 2024; Rice et al., 2016). Chronic widespread pain (CWP) – which is diffuse musculoskeletal pain– affects approximately one in ten individuals within the general population (Andrews et al., 2018). Evidence suggests that a subset of individuals with regional pain (e.g., back pain, neck pain, osteoarthritis) may progress to widespread pain (Kindler et al., 2010). Both CMP and CWP are multifaceted conditions characterized by complex interactions of biological, psychological, and social factors contributing to development and persistence of pain (Dunn et al., 2024; Edwards et al., 2016; Meints & Edwards, 2018). Several modifiable biopsychosocial factors have been consistently identified as prognostic factors and treatment targets (Edwards et al., 2016). Key modifiable factors, including fear of movement, catastrophic thinking about pain, anxiety, depression, poor coping strategies, lack of social support, and limitations in activities (Edwards et al., 2016), support the adoption of a model of treatment that targets physical and psychological aspects of pain.

Physiotherapy is one of the most widely used non-pharmacological approaches for chronic pain management (Chang et al., 2015). Modern non-pharmacological interventions that integrate physical and psychological approaches (Foster et al., 2018), or that target behaviors and cognitive processes underlying the pain experience (Wang et al., 2025), hold promise for providing relief to people living with chronic pain. Within this context, psychologically-informed physiotherapy (PiP) has emerged as an innovative approach that integrates physical, behavioral, and psychological strategies within standard physiotherapy practice (Ballengee et al., 2021; Keefe et al., 2018; Main & George, 2011). PiP is a specialized approach that identifies and addresses modifiable psychosocial factors of poor prognosis that have been demonstrated to interfere with recovery while remaining within the physiotherapist’s field of expertise (Keefe et al., 2018). PiP aims to identify and address emotional and cognitive factors—such as fear, beliefs, and coping strategies—that influence pain perception, recovery trajectories, and engagement in rehabilitation (Ballengee et al., 2021). Growing evidence supports the effectiveness of PiP interventions for pain, function and psychological outcomes in various chronic pain conditions. Examples include physical therapy informed by acceptance and commitment therapy (Godfrey et al., 2020); cognitive-behavioral-based physical therapy (Bennell et al., 2016; Thompson et al., 2016; Vibe Fersum et al., 2019); psychomotor therapy combined with exercise (Ingwersen et al., 2019); and behavioural graded activity (Bello et al., 2015). While physiotherapists reported positive attitudes and beliefs towards using behavioral and psychological interventions in their practice, they also identified substantial barriers such as the need for supplementary training that prevent effective incorporation of these techniques (Driver et al., 2017).

With the increasing shift toward PiP approach in physiotherapy practice, it is vital to explore how this approach is perceived and experienced by patients. Although a growing body of primary research examined patient perspectives on various PiP approaches across various CMP and CWP conditions (Aymerich et al., 2022; Bee et al., 2016; Bunzli et al., 2016; Cederbom et al., 2020; Coronado et al., 2022; Wilson et al., 2017), no synthesis has been conducted to identify overarching themes and concepts. A better understanding of the needs, preferences, and values of individuals living with chronic pain in relation to PiP is crucial for delivering high-quality, patient-centred care and for facilitating shared decision-making in chronic pain management (Gervais-Hupé et al., 2024; Slade et al., 2014). Although multiple healthcare professionals may provide psychologically-informed care, the current synthesis focuses solely on patient perspectives regarding such practice when provided by physiotherapists. Therefore, we formulated the following review question: How do patients living with CMP and CWP perceive and experience PiP interventions?

Objective

This review aims to identify, appraise, and synthesize qualitative studies exploring patient perspectives regarding PiP interventions for adults living with CMP and CWP.

Methods

Study Design

The qualitative evidence synthesis (QES) will adhere to the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) reporting guidelines (Tong et al., 2012). This protocol adheres to the PRISMA-P (preferred items for reporting systematic reviews and meta-analyses for protocols) 2015 checklist (Moher et al., 2015) (Appendix 1) and has been registered on the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/6YRQU). All data associated with this work will be available in an online repository.

Eligibility Criteria

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) tool (Amir-Behghadami, 2021; Cooke et al., 2012) framework will be used to define the study question and to guide study eligibility.

