Can Physical Therapists Deliver a Pain Coping Skills Program? An Examination of Training Processes and Outcomes

Abstract

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.

Effectiveness of a physiotherapist delivered cognitive-behavioral patient education for patients who undergoes operation for total knee arthroplasty: a protocol of a randomized controlled trial

“…Further, they normally see the patients several times in connection with the operation and taken into account the high number of TKA operations and the limited availability of psychologists at the hospital physiotherapists are highly qualified to provide this patient education. Recent studies shows that both nurses and physiotherapists are sufficient to deliver high standard pain coping skills training [17, 49]. …”

“…Potential advantages of using only one health care person may be a reduced overall cost to the health care system, increased opportunity of receiving the treatment and an experience of a more consecutive treatment because the patient has contact to fewer health care persons. Physical therapists have a history of teaching patients about pain and pain coping, and given their expertise with using physical treatments to treat patients pain and their experience in using the biopsychosocial approach in their treatment, physical therapists is a qualified choice to deliver a patient education in pain coping [17, 18].

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Translating Evidence-Based Protocols Into the Home Healthcare Setting

“…The low percentage of intervention group PTs documenting use of the CBPSM elements and the survey feedback suggest the program was not implemented as designed. PTs in other settings have been able to deliver cognitive–behavioral interventions with acceptable fidelity following extensive training and competency evaluation (Bryant et al, 2014; Johnson et al, 2007). The program implemented in our study was based upon cognitive and behavioral principles but took a self-management approach in order to simplify the protocol.…”

Improving stress reduction and wellness in interdisciplinary chronic pain management: Is transdisciplinary care a better option?

“…Bryant et al. () attempted to formally train 11 PTs on a 10‐session chronic pain coping skills program for individuals with lower extremity pain. Using workshops and ongoing supervision by a Psychologist, the PTs were able to implement the pain management program with over 96% fidelity, and with satisfactory performance ratings, and the outcomes of combined Physical Therapy and the pain management program outpaced those of either intervention on its own up to 1 year later (Bennell et al., ).…”

“…Recent published research has already shown that PTs can be trained to an effective level of competency in psychosocial interventions for pain, suggesting that a transdisciplinary pain management program blending PT and wellness skills (like FR) could be feasibly implemented. Future research on transdisciplinary care should examine the added effect of training PTs on an ICPM pain management model (existing studies have merely tested training on a unidimensional psychotherapeutic intervention for pain) and whether or not other professions can be trained to an effective level of competency in physical rehabilitation methods (Bennell et al., ; Bryant et al., ). Third party reimbursement for transdisciplinary pain management is largely unexplored, so future research on transdisciplinary models should study reimbursement models and credentialing issues that could serve as obstacles to transdisciplinary implementation.…”