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Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes?: A randomized controlled trial
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
2011 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, no 5, 804-819 p.Article in journal (Refereed) Published
Abstract [en]

Background: Psychosocial risk factors are important in the development of chronic pain but treatment providers often lack knowledge and skills to assess and address these risk factors.

Objectives: We examined the effects of a course on psychosocial factors for physical therapists on patient outcome in terms of pain and disability.

Design: A randomised controlled trail.

Participants: Forty-two primary care physical therapists attended an eight-day university course over eight weeks aimed at identifying and addressing psychosocial risk factors.

Methods: They were randomised to either the course or a waiting list. The physical therapists collected consecutive acute and sub-acute patients with musculoskeletal pain both before and after the course.

Results: There were no significant differences in outcome for pain or disability for all

patients of physical therapists who had participated in the course or for risk patients with higher levels of catastrophizing or depression compared to patients of physical therapists who had not participated in the course. Outcome for low risk patients on pain and disability and for high risk patients on pain was not dependent on if their physical therapists changed their attitudes and beliefs during the course. Yet, outcome on disability for high risk patients may have been influenced if their physical therapists change their attitudes and beliefs.

Limitations: no measure of actual practice behaviour.

Conclusions: An eight-day university course for physiotherapists did not improve outcome for the group of patients as a whole or patients at risk of developing long term disability. Yet, risk patients with higher levels of catastrophizing or depression may have had a greater improvement in disability if their physical therapist changed attitudes and beliefs during the course.

Place, publisher, year, edition, pages
Oxford University Press, 2011. Vol. 91, no 5, 804-819 p.
Keyword [en]
Physical therapy, musculoskeletal pain, psychosocial factors, dissimilation, evidence based, education
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:oru:diva-10398DOI: 10.2522/​ptj.20100079ISI: 000289961000020PubMedID: 21451098Scopus ID: 2-s2.0-79960955694OAI: oai:DiVA.org:oru-10398DiVA: diva2:311064
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2017-02-09Bibliographically 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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