Table 7 Quotes. Challenges in implementing the model

P1

…’ In Portugal, the system is pure biomedical. So, if your opinion is a little bit different or you apply the BPS model, then it is very difficult to change.’

P2

…’ The negative is that it is sometimes oversimplified. We know that many things are associated with pain. The problem is that these associations don’t necessarily help us in the treatment. Changing factors such as weight or stress don’t always reduce pain.’

P3

…’ If we talk about osteopathy specifically. We are told to remain classical and we are afraid of change, or we have some difficulties to change.’

P4

…’ We’re trained on manual therapy, the exercise and we’re starting while on the psychological aspect we still sometimes act as psychologists, but if you don’t have a solid background built up over years you will fail.’

P6

…’ I’m not a psychologist or I can’t do any intervention from a social perspective. If someone has a job they hate, tell them to quit the job it’s easier said than done. Many people say just, it’s not within my scope of practice.’

P7

…’ Changing something ingrained requires a greater commitment on the part of the practitioner, a greater loss of time, and a greater conversation with the patient that perhaps even in many working conditions you are not allowed to have. […] The student struggles to find the practicalities of the model itself, which is perhaps presented in a very abstract way. There is no explanatory part that allows us to understand what psychosocial factors are and how they should be managed ‘

P9

…’ They come from a session of what they think would be just mostly manual therapy and suddenly they’re sitting on psychiatrists, and they don’t want to feel like that sometimes.’

P10

…’ Without a deep understanding of all areas, we can fail and probably areas can also be developed a little more. I think it’s important that it’s taught at some point in education.’