title: Can physical therapists deliver a pain coping skills program? An examination of training processes and outcomes.
abstract: BACKGROUND
  Physical therapists are well established as providers of treatments for common, painful, and disabling conditions, such as knee osteoarthritis (OA). Thus, they are well placed to deliver treatments that integrate physical and psychosocial elements. Attention is usually given to outcomes of such programs, but few studies have examined the processes and outcomes of training physical therapists to deliver such treatments.
  
  
  OBJECTIVE
  The aim of this study was to describe the processes in training physical therapists: (1) to deliver a standardized pain coping skills treatment and (2) to evaluate the effectiveness of that training.
  
  
  METHODS
  This study was an analysis of data relating to therapist performance in a randomized clinical trial.
  
  
  METHODS
  Eleven physical therapists were trained to deliver a 10-session pain coping skills training program for people with knee OA as part of a randomized controlled trial (N=222). The initial training was provided in a workshop format and included extensive, ongoing supervision by a psychologist and rigorous use of well-defined performance criteria to assess competence. Adherence to the program, ratings of performance, and use of advanced skills were all measured against these criteria in a sample (n=74, 10%) of the audio recordings of the intervention sessions.
  
  
  RESULTS
  Overall, the physical therapists achieved a very high standard of treatment delivery, with 96.6% adherence to the program and mean performance ratings all in the satisfactory range. These results were maintained throughout the intervention and across all sessions.
  
  
  CONCLUSIONS
  Only 10% of the delivered sessions were analyzed, and the physical therapists who took part in the study were a self-selected group.
  
  
  CONCLUSIONS
  This study demonstrated that a systematic approach to training and accrediting physical therapists to deliver a standardized pain coping skills program can result in 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 potential for psychologically informed practice to be a feature of effective health care.
authors.affiliation: C. Bryant, MA(Hons), MA(Clin Psych), PhD, School of Psychological Sciences, University of Melbourne, Victoria 3010, Australia. cbryant@unimelb.edu.au.
authors.forename: Christina
authors.initials: C
authors.lastname: Bryant
authors.affiliation: P. Lewis, BA, BBus, GradDipEdPsych, MClinPsych, Private Practice, Melbourne, Australia.
authors.forename: Prudence
authors.initials: P
authors.lastname: Lewis
authors.affiliation: K.L. Bennell, BAppSci(Physio), PhD, Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Bennell
authors.affiliation: Y. Ahamed, BSc, MSc, Centre for Health, Exercise and Sports Medicine, University of Melbourne.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ahamed
authors.affiliation: D. Crough, BPsychSci(Hons), DPsych(Clinical), Private Practice, Brisbane, Queensland, Australia.
authors.forename: Denae
authors.initials: D
authors.lastname: Crough
authors.affiliation: G.A. Jull, MPhty, PhD, FACP, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
authors.forename: Gwendolen A
authors.initials: GA
authors.lastname: Jull
authors.affiliation: J. Kenardy, PhD, FAPS, Centre of National Research on Disability and Rehabilitation Medicine, School of Psychology and Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Kenardy
authors.affiliation: M.K. Nicholas, PhD, Anaesthesia, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Nicholas
authors.affiliation: F.J. Keefe, PhD, Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000534:rehabilitation*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D059825:Physical Therapists / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult