11 Objectives: Psychologically informed practice (PIP) is advocated for physiotherapists to help 12 people with chronic pain. There is little research observing how PIP is delivered in clinical 13 practice. This study describes behaviours and techniques used by experienced physiotherapists 14 working with groups of people with chronic pain. 15 16 Setting and Participants: Experienced physiotherapists (n=4) were observed working with 17 groups of people with chronic pain in out-patient pain management, and physiotherapy 18 departments, in a large UK city centre teaching hospital. 19 20 Design: We observed the clinical behaviours and interpersonal skills of experienced 21 psychologically informed physiotherapists, enriched by their accounts of intentions. The 22 physiotherapists were audio and video recorded delivering group movement sessions. 23 Recordings were reviewed with the physiotherapists for elaboration of intentions, then 24 thematically analysed for comparison with defined CBT competencies. 25 26 Results: Four themes representing physiotherapist intentions when working with people with 27 chronic pain were identified; building a therapeutic alliance, reducing perceived threat, 28 reconceptualising beliefs and somatic experience, and fostering self-efficacy. The 29 physiotherapists also reflected on challenges including engaging patients in self-management, 30 encouraging activity and reinforcing rather than correcting movement. Considerable overlap 31 existed between the observed behaviours in this study and existing CBT competencies. 32 Conclusions: This paper complements current recommendations for delivering psychologically 33 informed physiotherapy by providing examples of these skills being used in clinical practice. 34 Further research supporting the development of training for, and mentoring of, 35 physiotherapists, to promote competence and confidence in delivering psychologically informed 36 interventions is recommended. 37 38 Key words: 39 Chronic pain, Psychologically informed, Cognitive Behavioural Therapy, Qualitative 40 41 Contribution of paper 42  This study describes behaviours and techniques used by experienced physiotherapists 43 working with groups of patients with chronic pain. 44  This paper complements current recommendations for delivering psychologically 45 informed physiotherapy by providing examples of these skills being used in clinical 46 practice. 47 48 49 50 51 Background: 52 53Chronic pain is difficult to treat and poses a major healthcare challenge, affecting up to half the 54 UK population [1]. Its management requires a biopsychosocial model prioritising self-55 management [2], since treatment of even the most severely affected 1% requires more 56 resources than could ever be available [3]. Psychological approaches to extend and enhance the 57 skills of physiotherapists, and promote self management with patients, have been advocated for 58 over twenty years [4]. Delivering these psychological approaches and promoting patient self-59 management necessitates changes in us...

A fly-wheel ergometer (FWE) offering resistance training of the knee extensors has been designed for space travel and found to be effective during bed rest. The possibility exists that this device is also effective in training the knee extensors after knee injury. The purpose of this study was to compare the FWE to standard knee extensor training equipment for their effects on individuals with a history of knee injury, a group who commonly suffer from weakness of the knee extensors that effects their function. Twenty-nine subjects completed the study, which included tests of knee self-assessment, knee extensor static and dynamic muscle strength, size and neural activation as well as single leg power output, standing balance and vertical jump performance. Both groups showed statistically significant (P < 0.05) improvements in these variables over the 3-month training period but no differences were noted between the groups. The FWE appears to be as effective as standard resistance training equipment for improving knee extensor muscle group size and performance after knee injury.

A consecutive series of 45 women admitted to an obstetric unit were given the dexamethasone suppression test (DST) on days three to five post-partum, 82% being abnormal. The likelihood of an abnormal DST on one or both occasions increased linearly across the days of testing. Subjects completed the Beck self-report depression measure and the General Health Questionnaire at baseline and at six weeks. Baseline cortisol levels were not associated with baseline morbidity as assessed on the questionnaires and were not predictive of morbidity assessed at the six-week follow-up. It is concluded that the immediate post-partum period be included as a false-positive influence on the DST.

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