SPECIAL INTEREST REPORT PLATFORM PRESENTATION

TRAINING PHYSIOTHERAPISTS TO ASSESS AND INTERVENE ON PSYCHOSOCIAL RISK FACTORS FOR PAIN-RELATED DISABILITY. Sullivan M¹, Adams H²; ¹McGill University, Montreal, Canada. ²University Centre for Research on Pain and Disability

PURPOSE: This presentation summarizes the outcome of a recent initiative in Canada aimed at training physical therapists to detect and intervene on psychosocial risk factors for prolonged pain and disability. RELEVANCE: Psychosocial factors such as catastrophic thinking or fear-avoidance beliefs contribute to a higher probability that a pain condition will persist over time. At present, physical therapists receive minimal education in psychosocial assessment and intervention. Expanding the skill set of physiotherapists to include the ability to evaluate and intervene on psychosocial risk factors might enhance the impact of secondary prevention programs. There are indications that it might be possible to train physical therapists in the management of psychosocial factors such as fear of pain, catastrophic thinking or beliefs about disability. These types of risk factors can be modified with structured behavioural interventions that do not require a background in mental health practice. DESCRIPTION: In Eastern Canada, over 100 physiotherapists attended a two-day workshop to develop skills aimed at targeting pain catastrophizing, fear of movement/re-injury and perceived disability. Participants were introduced to methods of administering, scoring and interpreting the results of psychosocial risk assessments. Participants were also provided instruction in the use of computer-based methods of assessing psychosocial risk factors in patients with persistent pain symptoms. Participants received instruction in treatment techniques designed to 1) increase activity structure, 2) facilitate resumption of pre-injury life role activities, 3) promote goal setting, 4) enhance problem-solving abilities, 5) maximize motivation for rehabilitation progress, 6) reduce catastrophic thinking, 7) reduce fear of pain, 8) challenge disability beliefs, and 9) facilitate transition to work. EVALUATION: Initial research findings suggest that equipping physical therapists with the skills to assess and intervene on psychosocial risk factors improves return to work rates in individuals with musculoskeletal symptoms (Sullivan et al., 2006). Feedback from physiotherapists trained in the delivery of structured psychosocial intervention techniques has been mixed. Some physiotherapists have indicated that their newly acquired clinical-psychosocial skill set has enabled them to augment the impact of their physical therapy interventions. Others have reported that using psychosocial assessment and intervention techniques has pushed them beyond their clinical comfort level. Still others have noted that there are significant barriers to changing practice patterns of physical therapy treatment centres. CONCLUSIONS: Discussion addresses the need to incorporate skills training in psychosocial assessment and intervention within the core curriculum of physical therapy education. Discussion also addresses options for facilitating the uptake of new evidence-based clinical skills within the structure of existing physical therapy treatment centres. IMPLICATIONS: Current findings suggest that training in psychosocial risk assessment and intervention improves the impact of physical therapy interventions. Incorporating such training in curricula for physical therapy education holds promise of enhancing the benefits clients experiencing pain-related disability derive from participation in physical therapy interventions. KEYWORDS: pain, disability prevention, psychosocial risk factors. FUNDING ACKNOWLEDGEMENTS: Canadian Institutes of Health Research. CONTACT: michael.sullivan@mcgill.ca