Can Physical Therapists Deliver a Pain Coping Skills Program?

Physical therapists are well established as providers of treatments for common, painful and disabling conditions, such as knee osteoarthritis (OA). Therefore, they are well placed to administer treatments that integrate physical and psychosocial elements. Attention is usually given to outcomes of such programs, but few studies have investigated the processes and outcomes of training physical therapists to deliver such treatments. This study describes the processes in training physical therapists to deliver a standardised pain coping skill treatment (PCST), and to evaluate the effectiveness of that training. Eleven physical therapists were trained to deliver a 10-session pain coping skills training program for people with knee OA as part of a randomised controlled trial (N = 222). The initial training was provided in a workshop format, supported by extensive on-going supervision by a psychologist, and a rigorous use of well-defined performance criteria to assess competence. Adherence to the program, and ratings of performance, and use of advanced skills were measured against these criteria in a sample (N = 74, 10%) of the audio recordings of the intervention sessions. Overall, the physical therapists achieved a very high standard of treatment delivery, with a 96.6% adherence to the program, and mean performance ratings all in the satisfactory range. These results were maintained throughout the length of the intervention, and across all sessions.

This study showed that a systematic approach to training and accrediting physical therapists to deliver a standardized pain coping skills program can lead to high, and sustained levels of adherence to the program. Training fidelity was achieved in this group of motivated clinicians, but the supervision provided was time intensive. The data provide a promising indicator of greater possibility that psychologically informed practice can become a feature of effective health care.