The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain

Psychologically informed practice (PIP) is advocated for physiotherapists to help people with chronic pain. There is little research observing how PIP is delivered in clinical practice. This study describes behaviours and techniques used by experienced physiotherapists working with groups of people with chronic pain. Experienced physiotherapists (n=4) were observed working with groups of people with chronic pain in out-patient pain management, and physiotherapy departments, in a large UK city centre teaching hospital. We observed the clinical behaviours and interpersonal skills of experienced psychologically informed physiotherapists, enriched by their accounts of intentions. The physiotherapists were audio and video recorded delivering group movement sessions. Recordings were reviewed with the physiotherapists for elaboration of intentions, then thematically analysed for comparison with defined CBT competencies. Four themes representing physiotherapist intentions when working with people with chronic pain were identified; building a therapeutic alliance, reducing perceived threat, reconceptualising beliefs and somatic experience, and fostering self-efficacy. The physiotherapists also reflected on challenges including engaging patients in self-management, encouraging activity and reinforcing rather than correcting movement. Considerable overlap existed between the observed behaviours in this study and existing CBT competencies. This paper complements current recommendations for delivering psychologically informed physiotherapy by providing examples of these skills being used in clinical practice. Further research supporting the development of training for, and mentoring of, physiotherapists, to promote competence and confidence in delivering psychologically informed interventions is recommended.