Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists' perceptions and experiences

Nielsen, Mandy, Keefe, Francis J., Bennell, Kim and Jull, Gwendolen A. (2014) Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists' perceptions and experiences. Physical Therapy, 94 2: 197-209. doi:10.2522/ptj.20130047

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Author Nielsen, Mandy
Keefe, Francis J.
Bennell, Kim
Jull, Gwendolen A.
Title Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists' perceptions and experiences
Journal name Physical Therapy   Check publisher's open access policy
ISSN 0031-9023
Publication date 2014-02
Year available 2013
Sub-type Article (original research)
DOI 10.2522/ptj.20130047
Open Access Status DOI
Volume 94
Issue 2
Start page 197
End page 209
Total pages 13
Place of publication Alexandria, VA, United States
Publisher American Physical Therapy Association
Collection year 2014
Language eng
Formatted abstract
Background The importance of the biopsychosocial model in assessment and management of chronic musculoskeletal conditions is recognized. Physical therapists have been encouraged to develop psychologically informed practice. Little is known about the process of physical therapists' learning and delivering of psychological interventions within the practice context.

Objective The aim of this study was to investigate physical therapists' experiences and perspectives of a cognitive-behavioral–informed training and intervention process as part of a randomized controlled trial (RCT) involving adults with painful knee osteoarthritis.

Design A qualitative design was used. Participants were physical therapists trained to deliver pain coping skills training (PCST).

Methods Eight physical therapists trained to deliver PCST were interviewed by telephone at 4 time points during the 12-month RCT period. Interviews were audiorecorded, transcribed verbatim into computer-readable files, and analyzed using Framework Analysis.

Results Thematic categories identified were: training, experience delivering PCST, impact on general clinical practice, and perspectives on PCST and physical therapist practice. Physical therapists reported positive experiences with PCST and program delivery. They thought that their participation in the RCT had enhanced their general practice. Although some components of the PCST program were familiar, the therapists found delivering the program was quite different from regular practice. Physical therapists believed the PCST program, a 3- to 4-day workshop followed by formal mentoring and performance feedback from a psychologist for 3 to 6 months and during the RCT, was critical to their ability to effectively deliver the PCST intervention. They identified a number of challenges in delivering PCST in their normal practice.

Conclusion Physical therapists can be trained to confidently deliver a PCST program. The physical therapists in this study believed that training enhanced their clinical practice. Comprehensive training and mentoring by psychologists was crucial to ensure treatment fidelity.
Keyword Physiotherapy practice
Knee psteroarthritis
Pain management
Cognitive behavior therapy
Pain coping skills training
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published ahead of print: 12 September 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Health and Rehabilitation Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 9 times in Scopus Article | Citations
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Created: Thu, 07 Nov 2013, 12:04:08 EST by Ms Amanda Nielsen on behalf of Physiotherapy