Can physical therapists deliver a pain coping skills program? An examination of training processes and outcomes.
BACKGROUND: Physical therapists are well established as providers of treatments for common, painful, and disabling conditions, such as knee osteoarthritis (OA). Thus, they are well placed to deliver treatments that integrate physical and psychosocial elements. Attention is usually given to outcomes of such programs, but few studies have examined the processes and outcomes of training physical therapists to deliver such treatments. OBJECTIVE: The aim of this study was to describe the processes in training physical therapists: (1) to deliver a standardized pain coping skills treatment and (2) to evaluate the effectiveness of that training. DESIGN: This study was an analysis of data relating to therapist performance in a randomized clinical trial. METHODS: Eleven physical therapists were trained to deliver a 10-session pain coping skills training program for people with knee OA as part of a randomized controlled trial (N=222). The initial training was provided in a workshop format and included extensive, ongoing supervision by a psychologist and rigorous use of well-defined performance criteria to assess competence. Adherence to the program, ratings of performance, and use of advanced skills were all measured against these criteria in a sample (n=74, 10%) of the audio recordings of the intervention sessions. RESULTS: Overall, the physical therapists achieved a very high standard of treatment delivery, with 96.6% adherence to the program and mean performance ratings all in the satisfactory range. These results were maintained throughout the intervention and across all sessions. LIMITATIONS: Only 10% of the delivered sessions were analyzed, and the physical therapists who took part in the study were a self-selected group. CONCLUSIONS: This study demonstrated that a systematic approach to training and accrediting physical therapists to deliver a standardized pain coping skills program can result in high and sustained levels of adherence to the program. Training fidelity was achieved in this group of motivated clinicians, but the supervision provided was time intensive. The data provide a promising indicator of greater potential for psychologically informed practice to be a feature of effective health care.
Bryant, C; Lewis, P; Bennell, KL; Ahamed, Y; Crough, D; Jull, GA; Kenardy, J; Nicholas, MK; Keefe, FJ
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