Sample

Eligible studies must have recruited adult participants (18 years or older) of any sex, gender or race, diagnosed with CMP or CWP. CMP may be primary or secondary. The ICD-11 defines chronic primary musculoskeletal pain as chronic pain located in the muscles, bones, joints, or tendons that is characterized by significant emotional distress (i.e., anxiety, anger, frustration, and depressed mood) or functional disability (interference in activities of daily life and participation in social roles) and the symptoms cannot be attributed directly to a known disease or damage process (Nicholas et al., 2019). Chronic secondary musculoskeletal pain is chronic musculoskeletal pain that arises from a known disease and commonly results from: (i) persistent local or systemic inflammatory diseases caused by crystal deposition, infection, autoimmune and autoinflammatory disorders; (ii) local musculoskeletal structural changes (e.g., osteoarthritis, spondylosis, and musculoskeletal injury); and (iii) musculoskeletal problems caused by neurological diseases (e.g., Parkinson’s disease, multiple sclerosis, and peripheral neurologic disease) (Perrot et al., 2019). Eligible chronic musculoskeletal conditions will include, but are not limited to, low back pain, osteoarthritis, neck pain, tendinopathy and other musculoskeletal pain conditions. CWP (e.g., fibromyalgia) is defined as diffuse musculoskeletal pain in at least four of five body regions and in at least three or more body quadrants and axial skeleton (Butler et al., 2016). Studies in which chronic pain is due to serious pathology (e.g., infection, cauda equina syndrome, tumor) or other pain categories (e.g. neuropathic, cancer-related, postsurgical) will be excluded.

Phenomenon of Interest

Studies that delivered PiP to patients with CMP or CWP will be included. PiP is a multimodal pain rehabilitation approach that combines traditional physiotherapy treatments (e.g., manual therapy or exercise) with cognitive-behavioral therapies (e.g., pain coping skills or progressive relaxation) (Ballengee et al., 2021). An intervention will be considered PiP if (i) it is delivered by a physiotherapist (ii) it includes usual physiotherapy (e.g. exercises, manual therapy, advices), and (iii) it incorporates at least one of the following PiP components: patient-centered communication (e.g., motivational interviewing, goal setting, shared decision making) (Ballengee et al., 2021; Beneciuk et al., 2019); pain coping skills training (e.g., deep breathing, progressive muscle relaxation, activity pacing education, mindfulness, pleasant activity scheduling, problem solving, identifying and challenging negative thoughts, developing coping thoughts, pleasant imagery, distraction, replacing cognitive distortions) (Ballengee et al., 2021; Beneciuk et al., 2019; Bryant et al., 2014); cognitive-behavioral therapy (education, skill training [e.g., goal setting, activity pacing, relaxation techniques like deep breathing or distraction, and problem solving], and skill application and maintenance in the patient’s daily life) (Coronado et al., 2020; Ehde et al., 2014); acceptance and commitment therapy (e.g., focus shifting, goal setting and modification based on values, mindfulness practices, action planning, support system identification, and skill application) (Godfrey et al., 2020); cognitive functional therapy (O'Sullivan et al., 2018), and activity guidance (e.g., graded exposure, graded activity) (Ariza-Mateos et al., 2019; Ballengee et al., 2021; Beneciuk et al., 2019).

Design and Research Type

We will include qualitative study designs (e.g., ethnography, phenomenology, case studies, grounded theory) that used qualitative methods for both data collection (e.g., focus group discussions, individual interviews, observation, diaries, document analysis, open-ended survey questions) and data analysis (e.g., thematic, framework, grounded theory, narrative, interpretative phenomenological). We will include primary qualitative and mixed-methods research studies. Mixed-methods research that does not allow for the extraction of qualitative data will be excluded. Similarly, studies that collected data through qualitative methods but did not analyse these data using qualitative analysis methods (e.g., open-ended survey questions analysed solely with descriptive statistics) will be excluded. We will consider both published and unpublished studies, including peer-reviewed and non-peer-reviewed sources. However, conference abstracts will be excluded as they are unlikely to provide sufficient qualitative data for synthesis.

Evaluation

Patient perspectives, including experiences, perceptions, expectations, preferences, thoughts, views, or feelings with PiP will be included. Studies will be excluded if patient perspectives cannot be distinguished from those of clinicians or caregivers.

