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Do physical therapists change their beliefs, attitudes,knowledge, skills and behaviour after a biopsychosocially orientated university course?
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0001-9429-9012
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0001-5359-0452
2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 4, 724-732 p.Article in journal (Refereed) Published
Abstract [en]

Aim The aim of this study is to examine the effects of an 8-day university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment, in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes, knowledge, skills and behaviour.MethodWe combined a randomized controlled trail with a pre-post design. Forty-two physiotherapists applied for a university-accredited training course designed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain. The course participants were randomized either to receiving the course or to a waiting list for training. Attitudes and beliefs towards, and knowledge of psychosocial factors, patient vignettes and a video of an imaginary patient were tested before and after training. The patients of the course participants were asked to fill out a questionnaire with background questions at treatment start. The patients also received a questionnaire about the physical therapists' behaviour and patient satisfaction 6 weeks after treatment start.ResultsThe results show that physical therapists' attitudes and believes became more biopsychosocially and less biomedically orientated, they were less convinced that pain justifies disability and limitation of activities, and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course. Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result.ConclusionA course, which enhanced biopsychosocial attitudes and beliefs, as well as increased such knowledge and skills did not change the way patients perceived their physical therapists. A future question is whether it improves patient outcome.

Place, publisher, year, edition, pages
Oxford: Blackwell , 2009. Vol. 15, no 4, 724-732 p.
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:oru:diva-9128DOI: 10.1111/j.1365-2753.2008.01089.xISI: 000268271000021OAI: oai:DiVA.org:oru-9128DiVA: diva2:287301
Available from: 2010-01-18 Created: 2010-01-18 Last updated: 2016-08-10Bibliographically approved
In thesis
1. Implementing psychosocial factors in physical therapy treatment for patients with musculoskeletal pain in primary care
Open this publication in new window or tab >>Implementing psychosocial factors in physical therapy treatment for patients with musculoskeletal pain in primary care
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This dissertation focuses on 2 parts: 1) Whether evidence-based guidelines are recognized and integrated into clinical practice in primary care and 2) Whether a university course aimed at teaching physical therapists to identify and address evidence-based psychosocial factors in primary care might change practice behaviour and patient outcome. To this end practising clinicians were surveyed and a course for physical therapists was developed.Concerning the first part, we showed that a relatively large proportion of clinicians in primary care were unfamiliar with the content of evidence-based guidelines and/or with the concept of “Red flags”. Yet, concerning the self-reported practice behaviour, the majority indicated they followed the key points in the guidelines. To enhance the impact of guidelines, interventions or tactics for teaching and implementing guidelines should include interactive education,discussion, feedback, and reminders which in research have shown to enhance knowledge,skills and change behaviour. Furthermore, the clinical applicability of the guidelines needs to be further developed. We could also show that psychosocial factors were integrated up to a certain point and that physical therapists in primary care were well aware of the importance of psychosocial risk factors, but it seemed physical therapists lack specificity about which factors are important. Physical therapists may have heard about risk factors but probably did not have a clear model or structure about how these factors work.Concerning the second part, the results showed that we, by means of a university course, managed to change attitudes and beliefs, increase knowledge, skills and competencies towards a more biopsychosocial standpoint. But despite these changes, the results did not show a behavioural change on behalf of the physical therapists or a better outcome for patients at risk of longterm pain and disability. Several possible explanations for this are discussed. First, the content of the course should be changed so it focuses more on behavioural change on behalf of the physical therapists. This would facilitate implementation of new behaviour in clinical practice and increase the likelihood that the new behaviour is maintained and thereby the possibility of improved patient outcome. Second, treating patients at risk for long-term pain and disability may also be too difficult for a single physical therapist in a clinical setting. This would imply large changes in the way patients are directed through the health care system compared to now. The main tasks of the physical therapists in primary care would then be to select patients at risk for long-term pain and disability. They would then treat the patients not at risk and refer the patients at risk for long-term pain and disability to more suitable treatment, for example CBT treatment delivered by a psychologist or multimodal treatment delivered by a team of experts.Since risk patients experience most suffering and are the most costly for the health care system, it is important they get the appropriate treatment at the earliest possible opportunity.In summary, this dissertation shows that integrating psychosocial factors in physical therapy is not an easy task.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 69 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 44
Keyword
Physical therapy, musculoskeletal pain, psychosocial factors, dissimilation, evidence based, education, primary health care
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-10426 (URN)978-91-7668-727-7 (ISBN)
Public defence
2010-05-28, Bomanssonsalen, Universitetssjukhuset Örebro, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2010-04-21 Created: 2010-04-21 Last updated: 2011-04-26Bibliographically approved

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