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A.V. Silva Guerrero1, J. Setchell1, M. Sterling1
1The University of Queensland, School of Health and Rehabilitation sciences, Brisbane, Australia
Background: Whiplash-associated disorders (WAD) are the most common injuries following a motor vehicle crash. About half of those who experience a whiplash injury report ongoing symptoms up to one year later. The most tested treatments for patients with WAD have been physical exercise approaches but they have shown only small effects. The small effects of exercise treatments alone may occur because these approaches do not focus on the psychosocial aspects of the whiplash condition. Psychosocial factors such as stress symptoms, pain catastrophizing, anxiety, and depressed mood have been shown to be associated with poor recovery for people with WAD. In a recent randomised clinical trial (StressModex RCT), we demonstrated improved health outcomes when patients with acute WAD and at risk of poor recovery are identified, and psychosocial risk factors are then specifically targeted.
As a consequence of the growing awareness of the importance of psychosocial factors in health outcomes for people with musculoskeletal pain, physiotherapists are being encouraged to consider these factors and deliver “psychologically informed” physiotherapy. However, from 35 randomised clinical trials that have assessed the effectiveness of psychological interventions delivered by physiotherapists, only one study to date has explored patient’s experiences after participation in this type of trial. Hence, It is important to gain a wider understanding of the patients’ experiences of this type of combined intervention delivered by physiotherapists in order to understand which components of the intervention they found most useful.
As a consequence of the growing awareness of the importance of psychosocial factors in health outcomes for people with musculoskeletal pain, physiotherapists are being encouraged to consider these factors and deliver “psychologically informed” physiotherapy. However, from 35 randomised clinical trials that have assessed the effectiveness of psychological interventions delivered by physiotherapists, only one study to date has explored patient’s experiences after participation in this type of trial. Hence, It is important to gain a wider understanding of the patients’ experiences of this type of combined intervention delivered by physiotherapists in order to understand which components of the intervention they found most useful.
Purpose: To examine patients’ experiences and perceptions of a combined physiotherapist delivered stress inoculation training (SIT) and exercise intervention for patients with acute whiplash associated disorders (WAD).
Methods: Twelve patients from the 53 who participated in the SIT and exercise arm of a randomised controlled trial (StressModex RCT) participated in semi-structured interviews. Data were analysed using inductive thematic analysis.
Results: Five main themes were identified: ‘dealing with stress’, ‘coping with the injury’, ‘pain relief and return to function’, ‘balance between the physical and psychological components’ and ‘elements enhancing therapeutic alliance’. The majority of patients found the techniques to identify and manage stress, including abdominal breathing, body-scans, problem solving and coping skills, to be helpful in managing both stress and pain, coping with their injury and returning to function. The patients also found the exercises useful and acknowledged the importance of both the physical and the psychological aspects of whiplash injury. Many welcomed the inclusion of psychological strategies as part of physiotherapy treatment. The majority of patients felt understood, respected, and acknowledged. However, a few patients felt that the physiotherapists may need more skills to enhance the therapeutic alliance aspects of the treatment and that the personality and manners of the professional influenced their connection.
Conclusion(s): The majority of patients interviewed were supportive of a physiotherapist delivered integrated psychological and exercise intervention. Our results provide confidence for the further development of physiotherapist led psychological and physical treatment approaches.
Implications: This knowledge would assist in future development or refinement of combined psychological and physical treatment approaches.
Funding, acknowledgements: This research did not receive support from any grants. The StressModEx RCT (ACTRN12614001036606) was supported by the NHMRC (grant number APP1069443).
Keywords: Stress Inoculation Training, therapeutic alliance, Acute WAD
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: The University of Queensland
Committee: The University of Queensland Human Research Ethics Committee
Ethics number: 2018000114
All authors, affiliations and abstracts have been published as submitted.