Searching

Electronic databases, including Medline (Ovid), CINAHL (EBSCOhost), Embase, PsycINFO (Ovid), and Web of Science Core Collection, will be searched for studies published from March 2011 to 6 August 2025. The starting date was chosen to capture evidence published since the first publication on psychologically-informed practice (Main & George, 2011). Keywords relating to PiP interventions, chronic musculoskeletal and widespread pain, and qualitative studies were used to develop a full search strategy (Appendix 2). An academic librarian (MG) collaborated in developing the search strategy to ensure comprehensive coverage of relevant terms, as well as to translate and adapt the strategy for each database. In addition, backward and forward citation tracking of included studies (Hirt et al., 2020), and searches of gray literature (Paez, 2017) will be conducted to identify any further relevant studies. Gray literature search will be performed using selected sources relevant to health and social sciences, including OpenGrey (opengrey.eu), Google Scholar (https://scholar.google.com), NICE (National Institute for Health and Care Excellence), EThOS (https://ethosdatabase.org), Grey Literature Report (https://greylit.org), HAL (hal.science), OATD (https://oatd.org), and clinical trial registries such as the WHO International Clinical Trials Registry Platform (who.int/ictrp/en/) and https://ClinicalTrials.gov. For each gray literature source, the first 200 articles will be screened for eligibility. Where necessary, we will contact authors of included studies to clarify published information or to request unpublished data. To ensure methodological rigor and consistency in interpretation, the review will include only studies published in English, French, or Spanish, corresponding to the language proficiency of the review team members. This limitation helps maintain the integrity of the primary findings by minimizing the risks of misinterpretation that can arise when translating between languages in the primary studies (Duden, 2021).

Selection of Studies

All identified records will be imported into Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia) for automatic duplicate removal and screening (McKeown & Mir, 2021) (Figure 1). An initial calibration exercise using 100 citations will be conducted during the title and abstract screening phase to ensure consistency among reviewers. Two authors (IN and PM) will independently screen titles, abstracts, and full texts of potentially eligible studies. If the eligibility of a study is unclear from the title and abstract the full-text article will be assessed. A third reviewer (HMA, JSR or PMD) will be consulted to resolve any discrepancies.

Figure 1.

PRISMA 2020 flow diagram for reporting the study selection process (Page et al., 2021)

Sampling

Study selection and sampling in this QES will be conducted using a transparent and iterative approach, consistent with guidance from the Cochrane-Campbell Handbook for Qualitative Evidence Synthesis (2024). Sampling decisions will be made iteratively as the synthesis evolves, aiming to ensure that the synthesized findings are both trustworthy and conceptually rich. Review authors will begin with a comprehensive search to identify all relevant studies. Following the initial screening, we will assess whether the number of eligible studies is too large for thorough analysis. However, consensus on the optimal number of studies to include in a QES is unlikely due to varying data requirements of different synthesis methods (Campbell et al., 2011). If sampling is needed, RETREAT (Review question, Epistemology, Time/Timeframe, Resources, Expertise, Audience & Purpose, Type of data) considerations (Booth et al., 2018), along with GRADE-CERQual components (Lewin, Bohren, et al., 2018), will be used to inform and transparently justify a sampling strategy that may balance conceptual richness, methodological quality, practical constraints, and relevance. A purposive maximum variation sampling strategy (Ames et al., 2019) may be used to select a subset that maximizes conceptual diversity in patient perspectives regarding PiP interventions. A purposive maximum sampling strategy would use three dimensions of variations that included all studies scoring highly for data richness (Ames et al., 2024), studies where the focus closely resembled the synthesis objective, and the types of PiP interventions. By integrating both comprehensive inclusion and purposive sampling sequentially, this QES may generate findings that are both comprehensive and conceptually robust. All sampling decisions and their rationale will be transparently documented in an audit trail (Porritt et al., 2014).

Data Extraction

Contextual, methodological information, and qualitative findings will be extracted from the included studies (Noyes, Booth, Flemming, et al., 2018). To ensure consistency, a calibration exercise will be conducted on five articles prior to starting the extraction process. Two independent reviewers (IN and PM) will extract data using a standardized Microsoft Excel form specifically designed for this review. In case of any disagreements, a third reviewer (HMA, JSR or PMD) will be consulted to resolve them.

