Brief psychologically informed physiotherapy training is associated with changes in physiotherapists’ attitudes and beliefs towards working with people with chronic pain

C, Jacobs; Guildford, Beth J; Travers, Warren; Davies, Megan; McCracken, Lance M.

doi:10.1177/2049463715600460

Cited by 40 publications

(38 citation statements)

References 33 publications

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“…In our experience, physical therapists' initial perception was that implementing PIPT strategies in (21). We observed favorable treatment orientation shifts from predominantly biomedical to biopsychosocial, following attendance at the live workshop which is consistent with previous studies where similar duration of PIPT training was delivered (26,45). Our viewpoint is that this favorable change in treatment orientation and confidence is a practical indicator that the PIPT training has potential for altering therapists' attitudes, beliefs and confidence.…”

Section: Patient-centered Communicationsupporting

confidence: 88%

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Beneciuk

George

Greco

et al. 2019

Preprint

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Background: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically Informed Physical Therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET Trial. Methods: The PIPT training program was developed, tested and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training and confirmation of final course objectives. Methods of delivery consisted of a website that included brief online educational modules followed by a live 8-hour workshop that included video-based mock case scenarios and case-based role playing. Attitudes, beliefs and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact. Results: Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of ‘clinician champions’ providing brief follow-up sessions identified as best practice. Favorable post training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed. Conclusions: PIPT training for provider participation in the TARGET Trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training, however implementing ongoing training was challenging in general. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity which was a limitation of our approach. Trial registration: ClinicalTrials.gov Identifier: NCT02647658

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Section: Patient-centered Communicationsupporting

confidence: 88%

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Beneciuk

George

Greco

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…In our experience, physical therapists' initial perception was that implementing PIPT strategies in "buy-in" for treatment [29]. We observed favorable treatment orientation shifts from predominantly biomedical to biopsychosocial following attendance at the live workshop which is consistent with previous studies where similar duration of PIPT training was delivered [26,42]. Our viewpoint was that this favorable change in treatment orientation and confidence is a practical indicator that the PIPT training has potential for altering therapist attitudes, beliefs and confidence.…”

Section: Patient-centered Communicationsupporting

confidence: 85%

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Beneciuk

George

Greco

et al. 2018

Preprint

View full text Add to dashboard Cite

Background: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically Informed Physical Therapy (PIPT) is secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET Trial. Methods: The PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training and confirmation of final course objectives. Methods of delivery consisted of a website that included brief educational modules followed by a live 8 hour workshop that included video based mock case scenarios and case-based role playing. Attitudes, beliefs and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact. Results: Early stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of ‘clinician champions’ brief follow-up sessions identified as best practice. Favorable post training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed. Conclusions: PIPT training for provider participation in the TARGET Trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training, however implementing ongoing training was challenging in general. Consistent with a pragmatic trial whether this training directly impacted treatment fidelity was not measured, which was a limitation to our training approach.

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“…A qualitative study evaluated LBP interventions with a biopsychosocial focus found that 13 qualified PTs experienced improved confidence to manage the biopsychosocial dimensions after an average of nine workshops with cognitive Abbreviations: SD Standard Deviation, CI Confidence Interval, η p 2 Partial Eta Squared, PCS Practitioner Self-Confidence Scale (score 4-20, lower score indicates higher self-confidence), PABS-PT Pain Attitudes and Beliefs Scale for Physiotherapists, BM Biomedical orientation (score 10-60 indicates higher score higher orientation), BPS Biopsychosocial orientation (score 9-54, indicates higher score higher orientation) Abbreviations: SD Standard Deviation, CI Confidence Interval, η p 2 Partial Eta Squared, COM-B "Capability", "Opportunity", "Motivation" and "Behaviour" model functional therapy training [54]. Furthermore, a voluntarily 8-day university course [55] as well as a 7-h PT workshop [56] focusing on biopsychosocial treatment showed a similar result as in the current study. These three studies [54][55][56] however only performed follow-up directly after the training/course leaving long-term effects unclear.…”

Section: Discussionmentioning

confidence: 99%

Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care

Schröder

Öberg

Enthoven

et al. 2020

BMC Health Serv Res

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Background: Implementing clinical guidelines is challenging. To facilitate uptake, we developed a model of care (BetterBack Model of Care) and an implementation strategy to support management of low back pain in primary care. The aim of this study was to evaluate physiotherapists´confidence, attitudes and beliefs in managing patients with low back pain before and after a multifaceted implementation of the BetterBack Model of Care. A further aim was to evaluate determinants of implementation behaviours among physiotherapists. Methods: This clinical trial was an experimental before and after study within a hybrid type 2 effectivenessimplementation trial. The primary outcome was Practitioner Self-Confidence Scale (PCS), secondary outcomes were the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PT) and Determinants of Implementation Behaviour Questionnaire (DIBQ). Data was analysed using repeated measures ANOVA and pairwise comparisons. Results: One hundred sixteen physiotherapists answered a questionnaire before, directly after, as well as 3 and 12 months after implementation of the Model of Care. PCS improved over time with a large effect size post implementation (η p 2 = 0.197, p < 0.001). Changes in PABS-PT were only significant after 12 months with higher biopsychosocial orientation, (η p 2 = 0.071, p < 0.01) and lower biomedical orientation, (η p 2 = 0.136, p < 0.001). Directly after the workshop, after 3 and 12 months, physiotherapists had high ratings on all DIBQ domains, (scores > 50) implying that all were potential facilitators of the implementation. However, after 3 months, all domains had significantly decreased except for organisation, social influence and patient expectation domains. However, after 12 months, organisation and social influence domains had significantly decreased while domains such as knowledge, skills and beliefs about capabilities returned to initial levels.

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Brief psychologically informed physiotherapy training is associated with changes in physiotherapists’ attitudes and beliefs towards working with people with chronic pain

Cited by 40 publications

References 33 publications

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: Development and Delivery of a Pragmatic Training Course of Psychologically Informed Physical Therapy for the TARGET Trial

Confidence, attitudes, beliefs and determinants of implementation behaviours among physiotherapists towards clinical management of low back pain before and after implementation of the BetterBack model of care

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