Physiotherapists' Clinical Reasoning and Therapeutic Strategies in Fibromyalgia: A Qualitative Interpretative Study

Background/Objectives: Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain, fatigue, sleep disturbances, and psychosocial challenges. Although physiotherapists play a key role in FM management, little is known about how biopsychosocial principles are applied in clinical practice. This study explored physiotherapists' clinical reasoning, therapeutic strategies, and approaches to promoting adherence and functional recovery in FM. Methods: A qualitative study was conducted within a constructivist-interpretative paradigm. Thirteen physiotherapists with experience in FM management across different healthcare settings in Spain participated in semi-structured interviews. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke's framework. Methodological rigor was ensured through reflexive engagement among researchers with differing backgrounds, reflexive practice, and adherence to COREQ guidelines. Results: Three overarching themes and seven sub-themes were identified. Clinical validation emerged as a key strategy to reduce uncertainty and facilitate engagement. Therapeutic goals were progressively shifted from pain reduction toward function, autonomy, and participation. Pain neuroscience education and individualized exercise were identified as the main therapeutic strategies, while group-based interventions promoted social support, motivation, and adherence. Lifestyle recommendations, including stable routines, social participation, and work adaptation, complemented treatment. Conclusions: Physiotherapists perceive FM management as a multidimensional process extending beyond symptom reduction. Validation, pain neuroscience education, individualized exercise, and group-based support appear to facilitate adherence, self-management, and functional recovery within a biopsychosocial framework.