Physical Therapist-Delivered Cognitive-Behavioral Therapy

The significance of the biopsychosocial model in assessment and management of chronic musculoskeletal conditions is recognized. Physical therapists have been encouraged to develop psychologically informed practice. Not much is known about the process of physical therapists’ learning and providing of psychological interventions within the practice context. The authors conducted this study with the goal of investigating physical therapists’ experiences and perspectives of a cognitive-behavioral-informed training and intervention process as part of a randomized controlled trial (RCT) involving adults with painful knee osteoarthritis. They used a qualitative design. Participants were physical therapists trained to deliver pain coping skills training (PCST). Eight physical therapists trained to deliver PCST were interviewed by telephone at 4 time points during the 12-month RCT period. Interviews were audiorecorded, transcribed verbatim into computer-readable files, and analyzed using Framework Analysis. The thematic categories they identified included: training, experience delivering PCST, impact on general clinical practice, and perspectives on PCST and physical therapist practice. Physical therapists reported positive experiences with PCST and program delivery. They thought that their participation in the RCT had improved their general practice. Although some components of the PCST program were familiar, the therapists discovered delivering the program was quite different from regular practice. Physical therapists believed the PCST program, a 3- to 4-day workshop followed by formal mentoring and performance feedback from a psychologist for 3 to 6 months and during the RCT, was integral to their ability to effectively deliver the PCST intervention. They identified a number of challenges in delivering PCST in their normal practice.


The authors concluded that physical therapists can be trained to confidently deliver a PCST program. The physical therapists in their study believed that training improved their clinical practices. They add that comprehensive training and advising by psychologists was critical in ensuring treatment fidelity.