Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

Abstract

The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0-10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.

How do physiotherapists understand and interpret the “Pain Attitudes and Beliefs Scale”? A cognitive interview study

“…We believe that combining the PABS with other questionnaires may provide broader insights in clinician attitudes and beliefs. Recent studies evaluating the quality and impact of biopsychosocial educational interventions have supplemented the PABS-PT with other questionnaires measuring related biopsychosocial constructs (Bareiss, Nare, and McBee, 2019;Beneciuk et al, 2019;Demmelmaier, Denison, Lindberg, and Asenlof, 2012;Kongsted et al, 2019;Wang, Fisher, and Hall, 2018). These studies used clinician-level questionnaires such as the Practitioner Confidence Scale (PCS) (Bush, Cherkin, and Barlow, 1993) to measure clinicians' confidence in managing people with back pain; the Determinants of Implementation Behavior Questionnaire (DIBQ) (Huijg et al, 2014) to measure clinicians' implementation behavior; the Neurophysiology of Pain Questionnaire (NPQ) (Catley, O'Connell, and Moseley, 2013) to measure knowledge of pain physiology and the Patient-Practitioner Orientation Scale (PPOS) (Shaw, Woiszwillo, and Krupat, 2012) to measure patient centeredness.…”

Attitudes and beliefs on low back pain in physical therapy education: A cross-sectional study

“…Indeed, studies showed that attitudes and beliefs of physical therapists about LBP can change after a training session or lecture. 14,18,19 These findings suggest the need to study the attitudes and beliefs of physical therapy students during their education.…”

Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care

“…According to some reports, yellow flags are not systematically assessed in clinical physical therapy practice [ 3 , 9 , 20 ]. Recordings of brief telephone consultations on musculoskeletal pain in primary health care indicate that PTs can improve their exploration of yellow flags if they are guided step by step and if they receive specific performance feedback [ 21 ].…”