Psychosocial Strategies in Physiotherapy Practice

Christina Driver

doi:10.25907/00484

With the current shift towards adopting a biopsychosocial perspective in physiotherapy practice, and the incorporation of psychosocial strategies, there is a need to gain understanding and insight into how physiotherapists perceive this changing role and their challenges in accepting it. Previous research has synthesised information regarding sports physiotherapy and pain management, redominantly from a quantitative perspective in the UK and US. However limited research has investigated physiotherapists working outside sport and pain management settings, particularly in Australia. There is a need to determine if previous conclusions are universal and generalisable. Furthermore, qualitative research in this area is scarce. In response to the limitations of previous literature and the salience of this topic area, a mixed methods program of investigation, which comprised of four phases, was designed and conducted to determine the views and understandings of Australian physiotherapists towards the use of psychosocial strategies in their practice. In the first phase, a systematic review provided a comprehensive analysis and synthesis of current knowledge in this area and identified specific gaps in the literature at the time. In the second phase, quantitative data was analysed from a cross-sectional survey of 251 practicing physiotherapists in Australia. In the third phase, qualitative content analysis of textual data provided in response to various open-ended questions was conducted to explore the considerations of physiotherapists when deciding whether to use such strategies, and discover physiotherapists’ perceived benefits and barriers to implementing psychosocial approaches in their practice. Phase four was a qualitative investigation into physiotherapists training needs regarding their use of psychosocial strategies, and the proposal of a framework which provides a foundation for development of future undergraduate training or continued professional development packages, targeting teaching and learning of psychosocial strategies for physiotherapy practice. The combined results of this program of study illustrate that current practicing physiotherapists have positive attitudes towards the use of psychosocial strategies in their practice and are making decisions about their rehabilitation strategies within a biopsychosocial framework. Additionally, it appears they are accepting of the change in their role from a biomedical model to a more biopsychosocial perspective. They report using a range of strategies, with goal setting being the most frequently used, but are also starting to incorporate more complex strategies into their practice such as cognitive behavioural approaches and motivational interviewing. Physiotherapists in this program of study recognise the benefits of usingpsychosocial strategies for their patients, with specific reference to improved rehabilitation experience and improvements in psychosocial outcomes, and some also identified benefits for their own practice. Nonetheless, substantial challenges to effective employment of psychosocial strategies in practice still exist, with lack of confidence and knowledge attributable to a lack of training being a prominent barrier. Psychosocial strategies are considered to be within the scope of current physiotherapy practice, yet physiotherapists recognise the need to refer on for more complex cases, and want more training in the assessment and management of psychosocial issues and subsequent referral pathways. Furthermore, physiotherapists reported a preference for more training at a theory and practical level, motivated by a desire to improve their practice in terms of assessment and management of psychosocial issues, to enhance knowledge and confidence in the application of psychosocial strategies, and ultimately to help their patients achieve optimal outcomes. The combined findings from this program of investigation have important and useful implications for the development of continued professional development programs and undergraduate training, specific to physiotherapy and the use of psychosocial strategies.

Psychosocial Strategies in Physiotherapy Practice

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