Screening and Referral Practices for Symptoms of Anxiety and Depression in Private Physiotherapy Practices for Chronic Musculoskeletal Pain: A Qualitative Study

Musculoskeletal Care. 2026 Mar;24(1):e70213. doi: 10.1002/msc.70213.

ABSTRACT

BACKGROUND: Chronic musculoskeletal pain often co-occurs with psychological comorbidities such as anxiety and depression; however, little is known about the screening and management practices of physiotherapists in private physiotherapy services. Gaining insight into how physiotherapists navigate the complexities of mental health screening, management, and referral is critical, as the effective integration of these practices has the potential to substantially improve patient outcomes.

OBJECTIVE: This study explores the facilitators and barriers influencing physiotherapists' adoption of screening and referral practices for symptoms of anxiety and depression supporting a more biopsychosocial approach to physiotherapy.

METHODS: Semi-structured interviews were conducted with 18 Belgian physiotherapists working in private settings and analysed using framework analysis to identify themes capturing their approaches to recognising, screening, managing, and referring patients with anxiety and/or depressive symptoms in clinical practice.

RESULTS: Ten interrelated themes were identified. Physiotherapists relied predominantly on informal, intuitive screening rather than structured validated tools. Barriers encompassed limited formal training, unclear professional boundaries, and systemic challenges such as time constraints and inconsistent referral pathways. Key facilitators included intrinsic motivation to provide biopsychosocial care, strong therapeutic alliances, and clinical intuition. Many physiotherapists reported emotional burden when managing anxiety and/or depressive symptoms without adequate support.

CONCLUSION: Physiotherapists acknowledge the importance of addressing co-occurring anxiety and/or depressive symptoms in chronic musculoskeletal pain management but face personal, patient-related and systemic barriers. Enhancing training, embedding validated screening tools, and improving interprofessional collaboration are critical for advancing mental health practices within private physiotherapy settings.

PMID:41881815 | DOI:10.1002/msc.70213