INSTRUCTIONS: This test comprises of five question based on the text below. Read the text carefully and then mark the alternatives that answer the questions or complete the sentences presented after it.
Psychologically informed physiotherapy for chronic pain: patient experiences of treatment and therapeutic process
S. Wilsonª, N. Chalonerª, M. Osbornª, b , J. Gauntlett-Gilbertª, b
Abstract
Objectives
Psychologically informed physiotherapy is used widely with patients with chronic pain. This study aimed to investigate patients’ beliefs about, and experiences of, this type of treatment, and helpful and unhelpful experiences.
Introduction
Chronic pain is disabling, and difficult to treat both medically and surgically; as such, pain management treatments have increasingly emphasised self-management of the condition using physical and psychological techniques. Self-management approaches view disability and suffering as resulting from multiple factors beyond pain itself, including avoidant movement patterns, cognitions and coping styles.
There is increasing evidence that patients can benefit from physiotherapist-led cognitive behavioural self-management approaches for chronic pain. For example, STarT Back is a stratified care model for patients with low back pain (LBP), targeting patients at high risk of chronicity [4]. The STarT Back model incorporates psychological concepts in both screening and treatment, and is now integrated into UK national pathways and guidance for LBP. Undergraduate physiotherapy courses also increasingly emphasise ‘biopsychosocial’ approaches to treatment. Thus, psychologically informed physiotherapy (PIP) is becoming prevalent across care settings.
The majority of outcome data suggest that cognitive behavioural therapy (CBT)-based treatments for chronic pain yield superior outcomes compared with ‘treatment as usual’ and waiting list controls. However, effect sizes are small and reduced at follow-up. Thus, whilst CBT approaches are useful, they need to be developed to have more impact. As such, this article will use the broader term ‘PIP’ to describe all treatments where physiotherapy is delivered within a psychological framework. PIP treatments aim to use psychological techniques to increase the impact of physiotherapy, and to entrench the patient’s long-term maintenance of exercise recommendations (e.g. by targeting low motivation or negative thinking patterns). Both CBT and other psychological models may be used in the service of these goals.
In order to develop a treatment, it is essential to understand how and why it works. Change process research has been common in the psychotherapy literature for the past 20 years. In the chronic pain literature, changes in variables such as pain catastrophising and acceptance have been identified as active influences on treatment outcome. However, there is little consensus on which treatment processes are most important, and the variables under inspection have generally been selected based on psychological theory, as opposed to arising from patient, or physiotherapy, accounts.
Where important therapeutic processes are understood, they can be targeted specifically to improve clinical outcomes and support efficient dissemination of effective practice. Physiotherapists do not always feel adequately trained to implement PIP despite recognising its value, and therapist ‘drift’ into ineffective clinical approaches is common across professions. Both of these factors indicate that more in-depth training is required. Identification of important treatment processes should support clinicians to target consistent, evidence-based variables.
Some studies have investigated patients’ overall experiences of self-management treatment. However, this study aimed to focus more specifically on those processes that are important within PIP treatments. Currently, minimal data exist on this topic; indeed, there are cautionary data indicating that both treatment adherence and perception of benefit can be poor in selfmanagement approaches for back pain. The authors chose to explore this topic in participants with severe chronic pain who had: (a) received a high ‘dose’ of PIP at a specialist service; and (b) shown evidence of benefiting from this treatment. This allowed their experiences to be explored with confidence in the adequacy and competence of the PIP treatment.
Available at: . Accessed on: April 2nd 2017.
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