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Sandborgh M.1, Söderbäck M.1, Fritz J.1
1Mälardalen University, School of Health, Care and Social Welfare, Västerås, Sweden
Background: For patients with persistent muskuloskeletal pain a behavioral medicine approach in physical therapy is recommended, based on evidence. This approach implies the integration of cognitive-behavioral principles in clinical practice. Students at Mälardalen University are trained to use a behavioral medicine model for incorporating cognitive-behavioral principles in physical therapy practice. The core components, in addition to addressing physical factors, are: Behavioral goal setting, Self-monitoring of the patient, Functional behavioral analyses, Basic and applied skills training in everyday-life activities and Strategies aimed atmaintenance and relapse prevention. The skills, knowledge and attitudes of the individual physical therapist are important determinants for implementation of behavioral medicine in clinical practice. Self-reports are common methods to evaluate the impact of an implementation, but could be biased by social desirability. Thus, a combination of methods to explore the application of behavioral medicine in clinical practice was considered useful.
Purpose: To explore the use of a behavioral medicine approach in everyday physical therapy treatment for patients with persistent pain.
Methods: A purposive sampling was used when selecting four primary care physical therapists with academic training in behavioral medicine, either in undergraduate or graduate courses, one to two years post-graduation. Two treatment sessions for each physical therapist was video recorded and analyzed in relation to the appearance of core components in the behavioral medicine model. Selected sequences from the video recordings were used for stimulated recall in semi-structured interviews. The transcripts of 28 video selected treatment sequences and the interviews were contrasted by a qualitative content analysis.
Results: The overall results show a gap between the physical therapists intentions and clinical practice. In the video recorded treatment sequences core components in the behavioral medicine model were identified, except for Functional behavioral analyses and Strategies aimed at maintenance and relapse prevention. The physical therapists overall intentions were found to adhere to the other core components, but the variation in recorded clinical behaviors indicate a predominant biomedical focus. Goal setting was deemed important but behavioral goals were not clearly specified in relation to patients goal activities. The intentions were to support Self-monitoring of the patient related to goal activities, but instructions and feedback were unspecific and directed towards monitoring pain per se. Basic and applied skills training concerned mainly physical skills, although the need to also address patients psychosocial skills needed for behavioral change were emphasized in the interviews.
Conclusion(s): The physical therapists´ awareness of and intentions to apply a behavioral medicine model were not matched by their clinical performance.
Implications: Observations of clinical practice combined with interviews are useful for understanding the translation of academic training into everyday clinical practice. This study illustrates the advantage of combining data collection methods for exploring skills, knowledge and attitudes regarding how behavioral medicine is applied in physical therapy.
Funding acknowledgements: No funding
Topic: Education
Ethics approval: Regional Ethical Review Board, Uppsala, Sweden
All authors, affiliations and abstracts have been published as submitted.
