The elves have noticed that psychological interventions are on the rise in many areas of physiotherapy. For example, self-management of musculoskeletal conditions may include both physical and psychological interventions.

The aim of a recent systematic review was to review musculoskeletal physiotherapists’ perceptions and use of psychological interventions, and review how skilled they felt to use these interventions within their practice.

Here’s what they did

The authors searched for qualitative, quantitative or mixed methodology studies published between 2002-2013 in AMED, CINAHL, EMBASE, MEDLINE and PsychINFO. Studies were included which focussed on physiotherapists’ perceptions regarding their use of psychological interventions within musculoskeletal physiotherapy out-patient departments.

Only papers published in English were included. All papers included were appraised using the Critical Appraisal Skills Programme (CASP) tool by 3 reviewers.

Here’s what they found

• 6 studies were included, qualitative methods (n=3), survey methods (n=2) and mixed methods (n=1), all presented with low levels of bias
• Physiotherapists frequently encountered psychological symptoms amongst patients undergoing rehabilitation including anxiety, depression and fear
• Psychological interventions commonly used included goal setting, positive self-talk, effective communication and variations in rehabilitation exercises
• All of the studies found that physiotherapists would like to improve their ability to implement realistic goal setting
• Physiotherapists in 4 studies reported feeling that they received insufficient psychological training during their undergraduate physiotherapy degree programmes
• There was great variability regarding the undergraduate training of physiotherapists

The authors concluded

While physiotherapists already use psychological interventions in their practice, for patients to reach their full potential, physiotherapists need to develop their skills to effectively incorporate psychological interventions.

The Musculoskeletal Elf’s view

While physiotherapists appear to have embedded Yellow Flag assessment tools within their practice, to identify psychosocial factors which may act as barriers to recovery, it is positive to see that physiotherapists are now using psychological interventions to address some of these aspects. It does seem essential though that this should also be included in undergraduate training programmes. To ensure standardisation of the teaching of psychological interventions this would require a review of pre-registration physiotherapy training programmes.

What do you think?

• How much training did you receive in your undergraduate programme about psychological interventions?
• How confident do you feel about addressing psychological symptoms in patients?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community. Post your comment below, or get in touch via social media (Facebook, Twitter, LinkedIn, Google+).

Links

• Musculoskeletal physiotherapists’ use of psychological interventions: A systematic review of therapists’ perceptions and practice. Alexanders J, Anderson A, Henderson S, Physiotherapy [abstract]
• Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Nicholas, M. K., Linton, S. J., Watson, P. J., & Main, C. J. (2011). Physical therapy. [abstract]