Table 6 Quotes. Utilizing and integrating diverse skills for holistic care

P2

…’ We have to learn together how to deal with uncertainty, we both don’t know what is going to happen. I use motivational interviewing a lot. Now I’m moving to the fact that pain is reduced when you give less strength.”

P3

…’ To me, it is important to set up some goals, some very little goals, go step by step, grow confidence with them, and break some barriers in their minds. So it is not just about talking. They have to experience that what you have said, it’s correct.’

P4

…’ I take great care of the relational aspect. I explain certain mechanisms to the patient using models that are understandable to him, for example, I try to translate and facilitate some of the patient’s messages, I try for empathic communication and to realise an approach based and centred on the patient and considering his point of view.’

P5

…’ I would try to use open-end questions and affirmations, summaries, trying to use their own words, trying to elicit their fear, trying to understand their expectations. […] I try to explain to them that MRI changes do not predict current pain or the future of back pain’ […]’ A lot of them come from word of mouth, have been to many clinicians before seeing me, so they decided to come and see me because of my approach. […]’ So I do a lot of education because I think it’s quite key if we want people to be autonomous. But I also think that pure education is not very effective with patients. Experience is a really strong way of educating patients, sort of learning by doing sort of thing. Regarding manual therapy, it all depends on their previous experience. Therefore they might be not interested at all in that. We have to be mindful that patients with persistent pain do not like doing exercises and they feel that it’s very, they feel guilty about not liking exercises. So we have to be quite careful about how we approach these strategies.’ ‘

P6

…’ You need to create conditions where you’re kind of surprised by the system positively and develop a very robust relationship with the person, what is known as Alliance. Of course, it’s not gonna happen with everybody. So that’s life, that’s the nature of human relationships. People would say, communication, is just a soft skill. There are key skills. […] So it’s not just words. Sometimes with complex, I just test a few hypotheses. Let’s just see how this feels because that helps me also helps us to understand if I actually, can help you or not.’ […]’ I try and avoid pure passive care. So, manual therapy for me does have an important role for sure. It is a sort of a vehicle to get to try to understand better the person”

P7

.’ I try to give him some confidence in being able to handle the problem. I then try to use very simple examples to be able to explain why it hurts. I try to explain to them there is nothing unsolvable.‘[…]’ Generally, patients with chronic low back pain tend very much to attribute their problem to something purely structural at the level of the spine. It is therefore essential to dismantle this belief. […]Manual therapy in my clinical practice, to this day I use it a lot as a desensitisation tool, mainly to try to reduce the patient’s reactivity.’

P8

…’ I try to use, more neutral words. I avoid those words that might create an image inside of me of things being strangled or bone, or so I avoid those scenarios in their minds. I try to correlate what they feel with things that they have some control over in their daily life.’

P10

…’ My focus is on the person itself and I try to make them understand how sometimes X-rays do not show exactly what’s going on in the body. […]’ I always explain to them that low back pain is just a name and is not always directly proportionate to the degree of the lesion. So I try always to make them understand that in the higher percentage, this pain is not dangerous.’