“Living more and struggling less”: a qualitative descriptive study of patient experiences of physiotherapy informed by Acceptance and Commitment Therapy within a multidisciplinary pain management programme

Katy Aymerich,Angelika Wilczek,Soravis Ratanachatchuchai,Helen R Gilpin,Nicolas Spahr,Clair Jacobs,Whitney Scott

doi:10.1016/j.physio.2022.01.004

Abstract

ObjectivesPhysiotherapists increasingly deliver treatment informed by cognitive-behavioural therapy, including Acceptance and Commitment Therapy (ACT), for persistent pain. This study explored patients’ experiences of ACT-informed physiotherapy to better understand therapeutic processes and outcomes. DesignA qualitative descriptive study was conducted. Focus groups explored participants’ experience of ACT-informed physiotherapy in the context of a pain management programme. Responses were audio recorded, transcribed verbatim, and analysed using a hybrid inductive-deductive reflexive thematic analysis. SettingA single tertiary care pain management service. ParticipantsThe sample consisted of fifteen patients from two treatment groups who completed an intensive multidisciplinary ACT-based pain management programme. Participants were included irrespective of their treatment response. ResultsOne overarching theme (living more and struggling less) and four interconnected themes were generated from the data: 1) awareness and openness help to approach physical activities flexibly; 2) from battling against to working with the body compassionately; 3) from narrow focus to curiosity, freedom, and expansion; and 4) social connection is a catalyst for openness and engagement. ConclusionsParticipants experienced ACT-informed physiotherapy as helping them to live more and struggle less with pain; this occurred in the context of a psychologically flexible relationship with the physiotherapist and was catalysed by social connection. These findings should be seen as preliminary given the small number and relatively brief duration of focus groups conducted. Further research is needed to explore how principles within ACT-informed physiotherapy may support patients and clinicians to respond effectively to the challenges that persistent pain can bring.

Highlights

Persistent pain is prevalent and disabling and can affect physical, psychological, and social well-being [1,2]
This study explored patients’ experiences of ACTinformed physiotherapy
Openness, and engagement in meaningful activities were present across the four identified themes and overarching theme, and reflect key psychological flexibility processes [22]

Summary

Introduction

Persistent pain is prevalent and disabling and can affect physical, psychological, and social well-being [1,2]. Multidisciplinary pain management programmes (PMP) based on cognitive-behavioural principles are recommended to promote self-management when pain significantly impacts on functioning and quality of life [3]. Treatments based upon cognitive-behavioural therapy (CBT) are clinically- and costeffective for pain [4,5]. Acceptance and Commitment Therapy (ACT) is a form of CBT with growing evidence for persistent pain. ACT focuses on enhancing psychological flexibility—the capacity to experience pain with openness, focus on the present moment, and to consistently pursue personally-valued activities [6]. Randomised-controlled trials (RCTs) demonstrate that ACT contributes to improvements in pain-related disability, emotional functioning, and quality of life with effects similar to traditional CBT [7]

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