Journal article
More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain—a qualitative study
BMJ Open, Vol.16(6), pp.1-12
2026
PMID: 42373186
Abstract
Objective: To explore how physiotherapists and osteopaths who use manual therapy in New Zealand conceptualise, reason about and manage upper back pain (UBP), a clinically relevant but inconsistently defined musculoskeletal presentation.
Design: Qualitative study using semistructured interviews and reflexive thematic analysis. The study was conducted and reported in accordance with best-practice qualitative guidance, including Consolidated Criteria for Reporting Qualitative Studies.
Setting: Private and public musculoskeletal practice settings across New Zealand.
Participants: 17 physiotherapists and osteopaths with a minimum of 2 years’ clinical experience, recruited through national professional networks.
Results: Data analysis resulted in the generation of four themes: (1) a fuzzy construct; (2) more than biomechanics; (3) hands-on leads to facilitate active care and (4) towards patient-centred care. The analysis revealed an interconnected progression across the key themes, which reflects not only the evolution of clinical practice but also the integration of contemporary evidence, highlighting a shift from intervention-focused to relationship-focused and collaborative care.
Conclusion: Clinicians conceptualise UBP as a complex and multifaceted condition, increasingly managed through biopsychosocial reasoning, self-management strategies and patient-centred care. However, definitional ambiguity between UBP and thoracic spine pain, combined with profession-specific patterns, demonstrates the need for clearer terminology and greater interprofessional alignment. Further research incorporating patient perspectives is required to inform guideline development and promote coherent, evidence-informed care for UBP.
Details
- Title
- More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain—a qualitative study
- Authors
- Kesava Kovanur Sampath (Corresponding Author) - RMIT UniversityPrashant Mishra - Waikato Institute of TechnologyTep Mills - Waikato Institute of TechnologyGary Fryer - Victoria UniversityRebecca Mowat - Auckland University of TechnologyOliver P Thomson - Health Sciences UniversityJerry Draper-Rodi - Health Sciences UniversityBrett Vaughan - The University of Melbourne
- Publication details
- BMJ Open, Vol.16(6), pp.1-12
- Publisher
- BMJ Group
- Date published
- 2026
- DOI
- 10.1136/bmjopen-2025-113886
- ISSN
- 2044-6055
- PMID
- 42373186
- Copyright note
- © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
- Data Availability
- Data are available upon reasonable request. De-identified data that support the findings of this study are available from the corresponding author upon reasonable request. Requests will be considered in accordance with participant consent, ethical requirements and the need to protect participant confidentiality.
- Organisation Unit
- Healthy Ageing Research Cluster; School of Health - Nursing
- Language
- English
- Record Identifier
- 991243698402621
- Output Type
- Journal article
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