The extraction form will include general study information from each included study: study title, first author, year of publication, country, objective, study design, setting, data collection and analysis methods, author reflexivity, sample characteristics (e.g., number, age, sex, gender), chronic pain characteristics (e.g., pain duration, pain conditions), PiP intervention characteristics. In addition, a specific section will focus on patient perspectives, which represent the core of this review. To capture these perspectives with nuance, we will distinguish between participant data (e.g., verbatim citations or descriptions directly attributed to study participants) and author interpretations (e.g., themes, categories, or conceptual insights developed by the authors). Patient perspectives will be understood broadly, including aspects such as experiences, perceptions, expectations, preferences, thoughts, views, and feelings related to PiP, as well as other perspectives that may emerge from included studies. The extraction will begin with general categories and will be iteratively adapted as necessary during the calibration phase and throughout the extraction process, to ensure that emerging qualitative insights are adequately captured. Clear documentation of any modifications to the extraction form will be maintained throughout the process.

Assessment of Methodological Strengths and Limitations

Methodological strengths and limitations of included studies will be assessed using the Cochrane qualitative Methodological Limitations Tool (CAMELOT). CAMELOT is an evidence-based tool for making an assessment of the methodological strengths and limitations of primary qualitative research studies that are included in a QES (Munthe-Kaas et al., 2024). The tool includes 12 domains, including four meta domains (research aim and question(s), researchers, stakeholders, context) and eight method domains (research approach, ethical considerations, equity, diversity/inclusion considerations, theory, participant recruitment and selection, data collection, analysis and interpretation, and presentation of findings) (Munthe-Kaas et al., 2024). The tool assesses how well a study’s design and conduct address three key aspects: the suitability for the research aims and questions, alignment with researchers and stakeholders involved, and appropriateness for the study context (Munthe-Kaas et al., 2024). Two authors (IN and PM) will independently assess the methodological quality of included studies. An initial calibration phase will be conducted on five studies to ensure consistency in interpretation and application of CAMELOT. If any disagreements arise, a third reviewer (HMA, JSR or PMD) will be consulted to resolve them. Reviewers will identify specific concerns about study methods and will evaluate the fit between the study domains and methods. The overall assessment will be expressed using four levels of concerns regarding methodological limitations, as no or minimal concerns, minor concerns, moderate concerns, or serious concerns (Munthe-Kaas et al., 2024). A pilot assessment will be conducted on five sampled studies to assess the feasibility of using CAMELOT and to ensure the integrity of the assessment process. Studies will not be excluded based on quality, but assessment results will inform the interpretation and confidence in findings (Carroll & Booth, 2015). To ensure transparency, we will provide all documentations to justify our assessment in an online repository.

Data Synthesis

NVivo software (QSR International, Burlington, MA, USA) will be used to facilitate coding and synthesis (Houghton et al., 2017). Two authors (IN and PM or JP) will independently code a subset of studies to establish consistency in the coding approach before proceeding with full synthesis. Based on the RETREAT framework (Booth et al., 2018), we identified thematic synthesis (Thomas & Harden, 2008) as the most suitable approach for this QES (Table 1). Thematic synthesis enables the identification of both recurring patterns and novel insights. This method is particularly effective for handling both ‘thin’ data (descriptive themes) and ‘thicker’ data (in-depth analytic themes) (Thomas & Harden, 2008). The synthesis process will involve three phases, including iterative inductive coding of text, developing themes that describe patients’ perspectives on PiP, and generating analytical themes (Thomas & Harden, 2008). Descriptive theme development will remain close to the primary studies, with codes describing identical concepts being merged and codes expressing similar concepts grouped together. Reviewers will systematically examine similarities and differences between codes to organize them into a hierarchical tree structure. Analytical theme development will then generate new interpretive constructs, explanations, and hypotheses that extend beyond the original findings (Thomas & Harden, 2008). Theme generation will be stopped when new studies no longer provide novel insights relevant to the research question (Rohwer et al., 2021).

Table 1.

