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Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single subject studies
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Beteendemedicin och sjukgymnastik. Behavioural medicine and physiotherapy)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Beteendemedicin och sjukgymnastik. Behavioural medicine and physiotherapy)
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. (Beteendemedicin och sjukgymnastik. Behavioural medicine and physiotherapy)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. (Beteendemedicin och sjukgymnastik. Behavioural medicine and physiotherapy)
2012 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 28, no 5, 359-372 p.Article in journal (Refereed) Published
Abstract [en]

The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0–10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.

Place, publisher, year, edition, pages
2012. Vol. 28, no 5, 359-372 p.
Keyword [en]
Physical therapy, behavioural medicine, back pain, prognostic factors, screening, implementation, caregiver
National Category
Medical and Health Sciences
Research subject
Caring Sciences in Social Sciences
Identifiers
URN: urn:nbn:se:uu:diva-121422DOI: 10.3109/09593985.2011.629022PubMedID: 22145578OAI: oai:DiVA.org:uu-121422DiVA: diva2:305274
Available from: 2010-03-23 Created: 2010-03-23 Last updated: 2014-10-29Bibliographically approved
In thesis
1. Behaviours, Beliefs and Back Pain: Prognostic Factors for Disability in the General Population and Implementation of Screening in Primary Care Physiotherapy
Open this publication in new window or tab >>Behaviours, Beliefs and Back Pain: Prognostic Factors for Disability in the General Population and Implementation of Screening in Primary Care Physiotherapy
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to study prognostic factors for prolonged disability in back pain in the general population and physiotherapists’ screening for prolonged disability, applying a social cognitive learning perspective.

Methods and results: Studies I and II were based on a survey in the general population in Sweden. Study I included 1024 individuals aged 20-50 years, reporting non-specific back pain. Four groups (n = 100, 215, 172 and 537) based on duration and recurrence of back pain were formed and compared. After controlling for pain intensity, catastrophising and expectations of future pain were positively correlated to pain duration. Perceived social support was negatively correlated to pain duration. Study II was longitudinal over 12 months and analysed one group reporting first-episode back pain (n = 77), and one group reporting long-term back pain (n = 302). Future pain intensity and disability were predicted by initial levels of pain and disability and pain-related cognitions in both groups. Study III examined the inter-rater reliability of a research protocol for assessment of physiotherapists’ telephone screening for prolonged disability. The results demonstrated sufficient inter-rater reliability. Study IV evaluated the effect of a tailored skills training intervention on physiotherapists’ screening for prolonged disability in back pain. Four physiotherapists in primary care participated in four quasi-experimental single-subject studies. Effects were seen in all participants, with increased screening of prognostic factors and less time spent on detailed discussions about back pain.

Conclusions: The identification of mainly cognitive explanatory variables indicates the relevance of a social cognitive perspective of back pain-related disability (studies I and II). Physiotherapists’ telephone screening for prolonged disability in back can be reliably assessed (study III). It is suggested that interventions based on social cognitive theory are effective in producing change in specified clinical behaviours in physiotherapists (study IV).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 87 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 55
Keyword
Physical therapy, behavioural medicine, back pain, general population, caregiver, prognostic factors, implementation, screening
National Category
Social Sciences
Research subject
Caring Sciences in Social Sciences
Identifiers
urn:nbn:se:uu:diva-121424 (URN)978-91-554-7758-5 (ISBN)
Public defence
2010-05-07, Universitetshuset, sal IX, Övre Slottsgatan 2, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-16 Created: 2010-03-23 Last updated: 2012-05-21Bibliographically approved

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Demmelmaier, IngridLindberg, PerÅsenlöf, Pernilla

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