Experiências, percepções e crenças de fisioterapeutas sobre manejo fisioterapêutico em pacientes com fibromialgia: estudo qualitativo por análise do conteúdo de entrevistas

Abstract

Introduction: Fibromyalgia (FM) is a chronic syndrome characterized by widespread pain without any identifiable causal disease. Surprisingly, the role of the physiotherapist in managing the disease is not comprehensively described, leaving a gap in the available literature to describe relevant issues regarding physiotherapeutic management. The general objective is to evaluate experiences, perceptions and beliefs about the role of physiotherapists in the physiotherapeutic approach to FM. Methods: This is a qualitative study based on the Consolidated Criteria for Reporting Qualitative Studies (COREQ) and Standards for Reporting Qualitative Research (SRQR). The interviews were carried out by a physiotherapist following a structured script with 42 items via web conference lasting 60 minutes, with the participation of the interviewer, volunteer and observer. To increase the reliability of the interview, we perform consultancy analysis, pilot testing and audit trail. Data analysis and coding were carried out using the MAXQDA® software version 2022, containing the data and investigator triangulation method. Results: 27 physiotherapists from different regions of Brazil were evaluated. Data analysis resulted in n=28 subcategories. Difficulties were identified in assessing patients involving factors such as pain behavior, as well as concerns about diagnostic inaccuracy. Perceptions about the physiotherapeutic approach identified difficulties in the curricular basis, inadequate management of chronic pain and vision about patients' knowledge, emphasizing analgesic resources as a therapeutic purpose as patients seek. Difficulties with previous experiences in other services and with treatment adherence were reported. Physiotherapists use evidence-based practice, international classification of functionality and biopsychosocial model as facilitating approaches, however, professional training is a limitation of use. The reception of patients with FM is seen as low and health care is perceived as having professional and structural barriers in the system. Conclusion: The decision-making and performance of physiotherapists in the clinical management of fibromyalgia can be influenced by the professional's training and qualification level, as well as their experiences, perceptions and opinions about the disease. They report that factors related to the clinical condition, skills and competencies of the professional influence the adherence and evolution of physiotherapeutic treatment, as well as the relationship with the patient and health professionals. They report that factors related to the clinical condition, skills and competencies of the professional influence the adherence and evolution of physiotherapeutic treatment, as well as the relationship with the patient and health professionals.