The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain
Open accessAbstract
Objectives Psychologically informed practice (PIP) is advocated for physiotherapists to help people with chronic pain. There is little research observing how PIP is delivered in clinical practice. This study describes behaviours and techniques used by experienced physiotherapists working with groups of people with chronic pain.Setting and participants Experienced physiotherapists (n=4) were observed working with groups of people with chronic pain in out-patient pain management, and physiotherapy departments, in a large UK city centre teaching hospital.Design We observed the clinical behaviours and interpersonal skills of experienced psychologically informed physiotherapists, enriched by their accounts of intentions. The physiotherapists were audio and video recorded delivering group movement sessions. Recordings were reviewed with the physiotherapists for elaboration of intentions, then thematically analysed for comparison with defined CBT competencies.Results Four themes representing physiotherapist intentions when working with people with chronic pain were identified; building a therapeutic alliance, reducing perceived threat, reconceptualising beliefs and somatic experience, and fostering self-efficacy. The physiotherapists also reflected on challenges including engaging patients in self-management, encouraging activity and reinforcing rather than correcting movement. Considerable overlap existed between the observed behaviours in this study and existing CBT competencies.Conclusions This paper complements current recommendations for delivering psychologically informed physiotherapy by providing examples of these skills being used in clinical practice. Further research supporting the development of training for, and mentoring of, physiotherapists, to promote competence and confidence in delivering psychologically informed interventions is recommended.
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The inclusion of patient-centered communication, such as motivational interviewing, aids in supporting a healthy therapeutic alliance and self-efficacy for change.
“The inclusion of patient centered communication (e.g. motivational interviewing) aid in supporting a healthy therapeutic alliance and self-efficacy for change.31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [33]
Theme 1 describes patient-engaging behaviours directed toward building a therapeutic alliance, and Theme 4 describes fostering self-efficacy. The Background names motivational interviewing as a technique that may be part of psychologically informed practice, but the paper does not show that motivational interviewing specifically produced either outcome. (LLM, conf=0.85)
Experimental — accuracy not yet measuredChallenges to implementation and delivery of PiPT include wide variability in programs with no clear rationale or framework for inclusion or exclusion of specific components.
“Challenges to implementation and delivery of PiPT include wide variability in programs with no clear rationale or framework for inclusion, or exclusion, of specific components.22,31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [33]
The Background (page unavailable) says PIP is open to interpretation and can encompass a range of techniques; the competence-model discussion says its skills remain poorly specified. That supports a lack of clarity about what PIP involves, but the paper does not establish wide variability across programs or say there is no rationale or framework for selecting their components. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe lack of clear competencies, rationale, framework, and clinical models that are feasible and acceptable makes it difficult to develop, adopt, and apply best practices for the spread and adoption of PiPT programs.
“The lack of clear competencies, rationale, framework, and clinical models that are feasible and acceptable make it difficult to develop, adopt, and apply best practices for the spread and adoption of PiPT programs.22,23,31,33,36”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [33]
The discussion preceding Table 1 (page not supplied) says PIP interpersonal skills are poorly specified and that its competences and how best to train them remain undefined. The Background also says guidelines do not specify the skills needed to deliver PIP. The paper does not establish the broader claim that a lack of feasible, acceptable clinical models or frameworks impedes the spread and adoption of PiPT programs. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTypical components of PiPT interventions include some combination of education, cognitive-behavioral techniques for addressing coping strategies and responses to pain, and practices that influence psychophysiology such as body awareness and mindful movement.
“Typical components of PiPT interventions include some combination of education, cognitive-behavioral techniques for addressing coping strategies and responses to pain, and practices that influence psychophysiology such as body awareness and mindful movement.31-34”
From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [33]
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References 38 · Cited by 49
Research works printed but not linked: 1
- Beissner K, Reid MC. Reply. Physical Therapy. 2009;89(5):472-3
- Authors
- Denneny, D., Frijdal (nee Klapper), A., Bianchi-Berthouze, N., Greenwood, J., McLoughlin, R., Petersen, K., Singh, A., & C. de C. Williams, A.
- Affiliations
- University College London Hospitals NHS Foundation Trust (GB)
- University College London (GB)
- Corresponding author
- Denneny, Diarmuid
- Venue
- Physiotherapy
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 106
- Pages
- 163-173
- ISSN
- 0031-9406 (ISSN-L)
- OpenAlex
- W2914766658
- Cited by
- 49
- References
- 38
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 7 · 2023: 12 · 2022: 8 · 2021: 7 · 2020: 5 · 2019: 1
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Physiotherapy (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health Research
- Collaboration for Leadership in Applied Health Research and Care - Greater Manchester
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, physiotherapists, clinical behavior, social skills, therapeutic relationship, self-efficacy, threat perception, somatic experience, patient engagement, self-management, physiotherapist training
- MeSH terms
- Female, Humans, Health Knowledge, Attitudes, Practice, Male, Cognitive Behavioral Therapy, Physical Therapy Modalities, Qualitative Research, Chronic Pain, Pain Management, Physical Therapists
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