Feasibility of an Implementation Program for Delivering Psychologically Informed Physical Therapy for Persistent Pain
Purpose/Hypothesis: Research has shown there is an increasing need to address psychosocial aspects of musculoskeletal pain via psychologically informed physical therapy (PIPT). However, there is little research on how to effectively implement PIPT into routine clinical practice. The purposes of this project were to investigate how an educational intervention 1) changes Doctor of Physical Therapy student attitudes and beliefs about psychosocial approaches to patient care and 2) improves adherence to psychologically informed communication strategies during simulated interactions involving patients with musculoskeletal pain. Determining outcomes from the educational intervention was viewed as important precursor to developing a broader implementation strategy.
Number of Subjects: 28 Doctor of Physical Therapy (DPT) students
Materials and Methods: Twenty-eight DPT students took part in an educational intervention that consisted of one 4-hour didactic teaching session and three follow-up sessions of experiential learning for 1 hour each. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on adherent PIPT behaviors via a newly developed rating scale. The students also took a survey about their pain attitudes and beliefs. After the last educational session, students evaluated another standardized patient and were reassessed on the PIPT adherent behaviors with the rating scale. Students also completed a qualitative survey and the survey on pain attitudes and beliefs.
Results: Students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence and communication with complex patients, as well as concerns about implementing PIPT into daily interactions
Conclusions: This study illustrates the feasibility of adding PIPT skills training into an entry-level DPT program. Student attitudes and beliefs about pain management can be more psychosocially oriented and psychologically informed communication strategies can be learned after a brief educational intervention.
Clinical Relevance: There are challenges with implementation of PIPT into everyday practice and there is a need for scalable implementation approaches. One way to increase scale is through exposure to PIPT skills in entry-level DPT programs. Education is a positive first step, but additional implementation strategies are needed to ensure meaningful changes in provider behavior. Also, future research could explore the feasibility of this educational model as part of a broader implementation strategy for training practicing physical therapists.