Selection of the Most Appropriate QES Method Using RETREAT Framework

RETREAT criterion	Justification for selecting thematic synthesis
Review question	This review addresses a descriptive research question that aims to identify and synthesize patient perspectives on PiP interventions. Thematic synthesis aligns well with this exploratory objective, as it is specifically designed to identify recurring and novel patient experience themes
Epistemology	Thematic synthesis aligns with a pragmatic epistemology that values descriptive and interpretive summary of qualitative data without strong reliance on theoretical frameworks, providing flexibility in handling diverse qualitative studies
Time/timeframe	Thematic synthesis is adaptable and feasible within typical systematic review timelines, allowing iterative coding and theme development without excessive time demands compared to more complex interpretive methods
Resources	Thematic synthesis requires moderate resources and can be conducted with available personnel and qualitative data analysis software (e.g., NVivo)
Expertise	Our review team collectively holds expertise in primary qualitative research methods thematic analysis, systematic review methodologies, or clinical and research knowledge in chronic pain management and PiP interventions. Thematic synthesis, as selected for this review, aligns well with our team’s methodological expertise, without requiring advanced theoretical or interpretive expertise that characterize more complex synthesis approaches such as meta-ethnography
Audience and purpose	Thematic synthesis produces findings that directly inform practitioners, policymakers, academics, and designers of PiP interventions by producing actionable, clear insights on patient perspectives regarding PiP, thereby matching audience needs for practical guidance and evidence-based understanding
Type(s) of data	Thematic synthesis is flexible to handle both “thin” (brief/sparse) and “thick” (rich, detailed) qualitative data across a range of study designs, making it appropriate for synthesizing data ranging from descriptive to moderately analytical interpretive findings

Two independent reviewers (IN and PM) will develop an initial coding framework and identify emerging themes, which will be discussed with research team members to reach consensus. The final synthesis will include overarching themes and subthemes.

Assessing Confidence in the Review Findings

Confidence in the review findings will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research and Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach (Lewin et al., 2015, 2018b). CERQual provides a systematic and transparent framework for assessing confidence in the synthesized qualitative finding, based on consideration of four components, including methodological limitations (H. Munthe-Kaas et al., 2018), coherence (Colvin et al., 2018), adequacy of data (Glenton et al., 2018), and relevance (Noyes, Booth, Lewin, et al., 2018). Two review authors (IN and PM) will assess confidence in review findings. Disagreements will be resolved through discussion or consultation with a third author (HMA, JSR or PMD). The overall certainty of evidence of the themes will be interpreted as high confidence (very likely that the review finding is a reasonable representation of the phenomenon of interest), moderate confidence (the review finding is likely to be a reasonable representation of the phenomenon of interest), low confidence (it is possible that the review finding is a reasonable representation of the phenomenon of interest), and very low confidence (it is not clear whether the review finding is a reasonable representation of the phenomenon of interest) (Lewin, Booth, et al., 2018). All findings start as high confidence and will then be graded down if there are important concerns regarding any of the GRADE-CERQual components (Lewin et al., 2015). We will present summaries of the findings and our assessments of confidence in these findings in the summary of qualitative findings in two complementary tables (Lewin et al., 2018). The tables will provide concise summaries of each review finding, showing the overall CERQual confidence assessment. In addition, we will prepare a detailed evidence profile, which will describe the judgments for each of the four CERQual components, explain the overall confidence rating, and list the studies that contributed data.

Reflexivity

Reflexivity refers to the process by which researchers critically examine their own characteristics, such as, beliefs, values, knowledge, experiences, professional background, and potential biases, and consider how these factors may influence every stage of the research process, from study design to data analysis and synthesis (Berger, 2013; Dodgson, 2019). In qualitative physiotherapy research, reflexivity is recognized as a mean to enhance objectivity by making researcher biases explicit (Barradell & Peseta, 2025). Reflexivity will be an integral component of this qualitative evidence synthesis, ensuring transparency and rigor in the interpretation of findings.

To ensure reflexivity throughout the review, the team members will hold regular consensus meetings to discuss methodological decisions and emerging findings, while critically reflecting on individual assumptions or preconceptions that may influence interpretation. The research team consists of an academic librarian (MG), five physiotherapists (HMA, JSR, IN, PM, JP), and a social worker (PMD), each possessing clinical and/or research experience in chronic pain management and/or PiP interventions for chronic pain and/or expertise in qualitative research. Additionally, team members come with diverse geographical and healthcare system perspectives from Canada, Europe, and Africa, which may enhance cross-cultural interpretation of findings from different contexts. This iterative reflexive approach aims to make the researchers’ positions explicit while ensuring that interpretations remain grounded in the data, thereby enhancing the credibility and trustworthiness of the synthesis (Dodgson, 2019; Sibbald et al., 2025).

