{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:01:50Z","timestamp":1782741710396,"version":"3.54.5"},"reference-count":60,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Private and public musculoskeletal practice settings across New Zealand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>17 physiotherapists and osteopaths with a minimum of 2 years\u2019 clinical experience, recruited through national professional networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113886","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:32:34Z","timestamp":1782739954000},"page":"e113886","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["More than biomechanics: how New Zealand manipulative physiotherapists and osteopaths conceptualise and manage upper back pain\u2014a qualitative study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9908-3659","authenticated-orcid":false,"given":"Kesava","family":"Kovanur Sampath","sequence":"first","affiliation":[{"name":"School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia"},{"name":"Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, Waikato, New Zealand"},{"name":"Centre for Osteopathic Research and Leadership, Health Sciences University, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Mishra","sequence":"additional","affiliation":[{"name":"Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, Waikato, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tep","family":"Mills","sequence":"additional","affiliation":[{"name":"Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, Waikato, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Fryer","sequence":"additional","affiliation":[{"name":"College of Sport, Health and Engineering, Victoria University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M","family":"Mowat","sequence":"additional","affiliation":[{"name":"School of Nursing, Auckland University of Technology, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3062-9056","authenticated-orcid":false,"given":"Oliver P","family":"Thomson","sequence":"additional","affiliation":[{"name":"Centre for Osteopathic Research and Leadership, Health Sciences University, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Draper-Rodi","sequence":"additional","affiliation":[{"name":"Centre for Osteopathic Research and Leadership, Health Sciences University, London, UK"},{"name":"National Council for Osteopathic Research, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8623-4558","authenticated-orcid":false,"given":"Brett","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Centre for Osteopathic Research and Leadership, Health Sciences University, London, UK"},{"name":"Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia"},{"name":"School of Health & Human Sciences, Southern Cross University, Lismore, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062906301448000_16.6.e113886.1","doi-asserted-by":"publisher","DOI":"10.1539\/joh.K8007"},{"key":"2026062906301448000_16.6.e113886.2","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.math.2015.06.010","article-title":"Understanding why the thoracic region is the \u201cCinderella\u201d region of the spine","volume":"21","author":"Heneghan","year":"2016","journal-title":"Man Ther"},{"key":"2026062906301448000_16.6.e113886.3","first-page":"149","article-title":"Diagnosing and treating upper back pain: insights from New Zealand\u2019s manipulative physiotherapists and osteopaths","volume":"33","author":"Kovanur Sampath","year":"2025","journal-title":"JMMT"},{"key":"2026062906301448000_16.6.e113886.4","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2474-10-77","article-title":"Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. 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