Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting

Lindsay A Ballengee,J Kyle Covington,Steven Z George

doi:10.1186/s12909-020-02272-5

Abstract

BackgroundThere is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists.MethodsThirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected.ResultsAfter the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients.ConclusionStudents had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.

Highlights

IntroductionOver 30% of adults experience persistent pain and more than half of adults report pain daily [2]
There is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain
A systematic review by Holopainen et al investigated physical therapists’ perceptions of learning and implementing biopsychosocial interventions for musculoskeletal conditions and found that while there was a shift towards biopsychosocial care, inadequate training was a common reason for lack of confidence with implementation of psychosocial interventions [9]

Summary

Introduction

Over 30% of adults experience persistent pain and more than half of adults report pain daily [2] One way this increased burden can be met is to address psychosocial aspects of musculoskeletal pain. Informed practice can deliver psychosocially oriented care through the integration of biopsychosocial interventions into patient management. Clinical practice guidelines for low back pain have emphasized the importance of incorporating psychosocial treatment approaches into routine physical therapy care, but this process has proven to be challenging with multiple studies showing that guidelineadherence is widely variable [5,6,7,8]. Some trainings include single workshops while others include ongoing mentoring and learning support well past the initial didactic components [9] This variability in training could account for some of the inconsistency with psychologically informed treatment outcomes [10]

Objectives

Methods

Results

Discussion

Conclusion