Discussion

The study described in this protocol of qualitative evidence synthesis aims to explore how adults with CMP and CWP perceive and experience PiP. Findings from this synthesis are expected to identify key themes reflecting diverse patient perspectives related to the implementation of PiP interventions. By synthesizing patient perspectives from diverse PiP interventions, this QES may generate insights that are likely to provide a comprehensive understanding of patients’ needs, preferences, values, and expectations related to PiP interventions. This knowledge is crucial for informing clinicians, researchers, and educators in developing and implementing PiP interventions that align with pain management recommendations (e.g., patient-centred model of care, shared decision-making). Previous research suggests that integrating patient voices into care pathway can improve clinical outcomes and increase patient engagement (Cassidy et al., 2024). Given that PiP techniques vary from clinician-to-clinician, particularly in cognitive-behavioral-based physical therapy (Coronado et al., 2020), findings from this study can inform future PiP design initiatives and pedagogical development tailored to the documented preferences and needs of patients with CMP and CWP.

The strength of this review includes the use of a comprehensive methodological approach that represents current best practices in QES. This QES will adhere to established reporting guidelines (PRISMA-P and ENTREQ) and will incorporate the innovative newly developed CAMELOT, which provides a more nuanced evaluation of methodological strengths and limitations compared to traditional quality appraisal approaches. The use of the RETREAT framework (Booth et al., 2018) to justify the selection of thematic synthesis demonstrates methodological transparency and appropriateness of analytical choice. The implementation of GRADE-CERQual for assessing confidence in review findings adds a crucial dimension of evidence quality evaluation that has been increasingly recognized as essential for QES.

This protocol addresses several key methodological challenges inherent in synthesizing patient perspectives. The quality and depth of patient perspectives may vary significantly across included studies, potentially limiting the richness of synthesized findings. The use of thematic synthesis allows for both descriptive and analytical theme development while maintaining conceptual richness (Thomas & Harden, 2008). Additionally, the flexible and iterative sampling strategy informed by RETREAT considerations (Booth et al., 2018) and GRADE-CERQual components (Lewin, Bohren, et al., 2018) allows the synthesis to adapt to the available evidence while maintaining methodological rigor and transparency.

Conclusion

This paper describes the protocol for a QES that may provide an in-depth understanding of patient perspectives regarding PiP interventions for CMP and CWP. The findings are expected to enhance evidence base for designing and delivering PiP interventions, thereby supporting improvements in clinical outcomes and physiotherapist training.

Supplemental Material

Supplemental material - Patient Perspectives on Psychologically-Informed Physiotherapy Interventions for Chronic Musculoskeletal and Widespread Pain: A Protocol of Qualitative Evidence Synthesis

Supplemental material for Patient Perspectives on Psychologically-Informed Physiotherapy Interventions for Chronic Musculoskeletal and Widespread Pain: A Protocol of Qualitative Evidence Synthesis by Ildephonse Nduwimana, Philippe Meidinger, Jeremy Pouliot, Martine Gagnon, Pascale Marier-Deschenes, Jean-Sébastien Roy and Hugo Massé-Alarie in International Journal of Qualitative Methods

Footnotes

ORCID iDs

Ildephonse Nduwimana

Philippe Meidinger

Pascale Marier-Deschenes

Ethical Considerations

Our study did not require an ethical board approval because it did not directly involve humans or animals.

Author Contributions

Conceptualization: I.N., P.M., M.G., P.M.D., J.S.R. and H.M.A, Methodology: I.N., P.M., P.M.D, J.S.R. and H.M.A., Validation: I.N., P.M., P.M.D, J.S.R and H.M.A., Resources: I.N., P.M., M.G. and H.M.A., Writing – Original Draft: I.N. and P.M., Visualization: I.N., P.M., P.M.D., J.S.R. and H.M.A, Supervision: J.S.R. and H.M.A,, Project Administration: I.N. and H.M.A., Writing – review & editing: I.N., P.M., J.P., P.M.D., J.S.R. and H.M.A., Approved final manuscript: I.N., P.M., J.P., M.G., P.M.D., J.S.R. and H.M.A.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: IN received support from the Programme d’appui salarial pour stage postdoctoral (2025–concours 1) of the Center for Interdisciplinary Research in Rehabilitation and Social Integration. HMA was supported by a Research Scholar award from the Fonds de recherche du Québec – Santé (grant #347401, ).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material is available online.

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